Recent DKA - Need Advice & Help

KaitandMK

KaitandMK

Member Since 2019
Hi everyone!

This is my first post here. Although, I read all of your posts quite often. I first want to say thank you for providing such wonderful advice and support!

My 15 year old cat, Miss Kitty, is diabetic. The last few weeks have been quite the emotional rollercoaster for everyone. Miss Kitty’s diabetic journey began two years ago. She was drinking excessively and we took her to the vet. Her BG was over 600. We started her on vetsulin and changed her food to FF Pates. Within about 6 months, her sugar was consistently staying 90-150. She was OTJ.

About two months ago.. We noticed her appetite increased tremendously. This is where I think we dropped the ball. Miss Kitty is very picky and we were thrilled that she was eating! She wanted food and we did not have to constantly chase her around during feeding times. Little did we know, she was hungry because she was (and had been) out of remission. We have another cat, who is also diabetic. She is on vetsulin and for the most part, doing well. I test at home and I would test Miss Kitty as well – but obviously not as often as I should have been. For this, I feel awful and sad. Her physical state was great though. I had no reason to think that internally she was a disaster.

Anyways.. Back on track.

Miss Kitty got an ear infection. Her ear was oozing and had a lot of wax inside. We took her to the vet. She is an aggressive kitty (not to us.. She’s the sweetest!) – but to anyone else.. She is fiesty. The vet recommended putting in the claro drops that last for a month. We did that and went home. Two weeks passed, Miss Kitty is not getting better. She can’t hear and she is stumbling. We take her back.. They send us home with tresaderm.. 4 drops/2x day and a wash. I am doing this for another two weeks. Knowing what I know now, I wonder if any of this played a part in what was to follow.. although, most of you here will know more about that than me.

The ear looks better but she is getting worse. She’s hiding in places that I don’t even know how she got into. She’s lethargic. Her walk is very off. She’s losing weight. For the first time, I’m thinking it’s her diabetes. It’s back. I test at home and it’s 228. I was expecting it to be high.. 500, 600. I’m stumped at this point.

Late Saturday evening.. She’s looking very bad. We rush her to the animal hospital. Finally, they tell us.. We are in a bad situation – DKA. Her BG is 490 and her ketones are up. I can’t remember exactly how high.. I’m not near the paperwork.. But they tell us she needs immediate hospitalization.

So, over the next week.. My poor little Miss Kitty is put through it all. She is on a constant insulin, feeding tube, antibiotics.. Around day 3, she gets a blood transfusion. Her ketones are back to 0. We visit her every day and she looks tired. She looks tired and she looks bad. She’s not eating but at the time that was the least of their worries, since the feeding tube is in. Her sugar is still 300-450.. With being on the constant insulin. No one can give an explanation.. They simply don’t know why this is. They do an ultrasound and it is consistent with a bright liver and possibly some pancreatitis. They don’t find any lumps or tumors during the ultrasound. During examination, they don’t feel she is in pain. On Day 4, they call and tell us to expect the worse. This is not looking good.. BG still high, not eating, very lethargic.. Please think about putting her down.

I am heartbroken.. This is my best friend. I can’t do that!! I tell them - Please, do everything that you can!! But deep down, I know that she cannot live forever.. Maybe this is her time. I hope not, but I will not let her suffer. We go to visit her that day and the entire hospital has no words. Miss Kitty is walking around.. She’s growling again.. When they leave the room, we offer her some food and she dives right in! The entire hospital cheers!! They tell us continue the treatment.

The ER vet that was there when MK checked in is back. She is the best vet I have personally ever interacted with. She tells us please don’t give up on MK. She tells us how everyone is asking.. What is going on with this cat? Have you talked to the owners about putting her down? What are they going to do? She said.. Just wait. I’m not giving up on her and neither are they. I am so thankful for her.

Day 6.. MK comes home. She’s skinny. She’s tired but she is the best I have seen her in past 2 months. She’s playing.. She’s not hiding. She wants to be around us, like usual. She’s eating well and drinking well.

She’s sent home with 1.5 units of Lantus. The vet said she did not want to send her with such a high dose but she’s not responding well. They put on one of the freestyle libres. It has been such a great help. I wonder sometimes if it is accurate but when I test at home, the numbers are very close – so I am inclined to think that it is.

My problems..

On the first night home, MK went from 400 at the vet, slowly down to 94 overnight. I am testing every 2 hours with the libre. Excessively, at this point.. As I don’t want her to go too low. She gets back up to 200. In the morning at insulin time, she is 390. We feed and give the insulin.

The next few days.. We follow the same schedule and her BG is increasing! It stays within 400-500+. The libre reads “HI” after a reading of 500+ and we were getting that quite often throughout the day. She is acting MUCH better, though. She is acting very close to herself, which does make me feel better. I have ketone strips arriving today and I will start monitoring those now as well.

I know that the high readings are no good for her.. I’m so worried. What if we don’t get her regulated? What am I doing wrong? She had a recheck yesterday and they increased her to 2u/2x a day.

She eats Purina DM (which, I wonder is this any good? There is a small amount of gravy in this blend.) I swap this with FF Pates. She likes the Purina DM, so she often gets this because I need her to eat.

Another question I have is.. The vet tells us feed her 2x a day and that is it. I don’t know if this is ideal. When I got her regulated 2 years ago.. She was eating 2x a day with insulin and a small meal around 12-1pm to keep her happy.

She’s hungry. She sits and waits for her food for hours. I don’t know what to do. Do I feed her more often? Am I hurting her if I do that? Do I stick to the 2x a day only? Ugh! I am a mess. She looks so thin. Her weight at the vet yesterday was 8.5lbs. She’s a tiny little thing but I feel like this is too thin. The vet (same hospital/different vet) tells us that he feels okay about this weight. But I don’t, her sides seem “sunk in”. Is she dehydrated? I don’t know :( Will it just take time for her to build up more strength and put some weight on? She’s been through so much last week!

Any advice, please! I appreciate anything you can tell me.. Any tips.. Anything I am doing wrong.. Anything I should change. I wish I could be of more help here - but I can be a listening ear if anyone needs to talk!!

So sorry for the long post.. I just wanted to get everything out there, maybe I just need to talk :(

Overview -
  • Miss Kitty diagnosed DKA last week. Spends 6 days in the hospital – constant insulin, feeding tube, blood transfusion.
  • Sent home with 1.5u of lantus 2x a day. Increased to 2u 2x a day.
  • BG not responding well. Staying 400-500 most of the day.
  • Eating Purina DM with small amount of gravy and FF Pates twice a day.
  • Testing with Freestyle libre and test strips at home.

Thank you so much!!
 
First of all welcome to FDMB. Sounds like the last few weeks have been pretty rough on both Miss Kitty and you. I am by no means an expert on DKA however it sounds like the ear infection may have been a significant causative factor. Did the vet recheck Miss Kitty's ears at her recheck yesterday to ensure the infection has been totally eradicated? Infection or inflammation can cause elevated BG so I am wondering if the infection is still present with the BG seemingly increasing again at this point in time.

As for feeding, most of us feed our kitties multiple meals per day and if Miss Kitty needs to re-gain some weight, I would not hesitate to feed her as much as she wants within reason to get her strength back and get her weight up a bit. I agree the DM food with gravy is not the best choice however if it means the difference between her eating and not, then eat she must. There is another type of DM wet food (pate) that is not as high in carbs that she might like if FF or Friskies is not to her liking.

Do keep checking Miss Kitty daily for ketones and make sure she stays well hydrated. You can check to see if she is dehydrated by grabbing her scruff and then seeing how long it takes to settle back down. It should return to normal almost immediately. Any delay is indicative of dehydration. The other way to check is to see if her gums are moist or sticky. They should be moist. You can add extra water to her food to get some extra fluids into her.

It would be really helpful if we could get you to set up a signature....the light grey text you see below our messages. We use that to keep pertinent information about our kitties available for anyone helping so we don't keep asking you the same questions over and over.

To set up a signature, hover your mouse pointer over your user name in the upper right hand corner of the screen. A menu will drop down and you can select Signature from the left hand column by clicking on it. This will open a text box into which you can type information like Miss Kitty's name, age, sex, date of diagnosis, type of insulin, type of glucometer, current diet and health history (eg DKA with the date). There is only 2 lines of space so keep it brief. Once you are done, scroll down and click on Save Changes and voila you will have a signature for you and MK.

Hopefully those with more DKA experience will pop by shortly to offer more advice. :)
 
Hello and welcome! I'm sorry you are here under these circumstances. I am not one of the experts or most experiences (but those who are will arrive soon :) ) but I would first off say here on FDMB, many of us feed small meals throughout the day. I feed about 6 meals a day or 3 meals per cycle.

Purina DM is okay to feed as it is considered low carb. Other options like FF classics are also low carb and better for the wallet. I would definitely put away the gravy FF and only use them for when Miss Kitty is trending down/needs a carb boost.

As for DKA, the recipe for that is not enough calories + not enough insulin. It's good that MK is eating and that you'll be getting ketone strips soon. I would test daily for ketones if possible, especially when BG is high. Once that's stabilized, it's recommended to test ketones at least weekly.

And since MK is DKA prone, skipping a shot or not giving insulin would not be ideal for MK and any advice given will take into account that MK is DKA prone.

For now, are you able to set up a spreadsheet of MK's numbers? See instructions here: http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

Let us know if you need help setting up the SS!
 
Thank you all so much!
I’m not sure how to reply specifically to each person - since I am on my phone at the moment. Trip to petsmart picking up any type of FF Pate from the lists that I think she would eat! Tonight, I took away the DM and she did eat the FF Chicken Pate. Not a ton but I think she will pick at it a bit more. She did eat enough that I was comfortable giving her the insulin dose.

I just wanted to let everyone know, I am reading and I appreciate your concern and advice so much. I truly believe that the first time she went into remission (years ago) was directly linked to the information I absorbed from these boards.

I will add a signature tonight. I’ve been trying to find out how for awhile today so thank you for those instructions!
I am also going to start the spreadsheet today. I will start testing again tonight around 9pm as I think the Lantus should *hopefully* be working by then.

MK is off of dry food completely. Although, she will get a few pieces of freeze dried chicken treats throughout the day. Hopefully, this is okay for her.

The vet says that the Purina DM is fine for her but I personally don’t feel great about it because of the amount of gravy in there. We used to have Purina DM that was almost a Pate texture and it seemed to have pieces of rice mixed in. She liked that as well. We now get this formula from the vet. I think it’s called Savory Selects or Savory.. something! It’s got a “gravy-like” texture that makes me uneasy. But, as you’ve all said.. she needs to be eating so I will do all I can to make sure that is happening.

I feel better reading that many of you feed throughout the day. I thought maybe the high readings were from feeding her off of the 12 hour schedule but even when she only eats twice a day, I don’t see any remarkable differences in her BG.

I have enough FF Pates to make the switch this week. I think my first move is going to be taking away the Purina DM and swapping it with the FF only to see if anything changes.


Thank you all again so much!
Just knowing there is somewhere to come.. where people understand.. makes my heart smile!
 
I'm glad you feel safe to post here for advice :) And that MK is off of dry food. I hope the switch to FF works for you.

Here's a list of foods and its carb contents that a lot of us use. I don't think it's as up to date as I'd like it to be but the info for FF should be accurate. https://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf

I wouldn't skip doses if MK is DKA prone. If you come across another moment when MK's PS number is low and/or she is not eating, I would post here for help. Others can advise you on what dose to give and what steps to take.

I have given a full dose of insulin before when Ming wasn't eating normally. And other times, I have given a reduced dose. I just know NOT giving insulin is not a good option for Ming because he's had DKA.

But please, keep posting, read through the info and stickies on the forum, and ask lots and lots of questions! We're happy to help!
 
Kait, there is definitely a difference in the carbs with the Purina DM Savory Select vs the pates so if Miss Kitty doesn't like the FF or Friskies pates, then you can always go back to the DM pate version. Keeping her eating is of paramount importance more so than carb level right now but if you can keep the carbs down, so much the better. Insulin dose can be adjusted to suit diet if need be.
 
Welcome, Kait!

Did the vet happen to mention whether MK has an infection? You might look on the paperwork from the vet to see if this was the case. Was she sent home on antibiotics? MK's numbers could be running high if the infection is still present.

The "recipe" for DKA is not enough calories + not enough insulin + infection/inflammation. Is there any chance that MK has dental issues going on. Gingivitis, or any inflammation or infection, can be a cause for high numbers. A cat that's not eating well starts to burn off store fat which is what causes ketone bodies to form.

It's fine to feed your kitty more than twice a day. Multiple small meals or allowing her to graze is fine. Just make sure you're giving her low carb food. I'd lean toward food that's high in calories. If her appetite isn't the greatest, high calorie food will give you the biggest bang for the buck. Wellness tends to be among the higher calories foods but at this point, whatever MK will eat is just fine.

If you don't have a blood ketone meter, you can get Ketostix at any pharmacy. They will allow you to test your cat's urine for ketones. For a cat that's just recovering from DKA, testing ketones as often as you can is crucial. This is a critical period in that some cats that have had an episode of DKA will develop ketones easily.

Making sure you keep MK hydrated is also important. Adding water to her food can be helpful.

One perhaps dumb question -- how old is your insulin? Even if it's relatively new, if you have another pen, try is and see if you get better numbers. Sometimes, you just have a bad pen.
 
Hello Kate! Happy to see you with your little Miss Kitty! We are a huge family trying to help each other!
Keep posting, it's gonna be our pleasure to read you and help Miss Kitty! :bighug:
 
Sienne and Gabby (GA) said:
Welcome, Kait!

Did the vet happen to mention whether MK has an infection? You might look on the paperwork from the vet to see if this was the case. Was she sent home on antibiotics? MK's numbers could be running high if the infection is still present.

The "recipe" for DKA is not enough calories + not enough insulin + infection/inflammation. Is there any chance that MK has dental issues going on. Gingivitis, or any inflammation or infection, can be a cause for high numbers. A cat that's not eating well starts to burn off store fat which is what causes ketone bodies to form.

It's fine to feed your kitty more than twice a day. Multiple small meals or allowing her to graze is fine. Just make sure you're giving her low carb food. I'd lean toward food that's high in calories. If her appetite isn't the greatest, high calorie food will give you the biggest bang for the buck. Wellness tends to be among the higher calories foods but at this point, whatever MK will eat is just fine.

If you don't have a blood ketone meter, you can get Ketostix at any pharmacy. They will allow you to test your cat's urine for ketones. For a cat that's just recovering from DKA, testing ketones as often as you can is crucial. This is a critical period in that some cats that have had an episode of DKA will develop ketones easily.

Making sure you keep MK hydrated is also important. Adding water to her food can be helpful.

One perhaps dumb question -- how old is your insulin? Even if it's relatively new, if you have another pen, try is and see if you get better numbers. Sometimes, you just have a bad pen.
Click to expand...


Hi!
So the vet said no infection. On her paperwork, it says "no infection present, so no treatment needed".
Although, they did send us home with antibiotics to finish off after her hospital stay. They told us that it was standard to administer antibiotics during the DKA stay - but never really mentioned an active infection. They checked her ears and said that they did not feel her ear infection was still there. It has been a real fiasco getting the antibiotics in her, though. At her recheck, they said not to stress her trying since there is no cause for concern. I did get a pill gun today, so I am hoping that helps us finish off the rest.

Thank you for the blood ketone meter suggestion! I did not know that this exists. Her strips are arriving tomorrow so I will be checking daily with those but I will also head to get that blood ketone meter tomorrow as well.

The insulin is about a week old. I want to say I picked it up from the pharmacy with needles on Thursday of last week.

Thank you so much for the help and the important questions in your post!
 
MrWorfMen's Mom said:
Kait, there is definitely a difference in the carbs with the Purina DM Savory Select vs the pates so if Miss Kitty doesn't like the FF or Friskies pates, then you can always go back to the DM pate version. Keeping her eating is of paramount importance more so than carb level right now but if you can keep the carbs down, so much the better. Insulin dose can be adjusted to suit diet if need be.
Click to expand...

This is SO good to know! I knew something was up when I started getting the savory selects. She seems to really like that but I don't feel it works well with her system. I am incorporating FF Pates.. she seems to like some of the flavors, so I am hopeful we can work with that for now. Although, I may pick up some of the DM pates as well, just in case. She has a big appetite right now.. it is good to know that eating is of main importance right now. I wasn't sure if I should be feeding when she is looking for food or only at insulin times.
Thank you so much for your help and wonderful information!
 
Crista & Ming said:
I'm glad you feel safe to post here for advice :) And that MK is off of dry food. I hope the switch to FF works for you.

Here's a list of foods and its carb contents that a lot of us use. I don't think it's as up to date as I'd like it to be but the info for FF should be accurate. https://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf

I wouldn't skip doses if MK is DKA prone. If you come across another moment when MK's PS number is low and/or she is not eating, I would post here for help. Others can advise you on what dose to give and what steps to take.

I have given a full dose of insulin before when Ming wasn't eating normally. And other times, I have given a reduced dose. I just know NOT giving insulin is not a good option for Ming because he's had DKA.

But please, keep posting, read through the info and stickies on the forum, and ask lots and lots of questions! We're happy to help!
Click to expand...


Oh gosh, Thank you so much!
That is something I am struggling with right now as well.. do I miss a dose or do I reduce the dose? On the discharge papers from the vet, it says do not give insulin if MK's BG is 300 or below. But.. I think I would feel better giving a reduced dose rather than none at all. I am going to call in to talk to them about that tomorrow but it seems like Ming handles that well!
 
MrWorfMen's Mom said:
First of all welcome to FDMB. Sounds like the last few weeks have been pretty rough on both Miss Kitty and you. I am by no means an expert on DKA however it sounds like the ear infection may have been a significant causative factor. Did the vet recheck Miss Kitty's ears at her recheck yesterday to ensure the infection has been totally eradicated? Infection or inflammation can cause elevated BG so I am wondering if the infection is still present with the BG seemingly increasing again at this point in time.

As for feeding, most of us feed our kitties multiple meals per day and if Miss Kitty needs to re-gain some weight, I would not hesitate to feed her as much as she wants within reason to get her strength back and get her weight up a bit. I agree the DM food with gravy is not the best choice however if it means the difference between her eating and not, then eat she must. There is another type of DM wet food (pate) that is not as high in carbs that she might like if FF or Friskies is not to her liking.

Do keep checking Miss Kitty daily for ketones and make sure she stays well hydrated. You can check to see if she is dehydrated by grabbing her scruff and then seeing how long it takes to settle back down. It should return to normal almost immediately. Any delay is indicative of dehydration. The other way to check is to see if her gums are moist or sticky. They should be moist. You can add extra water to her food to get some extra fluids into her.

It would be really helpful if we could get you to set up a signature....the light grey text you see below our messages. We use that to keep pertinent information about our kitties available for anyone helping so we don't keep asking you the same questions over and over.

To set up a signature, hover your mouse pointer over your user name in the upper right hand corner of the screen. A menu will drop down and you can select Signature from the left hand column by clicking on it. This will open a text box into which you can type information like Miss Kitty's name, age, sex, date of diagnosis, type of insulin, type of glucometer, current diet and health history (eg DKA with the date). There is only 2 lines of space so keep it brief. Once you are done, scroll down and click on Save Changes and voila you will have a signature for you and MK.

Hopefully those with more DKA experience will pop by shortly to offer more advice. :)
Click to expand...


Hi!
Thank you so much for your reply and your concern!
So, the vet said no infection. On her paperwork, it says "no infection present, so no treatment needed".
Although, they did send us home with antibiotics to finish off after her hospital stay. They told us that it was standard to administer antibiotics during the DKA stay - but never really mentioned an active infection. They checked her ears while she was admitted and said that they did not feel her ear infection was still there. It has been a real fiasco getting the antibiotics in her, though. At her recheck, they said not to stress her trying since there is no cause for concern. I did get a pill gun today, so I am hoping that helps us finish off the rest, just incase.

It has been a real rollercoaster so far, but I am so glad that I found this forum!
I am also going to set up a signature tonight. I was trying to figure out how to do that all day.. so thank you for the instructions! :)
 
My heart is so full right now!
Thank you all so much for your wonderful advice and willingness to help me and my little girl.

It's 3am.. and I'm currently hoping I'm not at the tip of a crisis.
Today, I fed the DM savory selects in the morning and FF Pate at night.
Miss Kitty's sugar level was between 300-400 all day. At 7pm, she ate the FF and received her insulin. Since then, her sugar has been going down. I saw a lot of 100's since then, which made me very happy! I checked her at 12:30 and it was 133. Since it was going down fairly quickly.. I thought I would test again soon. I just tested at 2:00 and she was at 80. I panicked! It's been almost 7 hours since her insulin shot - I'm not sure if we are in "peak" or not. I *think* (idk what is considered to be on the low end, but still okay!) 80 is okay but.. any less and I'm sure problems arise quickly. I fed her some FF with gravy.. was this the right thing to do? I'm not sure. She's hungry and I figured that it would be better for her numbers to be up a bit than sitting so close to the 70s. I tested about 30 minutes after she ate and she is at 88. I'm wondering if the FF helped keep her sugar from her usual being sky high! I haven't seen much below 300 recently (and unfortunately) so I am worried! Will the lantus keep dropping her? The discharge papers from the hospital say if she tests below 80 to get her back immediately! She seems to be doing okay.. she always takes a nap after she eats, so that is what she is doing now.. while I watch her with hawk eyes. I will test again soon and make sure things are heading up and not down.

I'm not sure what I will do in the morning.. but I think I am jumping the gun as to I have no idea what her BG will read. The discharge papers also state that if MK BG is 300 or below to NOT give insulin. Does this sound like a good idea? I would feel better giving her a lower dose instead of none at all but I surely don't want to drop her too low!
 
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KaitandMK said:
My heart is so full right now!
Thank you all so much for your wonderful advice and willingness to help me and my little girl.

It's 3am.. and I'm currently hoping I'm not at the tip of a crisis.
Today, I fed the DM savory selects in the morning and FF Pate at night.
Miss Kitty's sugar level was between 300-400 all day. At 7pm, she ate the FF and received her insulin. Since then, her sugar has been going down. I saw a lot of 100's since then, which made me very happy! I checked her at 12:30 and it was 133. Since it was going down fairly quickly.. I thought I would test again soon. I just tested at 2:00 and she was at 80. I panicked! It's been almost 7 hours since her insulin shot - I'm not sure if we are in "peak" or not. I *think* (idk what is considered to be on the low end, but still okay!) 80 is okay but.. any less and I'm sure problems arise quickly. I fed her some FF with gravy.. was this the right thing to do? I'm not sure. She's hungry and I figured that it would be better for her numbers to be up a bit than sitting so close to the 70s. I tested about 30 minutes after she ate and she is at 88. I'm wondering if the FF helped keep her sugar from her usual being sky high! I haven't seen much below 300 recently (and unfortunately) so I am worried! Will the lantus keep dropping her? The discharge papers from the hospital say if she tests below 80 to get her back immediately! She seems to be doing okay.. she always takes a nap after she eats, so that is what she is doing now.. while I watch her with hawk eyes. I will test again soon and make sure things are heading up and not down.

I'm not sure what I will do in the morning.. but I think I am jumping the gun as to I have no idea what her BG will read. The discharge papers also state that if MK BG is 300 or below to NOT give insulin. Does this sound like a good idea? I would feel better giving her a lower dose instead of none at all but I surely don't want to drop her too low!
Click to expand...

Hi!!! Literally two months ago my girl Alice was in DKA. She was horribly emaciated. Since then, I got her on Lantus instead of NPH, I feed her LC pates as much as she wants basically, and she has gained two pounds, purrs, grooms, snuggles, chases the red dot, etc. She is recovering. I can see from your initial post that you’re probably in that early panic/overwhelmed stage. But it really can get better.

So have hope!!!

At the top of the Lantus etc forum there are stickies that have dosing guides and other info.

If the number before shot is under 200, and you are unsure, you can delay feeding for another 20 minutes and restest, to see if sugar is going up or down. If it is going up, it may be safe to give the regular dose. These numbers are based on a human meter. Hypoglycemia risk is below 50 on a human meter, and I believe 76 on AlphaTrak meter. We recommend that you do post and see if you can get some feedback anytime you are unsure! Better safe than sorry.

It’s okay that you fed a little higher carb food to boost kitty’s numbers. I did that last night, actually. It’s inportant to stock low carb (under 10%) for most feeding, and have mid carb (10-20) and high carb (>20%) for emergencies.

Are you familiar with what a bounce is? Some of these high numbers may be a result of the body not being used to going low, even if they are typically safe numbers, and it reacts with what we call panicky liver, and releases extra glucose it has stored. That’s normal and okay.

I basically spent about 5 weeks not sleeping much and testing Alice a lot, feeding her a lot, sometimes from my hand when she was too weak, usually mixing some water in with the food to keep fluids up.... but she is getting better and stronger every day. I don’t think the emergency vet would think she is the same cat.

Also you mentioned you think your cat is too thin around the hips—probably muscle loss. Ketones occur because the body is burning up fat and muscle because it thinks it is starving because lack of insulin is preventing the cells from utilizing the sugar it needs, so my guess is just that your cat will need some time to fill back out. Also diabetic cats may not utilize their calories and nutrients as well and may sometimes need some extra food.

They are pricy, but my cat LOVES the Sheba perfect portions in broth and so I keep those for any bouts of anorexia.

I know it probably feels like a lot right now, but please know it will get easier in time. Kitty needs fluids, food, and insulin, and for you to monitor and keep asking questions. You’re on the right path. :)
 
Hi Kait and MK
How much Lantus is MK on?
She is quite safe in numbers above 50. Anything below 50 and you would need to give some high carb food or honey or karo to bring the numbers up higher. It was quite fine to give her some food when you tested at 80. That will often help them to surf nicely in those numbers. Frequent small meals is fine. Just don’t feed for the 2 hours before the Preshots so they are not food influenced ( unless MK is in very low numbers and then of course you would feed something)
The numbers are looking much better with the lower carb food.
I would feed her as much as she will eat at this point as it is really important with kitties recovering from DKA that they eat lots of food and get the appropriate dose of insulin.
Keep asking lots of questions. You are doing a great job looking after her. What a week you have had!!!
 
Thanks Cassandra.
I would see what the Preshot number is in the morning and post and ask for help. Put ‘help with am dose’ after ‘recent DKA’ in the subject line to get attention. If the Preshot number is under 200, stall, don’t feed and ask for help. And test again 20 minutes later. It’s important that the insulin is kept going with the recent DKA. I would shoot the dose if it’s over 200. You can always feed some higher carb food if necessary. You are testing the blood sugars so are in control.
 
Bron and I are on the same page. Some of the basic "rules" about whether or not to give a dose of insulin do not necessarily apply with a cat that has a recent experience with DKA. It is critically important to get insulin into MK in order to insure that ketones are kept under control. This may mean delaying a shot if your schedule permits, shooting a reduced dose, or giving MK higher carb food. I've been known to suggest feeding a cat a hot fudge sundae minus the hot fudge to get numbers up in order to give a shot to a post-DKA cat!!

What you saw last night is the influence of high vs low carb food. It can be nothing short of amazing what a few extra carbs can do to a kitty's numbers. You did a great job with steering MK's numbers. There's also a sticky on how to handle low numbers.
 
MrWorfMen's Mom said:
First of all welcome to FDMB. Sounds like the last few weeks have been pretty rough on both Miss Kitty and you. I am by no means an expert on DKA however it sounds like the ear infection may have been a significant causative factor. Did the vet recheck Miss Kitty's ears at her recheck yesterday to ensure the infection has been totally eradicated? Infection or inflammation can cause elevated BG so I am wondering if the infection is still present with the BG seemingly increasing again at this point in time.

As for feeding, most of us feed our kitties multiple meals per day and if Miss Kitty needs to re-gain some weight, I would not hesitate to feed her as much as she wants within reason to get her strength back and get her weight up a bit. I agree the DM food with gravy is not the best choice however if it means the difference between her eating and not, then eat she must. There is another type of DM wet food (pate) that is not as high in carbs that she might like if FF or Friskies is not to her liking.

Do keep checking Miss Kitty daily for ketones and make sure she stays well hydrated. You can check to see if she is dehydrated by grabbing her scruff and then seeing how long it takes to settle back down. It should return to normal almost immediately. Any delay is indicative of dehydration. The other way to check is to see if her gums are moist or sticky. They should be moist. You can add extra water to her food to get some extra fluids into her.

It would be really helpful if we could get you to set up a signature....the light grey text you see below our messages. We use that to keep pertinent information about our kitties available for anyone helping so we don't keep asking you the same questions over and over.

To set up a signature, hover your mouse pointer over your user name in the upper right hand corner of the screen. A menu will drop down and you can select Signature from the left hand column by clicking on it. This will open a text box into which you can type information like Miss Kitty's name, age, sex, date of diagnosis, type of insulin, type of glucometer, current diet and health history (eg DKA with the date). There is only 2 lines of space so keep it brief. Once you are done, scroll down and click on Save Changes and voila you will have a signature for you and MK.

Hopefully those with more DKA experience will pop by shortly to offer more advice. :)
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Marje and Gracie said:
I’m sorry...I’m out of town dealing with a family emergency. But Sienne and Bron have given great advice,
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Hope all gets better
 
Sienne and Gabby (GA) said:
Bron and I are on the same page. Some of the basic "rules" about whether or not to give a dose of insulin do not necessarily apply with a cat that has a recent experience with DKA. It is critically important to get insulin into MK in order to insure that ketones are kept under control. This may mean delaying a shot if your schedule permits, shooting a reduced dose, or giving MK higher carb food. I've been known to suggest feeding a cat a hot fudge sundae minus the hot fudge to get numbers up in order to give a shot to a post-DKA cat!!

What you saw last night is the influence of high vs low carb food. It can be nothing short of amazing what a few extra carbs can do to a kitty's numbers. You did a great job with steering MK's numbers. There's also a sticky on how to handle low numbers.
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Thank you so much for this information!
SO valuable!! I was thinking that skipping the dose would be the right protocol but thank you for opening my eyes to the importance of her getting the insulin (and the suggestions on how to make that happen) Ketones are something we never want to experience again so I will do all that I can to help my little girl keep them away. I appreciate this!

YES - Amazing!! Her BG has dropped dramatically and we are staying between 95-180 for most of the day.. with a high of around 350 before the insulin is due. This relates directly with the food change. With her BG staying 400-500 constantly, it felt like I would never see better numbers again!
 
Bron and Sheba said:
Hi Kait and MK
How much Lantus is MK on?
She is quite safe in numbers above 50. Anything below 50 and you would need to give some high carb food or honey or karo to bring the numbers up higher. It was quite fine to give her some food when you tested at 80. That will often help them to surf nicely in those numbers. Frequent small meals is fine. Just don’t feed for the 2 hours before the Preshots so they are not food influenced ( unless MK is in very low numbers and then of course you would feed something)
The numbers are looking much better with the lower carb food.
I would feed her as much as she will eat at this point as it is really important with kitties recovering from DKA that they eat lots of food and get the appropriate dose of insulin.
Keep asking lots of questions. You are doing a great job looking after her. What a week you have had!!!
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She's on 1.5u right now twice a day!
Thank you so much! A long time ago in her first diabetic run, I do remember needing the karo so I always keep that on hand now! I am so glad you feel feeding at 80 was okay to do, as I was really unsure. It perked her up a bit and her numbers stayed pretty steady throughout the night after that!
It HAS been a week! I am so mentally & physically exhausted.. but it is all worth it if I can make MK feel better! I will do anything that I can! You don't know how much I appreciate your help and concern!! ❤️
 
AliceMeowliss&Cassandra said:
Hi!!! Literally two months ago my girl Alice was in DKA. She was horribly emaciated. Since then, I got her on Lantus instead of NPH, I feed her LC pates as much as she wants basically, and she has gained two pounds, purrs, grooms, snuggles, chases the red dot, etc. She is recovering. I can see from your initial post that you’re probably in that early panic/overwhelmed stage. But it really can get better.

So have hope!!!

At the top of the Lantus etc forum there are stickies that have dosing guides and other info.

If the number before shot is under 200, and you are unsure, you can delay feeding for another 20 minutes and restest, to see if sugar is going up or down. If it is going up, it may be safe to give the regular dose. These numbers are based on a human meter. Hypoglycemia risk is below 50 on a human meter, and I believe 76 on AlphaTrak meter. We recommend that you do post and see if you can get some feedback anytime you are unsure! Better safe than sorry.

It’s okay that you fed a little higher carb food to boost kitty’s numbers. I did that last night, actually. It’s inportant to stock low carb (under 10%) for most feeding, and have mid carb (10-20) and high carb (>20%) for emergencies.

Are you familiar with what a bounce is? Some of these high numbers may be a result of the body not being used to going low, even if they are typically safe numbers, and it reacts with what we call panicky liver, and releases extra glucose it has stored. That’s normal and okay.

I basically spent about 5 weeks not sleeping much and testing Alice a lot, feeding her a lot, sometimes from my hand when she was too weak, usually mixing some water in with the food to keep fluids up.... but she is getting better and stronger every day. I don’t think the emergency vet would think she is the same cat.

Also you mentioned you think your cat is too thin around the hips—probably muscle loss. Ketones occur because the body is burning up fat and muscle because it thinks it is starving because lack of insulin is preventing the cells from utilizing the sugar it needs, so my guess is just that your cat will need some time to fill back out. Also diabetic cats may not utilize their calories and nutrients as well and may sometimes need some extra food.

They are pricy, but my cat LOVES the Sheba perfect portions in broth and so I keep those for any bouts of anorexia.

I know it probably feels like a lot right now, but please know it will get easier in time. Kitty needs fluids, food, and insulin, and for you to monitor and keep asking questions. You’re on the right path. :)
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Oh my gosh - I am so sorry for what you and Alice have been through!
I have the biggest smile reading this.. you've given me so much more hope today when it felt like I was slowly losing it.
You hit the nail on the head - I am in the panic stage - LOL. I am naturally a very anxious person and this has been.. something else, to say the least. I am exhausted physically and mentally.. but I will do anything and everything to help MK feel better!

I've been reading into the information on here about bouncing. Honestly, I think this describes a lot of what I am seeing right now. It's so reassuring to think that her numbers may be doing just this, rather than something being seriously wrong..

Your post makes my heart so happy. You are describing my exact life at the moment. Hand feeding, not sleeping.. just doing everything we can for our best friends. I am so happy that Alice is doing better! Thank you for your help and concern.. and the hope that you have given me!! ❤️
 
Thank you, again, everyone!
I am sorry for my delay in getting back to you.. I am finally trying to get into a semi-normal routine after everything these past few weeks. It has been so hard, but I know you all understand.

So things have been going fairly well. A HUGE thank you to all who suggested (which I think is everyone!) to get rid of the DM with gravy. Her BG has dropped dramatically and we are staying between 95-180 for most of the day.. with a high of around 350 before the insulin is due. Personally, I attribute this to the food change. With her BG staying 400-500 constantly, it felt like I would never see better numbers again!

Although, I feel a little uneasy because this morning, MK was hiding.. in her "I don't feel well" spot. She looks okay to me. She's eating, drinking, playing. Her eyes look a little off, though. I can't exactly pinpoint it. Her pupils maybe a little bigger than usual but they are reacting to light appropriately. I don't know if I'm picking at any little thing because I am so extra worried about her after all of this. I have been waiting all morning to check ketones.. I went outside to grab the mail and when I came back in she was in the litterbox covering up! MY luck - lol. So.. I am here ready for when she goes back!

Another thing is she has been scratching near her ear again today. I don't believe it's fleas. I can't figure out if it is bothering her or she is scratching the scabs where her tubes were at in the hospital as they are starting to heal/scab and her hair is growing in. I checked in her ear today (what I could see) and they look fine to me. When she had her ear infection, they were oozing and had a lot of wax inside, I don't see any of that.

She feels a bit fevered to me. I have been trying to get the antibiotics (metronidazole) in her since she got home but it is so tough. She takes 1/4 of a pill 2x a day but by the time I get it in her.. the pill begins to dissolve and she "spits" out the pieces and such. Any suggestions? I've tried mixing it into her food, pill pockets, pill gun.. Can I dissolve it into water (or something else) and use a syringe? The vet told us not to stress her trying to get them into her but with her feeling a bit warmer than usual, I feel like it would be best.

She's napping right now in her little bed.. I am going to see how she is doing at her nightly insulin and feeding time, and go from there. She has a recheck on the 17th but if I feel that something is off with her, I will take her in as soon as possible!

Sending hugs to everyone and extra hugs to those having a hard day today!
 
@KaitandMK , thank you, but no need to be sorry! I often look at my struggles as a benefit—I am able to help others more when I learn how to handle an issue myself.

I am also naturally anxious, and with Alice I am finally starting to find a groove where not everything is an immediate panic spinning off into imagined catastrophes. With testing and time I have learned her patterns more, and have fewer surprises. When I do have a surprise, I come here for help.

That being said, if MK is hiding out, it may be well worth it to call your vet. If you can get your own sterile urine sample for instance, you could take that to the vet to check for infection. Saves money but still allows for things to be checked out. I was reading a blog about an Acro cat earlier today saying the first real symptoms noticed were behavioral, just acting “off”.... not suggesting your cat has acromegaly, just saying acting vaguely weird and hiding are signs of potential problems, and you’re not wrong to have some concern. Right before Alice’s brother died of “wet” FIP, he hid out for 2-3 days, but I was sick and didn’t think anything of it until the day he came to tell me he was sick, and he died within a few hours. Again, don’t panic, this doesn’t mean that is what’s happening at all. It could be nothing, or a mild infection, or just feeling crappy from the FD itself. But continue to monitor, for sure!

If you are staying up a lot to care for MK, please prioritize naps at any and every opportunity!!! I noticed some of my anxiety and uptight weirdness subsided when I actually got sleep, too, and then things would look a little clearer.

You really are on a good path. After about 5 weeks of severe sleep deprivation, and about 4 weeks of Lantus, I was able to start getting more sleep and Alice was stabilizing more and more. Her numbers are still all over the place sometimes, but her clinical signs (i.e. visible, not measured via tests etc) are still better. Much MUCH better. The day she fought me about her ear being poked was a good day. Crankiness is a sign of strength. :)

Hugs to you and MK both. Keep going, and keep checking in. :bighug::bighug::bighug:
 
Kait -

When you post today, could you start a new thread (we call them "condos")? We encourage people to post on a daily basis and link your posts together. It prevents a thread from getting too long -- it the thread is too long, many people won't read thoroughly. Linking the posts means you and everyone else can easily backtrack.

 
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