Recently diagnosed diabetic cat - seeking general advice

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ML31

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-Hi everyone. This is my first post. My name is Matt and my male cat, Oliver, is about 10 years old and has recently been diagnosed as diabetic. It started about 1 week ago. I noticed Oliver was extremely lethargic, drinking excessive amounts of water and generally appeared very weak. He was hiding in places he would never go before and acting very withdrawn. When he wouldn't eat and just hovered over his water bowl trying to drink I became extremely concerned. I took him to the ER last Sunday night where he was treated immediately. Unfortunately, he had DKA and needed to be treated and closely monitored. He was in the hospital until Friday night when I was able to pick him up. He is of course much better than when I took him in, but I am still a bit concerned.
-He is currently taking 4u of NPH twice daily, as prescribed by the emergency hospital. He also takes 1ml of Clavamox 62.5 twice daily, 1/2 teaspoon Renal K twice daily and Pepcid AC 1/2 tablet 10mg at night. Oliver's appetite has been very good. He is eating well, though he seems to always be hungry. They have prescribed him the Hills W/D canned food and also the dry food. I haven't actually picked up the food yet at a store, but I did purchase several cans from the hospital to get me through a few days. He was supposed to see the vet 2 days after release (today which is 2 days after Friday) but I have been unable to get him an appointment as it seems all vets nearby are closed. The earliest I could get him an appointment is Tuesday. I am a bit concerned as they wanted to test his BG levels to make sure he is responding well.
-Basically, my concerns lie in the treatment recommended by the ER. I am thankful that they have helped save my cat's life, but at the same time I am wary of some of the things they are recommending. From what I am reading, it seems like 4u is a high dose and I am not sure if that is good. Also, the food they are prescribing would not be my ideal choice. I definitely don't want him to have dry food and I would like to have him on a high protein/low carb diet but I don't want to change anything right now on my own. I want to wait to see my vet and see what they recommend. I'm basically just following the instructions given by the ER as I don't feel comfortable changing anything and don't want to jeopardize my cat's health.
-I'm not home testing by I did purchase all of the tools last night because of my concern for Oliver's health. I tried to test him but was unsuccessful. I didn't get much blood, or any. He is usually very calm and relaxed but he just does not let me touch his ears. He runs away and immediately shakes his head when his ears are touched. I had someone hold him while I tried to draw a sample but it still didn't work. I feel bad about the whole thing but I want to be able to make sure his BG levels aren't outrageous, but unfortunately it seems like it's going to be really tough.
-That's about all the information I have right now. I just wanted to get your thoughts on anything I should do or consider. As I said, his appetite is good but I'm a bit concerned that he is sleeping a lot and not too active. I haven't seen him drink much water and haven't been able to catch him urinate to test for ketones. He seems to be in good health, purrs, rolls over and is somewhat playful but I still feel like something is off. I feel like after he receives his insulin he does get tired and tends to hide. Any advice or tips you can provide will be helpful. Thanks for reading this lengthy post.
 
Hello and welcome!

So sorry about the diagnosis and the DKA hospital stay, and so glad that Oliver seems to be doing so much better!

Others will stop by soon, but here are a couple of quick thoughts/suggestions after reading your post:

1. DKA tends to take a lot out of a cat-- caregivers often report that it takes a while before they are back to 100%. It does sound like Oliver is well on the way, though, so that's great!

2. 4U is definitely a higher-than-usual starting dose of insulin, BUT: with a recent DKA, you want to be cautious about reducing that-- he needs the insulin, as well as food, to keep ketones at bay.

3. NPH is a tricky insulin to use in cats, it acts fast and hard, and wears off quickly, making it difficult to manage BG. Good for you for trying to get going with hometesting-- that is an absolutely crucial tool.

4. Tips on hometesting here. Especially important in the early stages, when it is always more difficult to make the ears bleed enough to test: make sure the ear is warm, and use a thicker lancet (26 or 28 gauge, usually labeled "for alternate sites" in the store-- the ones that come with glucose meters are usually 30 or 33 gauge, and are too thin). If all else fails with the ears, there are a small number of cats that tolerate paw pad testing, so that's worth a try if you think Oliver might be OK with that. Lastly, no matter what happens on a test, make sure Oliver gets a treat of some kind!

5. Most of us feed inexpensive grocery store canned food rather than vet-supplied "prescription" diets (which tend actually to be too high in carbs for a diabetic anyway!). Right now, though, the most important thing is that Oliver is eating well, and keeps eating well, after his DKA. Eventually you'll want to switch, but wait until you are hometesting-- switching to a low-carb diet can change insulin needs, sometimes drastically, so you don't want to do it without being able to monitor what is going on.

We have lots more advice to give around here, on types of insulin, food, and generally how to manage FD, but I think those are the main immediate points. Keep asking questions, and welcome again!
 
Hi Matt, glad Oliver is doing better! To help with the testing, try a little desensitization. Choose a spot that will be your testing spot, go there multiple times per day and rub his ears and give him a treat- don't try to test at all. Soon Oliver will be more relaxed and you can add the poke. Be sure his ear is warm, some use a sock with some rice in it heated in the microwave, if you use that, add it to the desensitization routine. If he really won't let you touch his ears, try the paw pad using the same routine. Always give a treat, even if you're unsuccessful. Also be sure you are relaxed, Oliver can sense if you're nervous and he will be too. Keep reading and asking us questions, that's the best way to help Oliver.
 
I really wouldn't try to switch food to low-carb until you are hometesting and (hopefully) are able to get on a more cat-friendly, gentler insulin like Lantus after you see your vet on Tuesday. I'm also very wary of lowering the dose after a DKA without doing any hometesting, even though I agree that 4U seems high.

There are a few people on this site who have much more experience with NPH and/or DKA than I do, I'm going to tag a few of them, @Jill & Alex (GA) , @Marje and Gracie , @Meya14 to see what they have to say about this dose. Weekend traffic is generally slow on the boards, so it may be a little while before they come on.
 
Nan & Amber said:
There are a few people on this site who have much more experience with NPH and/or DKA than I do, I'm going to tag a few of them, @Jill & Alex (GA) , @Marje and Gracie , @Meya14 to see what they have to say about this dose.
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Hello and welcome to the FDMB, Matt and Oliver! Unfortunately, I'm on my way out the door, but just wanted to take a minute to make a couple general comments...

If I were in your shoes, I would make testing blood glucose and testing for ketones at home a priority. It's the only way to know if the dose is too high. You also might want to take a look at these posts:
The basic recipe for developing DKA = an insufficient supply of insulin + inappetance + infection OR other systemic stresses.

At this time (subject to change as more information becomes available), I would not decrease the dose nor would I make any changes to diet.
My reasoning:
  • Oliver requires a sufficient amount of insulin, which he's getting.
  • Oliver needs to eat. He's eating W/D well so I wouldn't rock the boat at the moment. The W/D is a high carb food. The high percentage of carbs is what's probably keeping him from bottoming out. At this point, it's perfectly fine to feed higher carb foods (maybe even desirable) when you're trying to get as much insulin into the cat as is safely possible. If his appetite wanes or if he stops eating, call your vet immediately and post here for help.
  • Oliver is being treated with antibiotics... I presume for possible infection. He's getting Renal K to increase his potassium levels and pepcid AC for acid tummy. He's being treated for health issues.
Oliver is on the right track. All these things should go a long way towards keeping ketones at bay!


PS -- When Alex was diagnosed, I found it pretty easy to get blood when using 25 or 28 gauge lancets. Any drug store should have them. Oh, one more thing, when the blood beads up on his ear/paw, you can always use your fingernail to scoop it up to test. That helps when the cat is squirmy or uncooperative.


 
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Thank you all so much for your replies. I appreciate the input. I'm not going to be making any changes without seeing my vet first. Just a few points from reading your replies.

I'm not going to touch his diet. I'm not going to change any doses. He seems to be doing well enough to eat and function somewhat normally. I will wait for further advice from my vet.
I think I may need a lower gauge lancet. I was using the 30 but I realize this is making it more difficult.
I think I just need to get more comfortable doing it. I just tried testing him again and it went a little better but I'm still not sure. I got a blood sample but I don't think I did it right because it read 43. That would be very concerning, right?

As far as his BG levels.. I'm trying to decipher the sheet they sent home with me but it's a lot of terms I'm not familiar with. It does say "Glucose: 477H". I think I will just share the diagnosis with you because it might contain helpful information that I'm not able to get across, and many of you might be able to decipher these results better.

Diagnosis:

1. Complete Blood Count: WBC 14.79K, HCT 38.7%, Plt 470K
2. Chem: Alb 5.2, BUN 39, Phos 2.5, Glucose: 477H
3. PT/PTT (clotting times): normal
4. Urinalysis: USG 1.025, bacteria, ketones, glucose
5. Abdominal Ultrasound: Mild changes within the liver consistent with diabetes or hepatic lipidosis, ultrasound was otherwise normal.

That's what they gave me. I'm sure they have discussed the levels with me in detail but I just don't remember all of it. Right now he's resting on my bed. I just gave him a little snack after trying to test him. I praised him and pet him and he responded very well. He is quite alert and in good spirits so I feel pretty good. Testing went better this time, but was still really tough. I might have collected the blood too soon and didn't let it form because I was so rushed during the whole thing. But I think I will be able to do it successfully eventually. I found the best way is when someone holds him and I get the sample. I don't see myself being able to do it alone. I would need like 6 arms lol. Anyways, that's what I have for right now. I really do appreciate all of the replies. It means a lot to me.
 
ML31 said:
Thank you all so much for your replies. I appreciate the input. I'm not going to be making any changes without seeing my vet first. Just a few points from reading your replies.

I'm not going to touch his diet. I'm not going to change any doses. He seems to be doing well enough to eat and function somewhat normally. I will wait for further advice from my vet.
I think I may need a lower gauge lancet. I was using the 30 but I realize this is making it more difficult.
I think I just need to get more comfortable doing it. I just tried testing him again and it went a little better but I'm still not sure. I got a blood sample but I don't think I did it right because it read 43. That would be very concerning, right?

As far as his BG levels.. I'm trying to decipher the sheet they sent home with me but it's a lot of terms I'm not familiar with. It does say "Glucose: 477H". I think I will just share the diagnosis with you because it might contain helpful information that I'm not able to get across, and many of you might be able to decipher these results better.

Diagnosis:

1. Complete Blood Count: WBC 14.79K, HCT 38.7%, Plt 470K
2. Chem: Alb 5.2, BUN 39, Phos 2.5, Glucose: 477H
3. PT/PTT (clotting times): normal
4. Urinalysis: USG 1.025, bacteria, ketones, glucose
5. Abdominal Ultrasound: Mild changes within the liver consistent with diabetes or hepatic lipidosis, ultrasound was otherwise normal.

That's what they gave me. I'm sure they have discussed the levels with me in detail but I just don't remember all of it. Right now he's resting on my bed. I just gave him a little snack after trying to test him. I praised him and pet him and he responded very well. He is quite alert and in good spirits so I feel pretty good. Testing went better this time, but was still really tough. I might have collected the blood too soon and didn't let it form because I was so rushed during the whole thing. But I think I will be able to do it successfully eventually. I found the best way is when someone holds him and I get the sample. I don't see myself being able to do it alone. I would need like 6 arms lol. Anyways, that's what I have for right now. I really do appreciate all of the replies. It means a lot to me.
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IF HIS READING REALLY IS 43, IT'S A DANGEROUS NUMBER. can you please get another reading?? It's actually really important as hypos can be deadly. It could be a reading that is inaccurate because of too small a blood sample, but if it is acurate your cat could be in danger. Please, with determination, get another reading. Is it a human or pet meter?
 
Is he acting unusual at all? Staggering? lethargic? shaky? Those are some symptoms of hypo, but a cat can be in hypo numbers without showing symptoms until it's really serious.
 
No, he's not exhibiting any of these symptoms, just tired as usual. I will try and do another test right now.

edit: It's the ReliOn micro meter.
 
How long since the last shot?

43 is definitely a "take action!!!!" number for a cat on insulin, "action" being mostly feeding high-carb food and possibly some honey to try to bring the BG numbers up.

It's great that he's still feeling good, but we worry about where he might go from here-- hence the question about when the shot was (and thus how much longer the insulin will be going at full strength) (and hence Janet's worry above-- this is not a number that makes any of us comfortable at all!)

Congrats on your first successful BG test, by the way!
 
While you get the next test, I'll give a very brief outline of the strategies we use when numbers go this low:

1) feed high-carb, but don't fill him up all at once (we may need to do this for a while, easier if he is always willing to eat). We often use the gravy from canned food such as Fancy Feast Gravy Lovers-- high carb, not filling, but whatever you have on hand is fine.

2) honey or karo syrup. The real emergency supplies-- quick acting (though it wears off fast). Can be rubbed on gums for fast absorption. You can also drizzle a bit of honey on regular food to give it a "boost" of carbs.

Basically, we give a little snack, wait 20-30mins for it to hit the system, test again to see if the numbers have gone up. If not, repeat the process until they do start going up. Once they start rising significantly, we stop feeding for a while to make sure the cat is able to raise BG on his/her own without the food crutch.

Assuming he's still low at the next test, this looks like a definite indication that 4U of NPH is too much, hopefully some of the people who have used it can check in in the next four hours before the next shot is due.
 
I tested again and it is reading 48. This can't be an error, right? I don't know what to do. Carbs quick?
 
Feed a small snack of high carb wet food with gravy - more of the gravy than the food - and retest in 15-20 min. Post the result here as soon as you have it.
 
Yep, give him some more yummy snacks-- not tons, maybe just a tsp or two. If you don't have gravy, try drizzling a bit of honey or karo (even maple syrup in a pinch!) on the food for a bit of carb boost. Edit: or just the high-carb food you've got-- not the time to go to the supermarket unless someone can go for you.

To give you some reassurance: 8 hrs in, I wouldn't expect the NPH to be super-active for very much longer. But he certainly has gotten our attention!
 
Once you have given him the honey and food, wait and test him again in 20min,

You need to keep on testing at 20min intervals until he comes up. We would like to see him over 60.
 
Just got up to speed on this. All good advice from Nan & Amber and Gill & George!

Right now, feed him whatever high carb food you have in the house, just don't feed him a lot in case we need to get him to eat more, later. Any syrup-y stuff you have -honey, pancake syrup, corn syrup - can be added to his food.
 
I am concerned about the next upcoming shot. Obviously the 4U is too much, but as I have no personal experience with DKA or NPH I do not feel qualified to make any dosing recommendations.
 
I tagged a few people (Jill+Alex, Marje+Gracie, Meya14) earlier, but it's the weekend so I know everyone is busy. Can anyone think of others with relevant experience who might be on in the next few hours?

The encouraging thing is that Oliver's appetite and general mood has been pretty good since returning from the hospital.
 
All I can offer is that after my guy's bout of DKA he was started on ProZinc at the usual starting dose of 1 u BID. It took him a couple of weeks to regain his strength though.
 
Matt, the W/D you're feeding is considered high carb food (25%). Glad you gave him some food.

How long has it been since the last test when you got the 48 and how many hours was that from the shot?


Edited to add: Are we about 9 hours post shot now?
 
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Jill & Alex (GA) said:
Matt, the W/D you're feeding is considered high carb food (25%). Glad you gave him some food.

How long has it been since the last test when you got the 48 and how many hours was that from the shot?
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JIll, the last information we had was that he tested at 48 a little over an hour ago, and that would have been about 8 hours after his last shot.
 
Hi everyone. Sorry about the silence. I had a lot of issues with testing him. Got two errors. I did get a successful test and he's at 135. I just gave him a little bit more food with gravy as my dad was able to run out and grab some. Glad to see his levels are rising. Hopefully he can continue in the right direction.
 
He looks much better. Eyes are fully open. His head is up. Seems very responsive and alert. His appetite is very good, it seems like he cannot get enough food.

Edit: Yes about 9 hours ago he was given 4 U. Very concerned as I seriously think this is too much and I have just noticed how he behaves after his insulin.
 
Glad his numbers are up and you guys are hanging in there! We worry when we don't hear anything. Still trying to find someone who can help you with tonight's dose.
 
ML31 said:
Hi everyone. Sorry about the silence. I had a lot of issues with testing him. Got two errors. I did get a successful test and he's at 135. I just gave him a little bit more food with gravy as my dad was able to run out and grab some. Glad to see his levels are rising. Hopefully he can continue in the right direction.
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Hi Matt! Sorry, I think some panicked when you posted the 43. Going forward, please understand the W/D you're feeding is considered high carb food... probably has a higher percentage of carbs than the gravy food your dad was nice enough to go out and get.

I'd really like to see you test in an hour from when you got the 135. We want to make sure his numbers are staying up.
ML31 said:
He looks much better. Eyes are fully open. His head is up. Seems very responsive and alert. His appetite is very good, it seems like he cannot get enough food.
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Wonderful!
ML31 said:
Edit: Yes about 9 hours ago he was given 4 U. Very concerned as I seriously think this is too much and I have just noticed how he behaves after his insulin.
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I agree. This is why testing is a priority. Let's see how the rest of the cycle goes before making dosing decisions, ok?


 
I actually just received a call from the ER he went to. They wanted to check up on him. When I mentioned the low levels they suggested I bring him in right away so they can determine the correct insulin dose and check his BG levels. I'm assuming that's the best option right now.
 
ML31 said:
I actually just received a call from the ER he went to. They wanted to check up on him. When I mentioned the low levels they suggested I bring him in right away so they can determine the correct insulin dose and check his BG levels. I'm assuming that's the best option right now.
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If it makes you more comfortable to bring him in, please do.
Is it necessary? Probably if you're not able or available to monitor at home. It really depends on your schedule, ability to test, and availability over the next day or two.
 
ML31 said:
I actually just received a call from the ER he went to. They wanted to check up on him. When I mentioned the low levels they suggested I bring him in right away so they can determine the correct insulin dose and check his BG levels. I'm assuming that's the best option right now.
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That was really great of them! If he was my kitty, I would go ahead and take him in. It would be well worth it to me for peace of mind, if for no other reason.

ETA: Please let us know what they recommend, if you do take him back in to be seen!
 
Yes I am going to take him in. See what they recommend. I just worry about if he will have to stay overnight. But I am going to do it. I think it's the best thing for both of us. I really do appreciate the concern. Thanks so much. I will post an update when I have one.
 
ML31 said:
Yes I am going to take him in. See what they recommend. I just worry about if he will have to stay overnight. But I am going to do it. I think it's the best thing for both of us. I really do appreciate the concern. Thanks so much. I will post an update when I have one.
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Yes, please update when you can.
Good luck!
 
ML31 said:
Yes I am going to take him in. See what they recommend. I just worry about if he will have to stay overnight. But I am going to do it. I think it's the best thing for both of us. I really do appreciate the concern. Thanks so much. I will post an update when I have one.
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I think that's a good decision! Please do let us know how it goes, and how Oliver is doing. Sending prayers! :cat:
 
I just got home and got a tag. I do not have any experience with DKA but, Bubba had ketones that he got rid of. Jill and Alex gave the recipe for a DKA event and so glad to read that you will be taking your kitty to the vet. Good luck and keep us posted.
 
I just got home from the animal hospital. The end result is I am relieved, feeling much better, but a tad bit frustrated at the same time. Basically, what happened was when I arrived at the vet the nurse wanted to check his BG levels right away as they were concerned about his low levels. After she tested Oliver, she told me that he read 487. Of course, this is high. So she told me to wait and the doctor would meet with me. After a few minutes, I met in a room with the doctor. The doctor told me that Oliver's BG was dangerously low and that he needs to be treated immediately and stay overnight. I was shocked and baffled. I told her the nurse just told me he is at 487, how is that low? And she told me that that is incorrect that it was "43" and that he is in danger. The whole thing didn't make sense, but I trusted the doctor and thought maybe the nurse somehow made a mistake in reporting the BG. So she sets up the paperwork for an overnight stay, gives me an estimate and asks me to sign. Of course, again, it's a lot of money but when I consider the alternative I don't hesitate to sign. I say goodbye to Oliver and pay my bill on the way out. He will be ready to go home tomorrow.

A minute or two after I get inside my house I receive a phone call from the vet. She promptly apologizes to me and tells me there has been a misunderstanding. The number the nurse originally told me was the correct BG level. When the nurse saw the doctor getting ready to give him sugar in an IV she asked what the hell she was doing. It was at that moment they realized there had been a miscommunication. The doctor must have mistaken Oliver's original reading when this episode began as the level that was just taken. She apologized again and told me Oliver would be able to come home right now if I wanted to pick him up, or he can stay. I ultimately decided to let him stay so they can monitor him and hopefully see how he reacts to a lower dose of insulin. When I mentioned that I thought 4U was too high, she agreed with me especially when she learned his levels dropped that low. Although she admitted 4U is a high dose for a small cat, she told me that this was the dose he responded best to. They tried 1, 2, 3, and other various doses I'm assuming but they had the best results with 4U, so that is what they sent me home with. We are going to try 3U so that will be the new dose going forward. Since it was right before he was due for his insulin, I hope they will give him 3U tonight and be able to give me some results in the morning. He can go home in the morning and I will likely pick him up before 9 AM.

So I am struck with mixed emotions currently. I am elated that Oliver is well enough to be home, didn't require hospitalization, and is overall doing well. I'm a bit frustrated over the miscommunication and the fact that I paid a lot of money for something that isn't necessary, which I will be reimbursed for tomorrow. All-in-all I hope this overnight stay will provide me with some useful information going forward and that Oliver won't have to go through a day like this again.

Just as a closing question... Should I be concerned that his BG was 487? I understand he had been between 11-11 1/2 hours since his last dose of insulin and that he was prone to higher BG levels due to increased stress levels, but how high is too high? I'm just trying to get a better understanding of the numbers.

I really can't thank you all enough, again. The knowledge I have gained here so far and the support I have received is nothing like anything I am used to. If it wasn't for you guys today may have had a different outcome. This is probably the last update of the night. Will pick Oliver up in the AM and will continue the daily treatment. Have a good night.
 
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