Unanswered Questions on Why My Beloved Cat Died

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Shadowcub

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Hello,

I apologize if this is not the correct place for my questions. I have been a reader on and off since my beloved cat was diagnosed with diabetes 2.5 years ago. I have never posted before. My beatiful Shadow died this week suddenly after an episode of Ketoacidosis. I am distraught but also filled with guilt about why I didn't seen it coming, was switching her insulins the cause, etc? Is there a place here where I can share my concerns?
 
I am so very sorry for the loss of your sweet Shadow.Fly free little one. This is an awesome place sorry you did not find it sooner but yes the people here will be able to answer most of your questions. They are the best.I will keep you in my prayers It is so hard to lose our babies. May you find the answers you are looking for and may your broken heart find peace..Hugsssssssssss Kath
 
(((((Shadowcub)))) So sorry about your loss.

Did you test Shadow's blood sugar at home?

What insulin -- what change, when and how much were you giving?

DKA - Diabetic ketoacidosis generally occurs when blood sugar is high and maybe in conjunction with infection or other physical stress.
 
I'm so sorry for the loss of your sweet baby . We cant know everything all the time.
Fly free sweet kitty land ever so softly...
jeanne
 
So very sorry to hear of the loss of your cat. I had to have my cat euthanized in Dec, and I understand your feelings. I think when someone we love dies, no matter how hard we have tried to take care of them, there remains some guilt and "what if I had..." I am not sure if it is ever possible to not have those feelings and questions. If you want to post more specifics here, feel free to do so and ask questions. You might also consider posting in the Grief forum.
I hope your memories will sustain you and help you to be strong. Take comfort in knowing your cat is not suffering.
 
I had her on Humulin N, 7 units. She started drinking more water and wanting more food in January. I gave her more food but she still seemed ravenous and also appeared to be losing weight. I took her to the vet over a week ago and he did a Fructosime that showed she was unregulated, she'd also lost weight (about a pound since last year). I asked if she was dehydrated and he said no but thought we should switch insulins since she was already so high on Humulin N.

I started her on Glargine, 1 unit per day, a week ago Saturday. She behaved like her usual self but kept drinking water and wanting food. I checked the instructions and they said it takes about a week to adjust to a new insulin. On Monday night she was lethargic but still ate her dinner. In the middle of the night she vomited severly (almost as if food poisoned), but then after hiding for a short time came out and went to sleep. In the a.m. I gave her some food, she ate it but then vomited again. I took her to the vet hospital and they admited her. They said her BG was 460 and that she was dehydrated. After two days they got her electrolytes back to the normal range and were optimistic. Then overnight the electrolytes swung in the opposite direction and caused arrhythmia. They got her back on track with medication but then a few hours later she stopped breathing and they could not revive her.

She had an episode of pylonephritis (sp?) during the first year she had diabetes, but her symptoms then were so much different. She stopped eating, was vomiting and was hiding somewhat. This time she just seeme to get sick so quickly. I don't know if switching insulins caused this, or if she was in dangerous waters even at 7 units of Humulin N and I missed it.
 
I am no vet, and no FD expert, either. But it seems to me you are expecting too much of yourself. You took your cat to the vet, who is supposed to be able to accurately diagnosis what is going on. WHy do you think it was your responsibility?
 
I'm so sorry for your loss. Please don't be too hard on yourself or your vet. DKA can come on quite suddenly and recovery isn't assured. "What if's" don't really solve anything.
 
Our last diabetic cat died of DKA which came on very suddenly after she seemed well regulated. We rushed her in, initial response was good and then she nose-dived again. The clinic did a huge workup and found our cat was literally riddled with cancer. We took her home for a day and then had her euthanized. The workup and the DKA treatment cost over $2000 and then she was dead within 4 days of getting sick. We were devastated. We felt guilty. How could we have missed any symptoms? Our diabetic dog 2 years ago was tremendously well-regulated and went into DKA. To the ER, recovered, sent home, and promptly went back into DKA. Turns out she has Cushing's Disease. $8000 later, she was home again and has done well since then. But we worry every day we are not doing enough.

My point is, we always blame ourselves, always feel guilty after losing an animal, especially one with a chronic disorder that is being treated. This is a pretty normal human reaction. Even if there is no underlying disease, DKA is often fatal. It is a very sad fact and one reason why so many of us harp on checking ketones.

I am so so sorry for your loss of Shadow but she is now happy and well at Rainbow Bridge. I know that doesn't help your pain any but you have my deepest sympathy.

Best,
Rebecca
 
Such a sudden decrease in insulin dose from 7u to 1u can cause ketones, which can lead to DKA when the cat really needs the higher dose of insulin.
The vet should have mentioned testing the urine for ketones using test sticks that you can buy for humans (ketostix)

My first diabetic cat, Norton, needed a higher than usual dose of insulin -- we discovered that he had acromegaly after we found this web forum.
 
So sorry for the loss of your beloved kitty. Its possible switching insulins opened the door for the DKA, but you were on a high dose of a harsh insulin so the switch was probably a good course of action by your vet.

1U is considered the safe starting dose for glargine. But it takes a while to build a shed and that takes insulin away from the body to use so sometimes a kitty already on a higher dose of another insulin is started on a higher dose of glargine. There is just no way to know how these kitties will react so start low and take is slow is often the safest way to go. There is no way to know for sure if the switch did it, or if your kitty was already showing ketones if there was no testing for that done prior to the final ER trip, or if it was something totally unrelated to the insulin dosing that caused the sudden change. Try to focus on the fact that you were trying everything possible to make your kitty better, she knows you were doing your best for her. I know hearing those words, even knowing them to be true doesn't stop the second guessing. I know it too well :( But eventually you will accept them and even while wishing you had somehow been able to do something different that had the outcome you so desire, you tried your best.
 
Thank you to everyone for the responses. Shadow had had ketones when she was first diagnosed with diabetes (in 2008) and when she had pyelonephritis four months later, but her symptons were so different then (loss of appetite, going outside her litter box, not greeting me at the door), that I never even considered she had them at this time. Also, they seemed to be able to correct the situation as soon as she got to the vet. This time they couldn't due to electrolytes and ph (which I have to say I don't fully understand).

The doctor said she had no other underlying condition, but it never seemed like we could get her truly regulated. She'd be ok for a while and then need more insulin. I gave her first dose of glargine on Saturday night, then a dose on Sunday and on Monday. She got sick overnight Monday and I took her to the hospital Tuesday morning. How long does it take for ketones to build up? Is it weeks or can the come on in just a few days?

I had checked her in the past with the stix, but she had been doing so well I hadn't used them in a long time. I wish I had now! She was only 13 and, in my opinion, heaven sent.
 
I so wish I knew your name, sweetie. I so wish...



Sigh...

DKA can take whatever time it takes to onset. I suppose it depends on the cat. I am a tall person with a small bladder who drinks a lot of water daily. And, no, I'm not diabetic. It's just that I'm used what goes in pretty much goes out. So, even though I noticed Giz was drinking and peeing more, I did not know this to be a sign of diabetes...

She was simultaneously diagnosed diabetic and DKA in the same breath. Came home to an emotionally rocky start after three days in ICU at the ER hospital, and we were blessed to dance for four more years... Took me two years to pay off my mom's Giz's ER vet loan...


What I'm trying to tell you is, gosh, I so wish I knew your name, sometime's DKA just takes our precious furries in a heartbeat. Sometimes it doesn't. It's not your fault, darling. Sometimes, it just happens.




Please remember your love for Shadow. Please allow your aching heart to remember the good memories. You know, the ones that make you smile and will heal your aching heart. It will happen, it just takes time...




And, please accept my heartfelt condolences and deepest sympathies.
























Fly free, precious Shadow! Soar high on your beautiful new gossamer furry wings! Visit your parent's dreams and let them know you're okay now. You're chasing butterflies and ordering pizza with Giz, unless she's in the mood for Yung Chow Fried rice with shrimp. She'll show you the best sun spots at The Bridge... And, you'll have so many new friends to play with.


Much love and countless gentle hugs,
Deb and Nikki -- and, Giz...






Solace

From the silence of your pain I heard my name
and on the wings of light I have come
to see the sadness in your eyes
that cry without tears.

Can you see me? I am here.

I will always be near you
to calm your shattered heart
and to make you smile at the memories.

Do you feel me, perhaps a soft brush of fur?

You ache to believe it's real
but you are afraid to hope.

You brush away a strand of hair
But it was I, whispering.....

I am only here for but a moment;
The silver thread gently quivers.
I will leave behind my love in a dream.

When you awaken, and without really knowing why
Your heart will know at last
That it is all right, for now
to say good-bye

Copyright © Lisa Carmel Singer Printed with permission
 
I am so sorry for your loss.
More than likely something else was also wrong that didnt show up in normal blood tests.

Last Oct. my 13 year old cat had to be put to sleep because of fatal diabetic complications and suspected other conditions.
10 days before that she had blood work done, and everything was normal, except her BG.
She was on Humulin N for 2 weeks and Lantus for 3 weeks. Her BG was very high and unregulated.

Normally Lantus should be given to felines 2x a day, 12 hours apart but many vets are not familar with the protocol. At least my vet wasnt. Reading all the info here at this site taught me what to do.
Home testing is important to do before each injection, but many vets do not believe in it.
 
The vet who switched Shadow to Glagine did say some cats take it 2x a day but he wanted Shadow to take it 1x a day because it was long lasting. He said to come back in 2 weeks for a blood glucose curve and we'd determine how well it was working.

I hate to think that I wasn't giving Shadow enough insulin those 3 days. She had her Humulin N on Saturday a.m. then the Glargine Saturday p.m., Sunday p.m. and Monday p.m. before going to the Emergency Hospital Tuesday a.m.

She didn't seem at all impacted until I got home Monday night -- though she ate dinner -- when she was a bit lethargic. Then she vomited overnight and in the morning.

Do ketones exist without vomiting? Or do they always cause vomiting?

Shadowcub's proud "mother"
 
I don't think that ketones and vomitting go hand in hand, but I think that ketones may cause a cat to feel ill enough to vomit.

Yes, lantus should be given twice a day...and insufficient insulin is one of the causes of ketones.

I'm sorry. I'm not certain you are going to get the answers you need. It may be that your vet's actions lead to the development of ketones but it may be that your cat was at risk for them anyways :(
 
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