Update--great news!

Status
Not open for further replies.
S

smokeymay

Member Since 2012
To recep the situation: My Smokey cat had DKA and while recovering, had good numbers on paper but was lethargic and not eating or drinking. This was a week after she was initially brought to the hospital and diagnosed as DKA.

Today the vet called. She was eating on her own, and with good appetite, even though she is still lethargic. He's feeding her maybe not the first choice healthiest food, but just wants her to eat, period. He'd put out one of those huge cans of fancy feast. She quickly ate 70% of it while he was out for a brief time, and threw up. They gave her an anti nauseant shot. She's been eating well ever since, and not been ill again. No more force feeding is necessary, apart from receiving fluids under her skin (she has slightly elevated kidney levels). Unless anything happens he will discharge her to us tomorrow and we will see how she does at home. Hopefully after eating more and gaining weight she will gain her usual energy. He said not to even start with kidney food right now since kidney her elevation levels are so slight and he just wants to see her eat what she loves and gain weight and health. She is also currently still on an antibiotic (precautionary measure, since diabetes and kidney problems increase risk of infection).

With her health.... so we had a conversation about different insulins. He said I may want to consider lantus. He said PZI isn't always available consistently. Also that he'd monitored cats on it, and that it isn't necessarily better than NPH from what he's seen in his own experience. However he said lantus is longer acting, and since my girl seems to spike between doses I am considering it. However he was reluctant to do so right now, said he'd think about it and let me know tomorrow. Since she is doing well right now he is reluctant to make any changes. We don't want to send her into a tailspin. So maybe I will continue her as before and then switch to lantus once she's back to herself. My only other concern with lantus is that my cat is so sensitive to insulin.... so if I gave her too much, maybe it's safer to have had the shorter acting one in her system?

I originally wanted to test her 4x/day for BS levels. The vet said I dont' want to torture her, so maybe test her only once a day, 4 hours after a shot.... but I'm very afraid after this experience. One of my relatives suggested maybe 3x/day. The hospital had recommended testing the paw vs ear... but I noticed a lot of people on here seem to use the ear. Just curious as to your own experiences with this, and if you all test at least 4x/day. Certainly if I switch insulins I'd test her a lot in the beginning. I may test her 4x/day forever because I'd rather have her dislike me than end up in the ER where surely she (and I) would be far more upset.

I'm nervous, will feel better after she exhibits her usual behavior, but overall am so relieved that she's improving and am sooo excited about brining my princess back home. Hopefully she will continue to be a presence for years to come. She is like my child and so gentle and loving and I cannot imagine life without her. This experience was eye opening and I'm so glad I discovered this message board so I can be more educated and pro active in caring for my darling. THanks for all your support and advice.
 
A spot of Neosporin ointment w/ pain relief applied to the ear a few minutes before testing then wiped off reduces the annoyance factor from a trivial prick, plus helps the blood bead up for testing.

We recommend you always test before giving insulin for the safety of your cat. Also, Lantus doses are adjusted based upon the nadir which is around 6 hours after the shot is given, so a 3rd, mid-cycle test is needed to monitor effectiveness and safety - its not just about the pre-shot levels.

Additionally, since the DKA happened, you'll want to monitor for ketones in the urine or via blood testing (the latter is somewhat expensive, but less costly than hospitalization!). See my signature link for Secondary Monitoring Tools for some options.
 
Oh, yes, the vet and I discussed urine ketone strips. I was planning on trying to catch her in the litterbox. She tends to want to go after her litter has been scooped, but not sure how she will take the lack of privacy factor. I wanted to do this daily, esp her first week being discharged back to us.
 
Don't worry too much about kitty not liking you for extra testing. Once they get used to it and realize there's treats, they settle right in. Often times they will purrr through the entire process! I test my Buster a minimum of 4 x day. Once before each insulin shot and then at least once during mid cycle. As BJM said, dose changes are made based on the mid-cycle numbers moreso than the number right at pre-shot, so it's important. I even set an alarm to test in the night when I can't stay up so late. Good luck to you! Please ask all the questions you need - we're here to help!
 
Sounds like she is making great strides!

so maybe test her only once a day, 4 hours after a shot....
Click to expand...

Are you only giving 1 shot per day? Testing preshot is really important, you don't want to give insulin to a cat that is 40 already. If you switch to Lantus, I am not sure how the vet intends to give dose advise without any nadir (midcycle) numbers since that is what the insulin dose is based on. Your idea of 4 tests a day is a good idea.

Testing isn't torture for most kitties. Some may never adjust, but most won't care or even come to look forward to the time with mommy or daddy. I don't give treats with our tests just some love time, and all I have to do is push the button to load the lancet device and Smokey comes running. If she is asleep, she often doesn't even wake up. The first week was rough, no doubt about it. While she got used to what we were doing. Once she got used to it, she's been fine. When we went off of insulin for a while, she even refused to get out of her testing spot to eat at first. I had to go test her in order for her to think we were done with business and it was time to go eat.
 
Lol, that's great Melanie, that your Smokey comes running. My Smokey loves affection. And food, certainly, so I was planning to feed her after a testing and shot. With treats, if I do need to go that route (I remember initially after starting insulin she would hide), since she is both diabetic and has slightly elevated kidney levels, does anyone have advice for a "safe" treat for her? I will ask my vet too. I know that since becoming diabetic and receiving insulin, she won't sit on my lap anymore. That's sad but not as sad as her ending up in the ER.

With the vet's recommendation re: testing, that's for the Humulin N which she is on now, twice a day. Lantus is a whole different story. He explained to me how the numbers and approach are all different. I do believe he would go through the testing and numbers with me should we decide to switch. He also mentioned that he has clients who test regularly and are extremely careful... yet their cat ends up with DKA anyway, because sometimes it is sudden and there is nothing you can do. So I think he is hesitant to say that switching insulin/approaches will necessarily yield a better result in the long run. However he was all for buying the ketone meter or using urine strips if I am able to test her that way, and test for ketones every day. Since my cat is on a microscopic and short acting dose maybe he feels she is low risk for hypo. Don't worry though, testing pre shot is something I plan to do from now on.

Just curious with the lantus... if you have to test every 6 hours after every shot and you are the only one in the household who can do it... how do you manage? I imagine there is lots of setting the alarm in the morning/evening hours. What if you are going to be away a long stretch during the day? I'm committed to my cat's care but am trying to imagine how I will manage this.

Thanks for all your stories and advice.
 
I went home for lunch to get mid-cycle tests on Spitzer.

Some folks do set an alarm and test in the middle of the night, which is when some cats may go lower anyway, so its a good way to catch a possible hypo.

Make changes cautiously, one change at a time, when you know you'll be around to monitor. Weekends are a good time for making planned changes, or vacation days.
 
And you don't have to do a mid-test EVERY cylce- just once out of two cycles. I test at night.

I don't know about Lantus but on Levemir the nadir is usually around +8 or +9 instead of 6 hours after the shot. Which is good when you normally wake up at that time to go to the bathroom. Sneakers knows every time I get up at night she gets tested and then I feed her- usually an ounce to 1.5 ounces at a time. She doesn't mind it at all and if I forget looks at me as if to say "Mom! You forgot something!" so it isn't torture for her.

While I am at school I only test about 5 times a day. Out of school it is usually 7.

Treats can be chicken cubes you make, little shrimps, or freeze dried bites of chicken, shrimp, beef, lamb. Anything protein only is good- once they start adding ingredients you need to read the label carefully.
 
I apologize for the length of this post--but I wanted to answer your questions on insulin, testing and food thoroughly!

Insulin:

Lantus is a much better insulin than Humulin N, which does not work very well in cats because the duration of action is too short because of their faster metabolisms (6-8 hours). Lantus lasts a full 12 hours in cats and offers much better BG control. Because of this the American Animal Hospital Association does not recommend Humulin N for use in cats. Their recommended insulins are Lantus, Levemir, or Prozinc. Also, the the remission rate is less than 25% for Humulin N, but 86%+ for Lantus.

I hope that your vet does not scare you away from Lantus with the testing recommendations (which is 3 times a day--once before each shot, and then a mid-cycle check about halfway through either cycle). You actually should be testing MORE frequently with Humulin N (before each shot, then 2hrs, 4hrs, and 6hrs after the shot) because of its harsh rises and drops. To test less than that on Humulin N is dangerous, in my opinion. Way too many cats hypo easily on that insulin.

Testing:

When Bandit started Lantus (he's been in remission for several years, and is doing great), I was working two jobs and going to grad school. My full time job kept me away from home for nearly twelve hours during the day, because I also had an 1hr commute in either direction (which meant I could not run home to test on my lunch break). Bandit's shots were at 7am/7pm. So what I did was test and shoot at 7am, go to work, get home a little before 7pm and test and shoot again, get a test before bed at 10-11pm (3-4 hours after the shot), and then I would set an alarm for 1am, get up and test him quickly, then go right back to sleep. Yes, it was a pain the first couple weeks while my body adjusted, but after that it wasn't even an issue. Many parents do this with newborns to a much greater extent. On the weekends when I was home to test during the day, I would get a curve on Sat. or Sun.

The thing is, that little extra work you put into adjusting your schedule and getting those needed tests will pay off for both you and your cat in the long run. You'll have the data you need to make the correct dosing decisions, which will most likely lead to your cat no longer needing insulin (the large majority of cats go into remission when Lantus is dosed correctly). This is the most convenient situation for you (only having to test once every couple weeks or so), and is the safest and healthiest condition for your cat to be in. Also, it will save you loads of panic and worry because it drastically lessens the chances of a severe hypoglycemic incident, because nuanced dose adjustments combined with the the daily testing make sure you'll catch and adjust the dose as his pancreas heals and his need for insulin lessens.

Food:

There are several foods that are good for both early stage kidney disease and diabetes. To manage diabetes, you want to feed a low carb (less than 10%) canned food, and to manage the kidney disease, you want to feed a high quality, low phosphorus canned food. Many vets simply recommend low protein prescription diets (like K/D) for cats with CKD, because they are by default low in phosphorus. However, it's the quality of protein and phosphorus levels that matter, not the protein values. The low-protein prescription kidney diets have only been shown to be beneficial in end stage renal failure and definitely should not be fed early stage. In fact, they cause muscle wasting when fed in early stage CKD and are completely inappropriate for an early stage cat--the muscle wasting is more debilitating than the CKD.

Keeping your cat well hydrated is also key in managing CKD, which means NO DRY FOOD. At all. Dry food is moisture depleted and causes chronic dehydration in cats, often the cause of CKD as cats progress in age. Adding a little water with the canned food portions helps, as do pet fountains, since they encourage cats to drink even when they are not thirsty (cats have very low natural thirst drives, so by the time they seek out their water dish they're already dehydrated). See this article on Kidney Disease written by a vet who is an expert in feline nutrition for more information: http://catinfo.org/#Kidney_Failure.

Here's an updated food list with the values for several premium foods: https://docs.google.com/leaf?id=0B8Uu8g ... ist&num=50. Also see this list (in alphabetical order by brand): http://catinfo.org/docs/Food%20Chart%20 ... -22-12.pdf, and this list (in order by Phosphorus content): http://catinfo.org/docs/Food%20Chart%20 ... -22-12.pdf. You're looking for something with less than 10% carbs (for the diabetes) and less than 250 mg/kcal of phosphorus (for the kidneys). The foods I would suggest are Merrick's Before Grain Beef, Merrick's Before Grain Turkey, Merricks' Cowboy Cookout, Merrick's Surf & Turf, Wellness Turkey, EVO 95% Chicken & Turkey, or Blue Wilderness Duck.

If those are out of your price range the next best thing to feed are the low carb Friskie's Special Diet Turkey & Giblets and Salmon flavors. However, I would strongly urge a food without byproducts, and keep in mind that they're still cheaper than the prescription foods and usually about the same as many grocery store brands if bought in large cans or in cases. Studies have shown that the quality of the protein source does make a difference in controlling the disease, and that needs to be considered along side phosphorus content.
 
I apologize for the length of this post--but I wanted to answer your questions on insulin, testing and food thoroughly! I don't want to overwhelm you with information, so make sure you questions if anything is too much. :smile:

Insulin:

Lantus is a much better insulin than Humulin N, which does not work very well in cats because the duration of action is too short because of their faster metabolisms (6-8 hours). Lantus lasts a full 12 hours in cats and offers much better BG control. Because of this the American Animal Hospital Association does not recommend Humulin N for use in cats. Their recommended insulins are Lantus, Levemir, or Prozinc. Also, the the remission rate is less than 25% for Humulin N, but 86%+ for Lantus.

I hope that your vet does not scare you away from Lantus with the testing recommendations (which is 3 times a day--once before each shot, and then a mid-cycle check about halfway through either cycle). You actually should be testing MORE frequently with Humulin N (before each shot, then 2hrs, and 4hrs after the shot in ALL cycles) because of its harsh rises and drops. Humulin N also usually needs to be given three times a day in order to be effective in lowering BG, which means more frequent testing in order to keep your cat safe. To test less than that on Humulin N is dangerous, in my opinion. Way too many cats hypo easily on that insulin.

Testing:

When Bandit started Lantus (he's been in remission for several years, and is doing great), I was working two jobs and going to grad school. My full time job kept me away from home for nearly twelve hours during the day, because I also had an 1hr commute in either direction (which meant I could not run home to test on my lunch break). Bandit's shots were at 7am/7pm. So what I did was test and shoot at 7am, go to work, get home a little before 7pm and test and shoot again, get a test before bed at 10-11pm (3-4 hours after the shot), and then I would set an alarm for 1am, get up and test him quickly, then go right back to sleep. Yes, it was a pain the first couple weeks while my body adjusted, but after that it wasn't even an issue. Many parents do this with newborns to a much greater extent. On the weekends when I was home to test during the day, I would get a curve on Sat. or Sun.

The thing is, that little extra work you put into adjusting your schedule and getting those needed tests will pay off for both you and your cat in the long run. You'll have the data you need to make the correct dosing decisions, which will most likely lead to your cat no longer needing insulin (the large majority of cats go into remission when Lantus is dosed correctly). This is the most convenient situation for you (only having to test once every couple weeks or so), and is the safest and healthiest condition for your cat to be in. Also, it will save you loads of panic and worry because it drastically lessens the chances of a severe hypoglycemic incident, because nuanced dose adjustments combined with the the daily testing make sure you'll catch and adjust the dose as the pancreas heals and the cat's need for insulin lessens.

Food:

There are several foods that are good for both early stage kidney disease and diabetes. To manage diabetes, you want to feed a low carb (less than 10%) canned food, and to manage the kidney disease, you want to feed a high quality, low phosphorus canned food. Many vets simply recommend low protein prescription diets (like K/D) for cats with CKD, because they are by default low in phosphorus. However, it's the quality of protein and phosphorus levels that matter, not the protein values. The low-protein prescription kidney diets have only been shown to be beneficial in end stage renal failure and definitely should not be fed early stage. In fact, they cause muscle wasting when fed in early stage CKD and are completely inappropriate for an early stage cat--the muscle wasting is more debilitating than the CKD.

Keeping your cat well hydrated is also key in managing CKD, which means NO DRY FOOD. At all. Dry food is moisture depleted and causes chronic dehydration in cats, often the cause of CKD as cats progress in age. Adding a little water with the canned food portions helps, as do pet fountains, since they encourage cats to drink even when they are not thirsty (cats have very low natural thirst drives, so by the time they seek out their water dish they're already dehydrated). See this article on Kidney Disease written by a vet who is an expert in feline nutrition for more information: http://catinfo.org/#Kidney_Failure.

Here's an updated food list with the values for several premium foods:https://docs.google.com/leaf?id=0B8...MzhkYTkxOGM4NThk&sort=name&layout=list&num=50. Also see this list (in alphabetical order by brand): http://catinfo.org/docs/Food Chart Public 9-22-12.pdf, and this list (in order by Phosphorus content): http://catinfo.org/docs/Food Chart Phosphorus 9-22-12.pdf. You're looking for something with less than 10% carbs (for the diabetes) and less than 250 mg/kcal of phosphorus (for the kidneys). The foods I would suggest are Merrick's Before Grain Beef, Merrick's Before Grain Turkey, Merricks' Cowboy Cookout, Merrick's Surf & Turf, Wellness Turkey, EVO 95% Chicken & Turkey, or Blue Wilderness Duck.

If those are out of your price range the next best thing to feed are the low carb Friskie's Special Diet Turkey & Giblets and Salmon flavors. However, I would strongly urge a food without byproducts, and keep in mind that they're still cheaper than the prescription foods and usually about the same as many grocery store brands if bought in large cans or in cases. Studies have shown that the quality of the protein source does make a difference in controlling the disease, and that needs to be considered along side phosphorus content.
 
Status
Not open for further replies.
Back
Top