UPDATE: new member/ kitty in hospital for DKA

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Megan Rizzo

Megan Rizzo

Member Since 2024
Hey everyone! Just a quick update from my original post ->
https://www.felinediabetes.com/FDMB...tty-in-hospital-with-dka.288524/#post-3168114

Thank you so much for the kind welcome and all the advice and guidance during these last couple days!

Just wanted to update everyone. Mr. Cutesy is home! As soon as we got him home I could tell he was feeling better. He’s up and moving around and acting more like himself. I’ve found a new vet who should be a better fit dealing with managing his diabetes and we will see them Monday. In the meantime I'm doing smaller / multiple feedings with water mixed in (FF classic pure)… blood checks before feeding/insulin. Hes getting 1unit of Lantus every 12 hours. He’s also on clavamox for a UTI. He does have a med for nausea but he doesn’t seem to need it anymore, as he’s eating very well! I’m also watching his behavior to see if I need to test for ketones in urine. I’m still working the kinks with checking blood sugar using the ReliOn meter. I kept getting ER4… even tried it on myself and same thing. Hopefully it is better tonight!

I’ve also updated his SS with labs from 4/2 (Dr office which diagnosed diabetes) and then 4/6 emergency vet hospital.
 
Thanks for the update. Sounds as if MC is doing really well.
Keep up the multiple meals and snacks and with water. He needs to be eating 1 and a 1/2 times his normal amount. It is possible he may need anti nausea meds again so any sign of him not wanting to eat…I would start them again. It is very common for post DKA kitties to be nauseated for a week or two afterwards.
I’m glad to hear he’s on an antibiotic for a UTI.make sure he finishes the course and you get his urine tested again to see it has resolved.

Could you do 2 things please?
  • Test every day for ketones. It is really important we can see there are no ketones at all. You can’t tell just by observing. We need to see test results as any ketones may mean the food and insulin need adjusting to keep him safe. It is much easier to deal with when the ketones are first found than later!
  • Try and get some tests in during the cycles so we can see how low the dose is taking MC. Lantus dosing is based on the nadir (lowest point) in the cycle, not the preshot BG.
Keep posting with updates and any questions. We are here to help:)
 
Thanks for your reply! I’ve got the nausea meds on standby! Ready if he needs them! I’m also using the ReliOn meter but it’s not working properly so I reached out to the company for a replacement but in the meantime tomorrow AM I’m going to the store for a new one. I am going to test pre- feed/shot but then also sometimes in between like you mentioned! I haven’t tested for ketones since he got home but I will start. Since we only did 2 days in patient I’m sure there are still some present. I’ll keep you updated. Thanks so much!

Bron and Sheba (GA) said:
Thanks for the update. Sounds as if MC is doing really well.
Keep up the multiple meals and snacks and with water. He needs to be eating 1 and a 1/2 times his normal amount. It is possible he may need anti nausea meds again so any sign of him not wanting to eat…I would start them again. It is very common for post DKA kitties to be nauseated for a week or two afterwards.
I’m glad to hear he’s on an antibiotic for a UTI.make sure he finishes the course and you get his urine tested again to see it has resolved.

Could you do 2 things please?
  • Test every day for ketones. It is really important we can see there are no ketones at all. You can’t tell just by observing. We need to see test results as any ketones may mean the food and insulin need adjusting to keep him safe. It is much easier to deal with when the ketones are first found than later!
  • Try and get some tests in during the cycles so we can see how low the dose is taking MC. Lantus dosing is based on the nadir (lowest point) in the cycle, not the preshot BG.
Keep posting with updates and any questions. We are here to help:)
Click to expand...
 
I keep getting Er4. Even with a good amount of blood on the strip. Tried so many times with kitty.. changed batteries… tried again on myself and same thing… checked to make sure I wasn’t putting blood on until the picture came up too.. I took pictures to ask for help from an admin on the fb group.. but I can’t upload them to the forum idk how.

Any tips would be helpful!!


Larry and Kitties said:
Just wondering how is the meter not workig properly?
Click to expand...
 
To put photos on the forum just copy and paste them. The upload thing doesn’t work .
I don’t live in the US and haven’t used a ReliOn meter but I’ll tag @Diane Tyler's Mom as she might know what the problem is.
Did you manage to get a urine sample to test for ketones yet?
 
@Megan Rizzo that's strange about the ER4 error code
Only because it says
When the meter display screen shows an error message “Er4”, it could mean there is not enough blood sample on the test strip to perform a test. Repeat the blood glucose test. Take out a new test strip and insert it into the meter's test strip port.

What does the manual say about the message ?
Which Relion Meter do you have
 
upload_2024-4-10_8-32-58.png
upload_2024-4-10_8-33-27.png



Diane Tyler's Mom said:
@Megan Rizzo that's strange about the ER4 error code
Only because it says
When the meter display screen shows an error message “Er4”, it could mean there is not enough blood sample on the test strip to perform a test. Repeat the blood glucose test. Take out a new test strip and insert it into the meter's test strip port.

What does the manual say about the message ?
Which Relion Meter do you have
Click to expand...
 

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Thank you! I just uploaded some pictures! I’m going to test this AM for ketones! I’ll post back here after!


Bron and Sheba (GA) said:
To put photos on the forum just copy and paste them. The upload thing doesn’t work .
I don’t live in the US and haven’t used a ReliOn meter but I’ll tag @Diane Tyler's Mom as she might know what the problem is.
Did you manage to get a urine sample to test for ketones yet?
Click to expand...
 
Maybe it could mean

the strip did not fill all the way up. so you may be removing the strip before blood is totally sipped or there is not enough blood there to sip and fill up strip.
 
Did you see the pictures I posted? That seemed like a lot of blood, but I could be 100% wrong. I know I didn’t pull the test strip out after testing because I kept messaging admin. lol

I’m going to contact and troubleshoot this AM with the company. Maybe I’m doing something wrong!
Also/ what does sip mean?

Diane Tyler's Mom said:
Maybe it could mean

the strip did not fill all the way up. so you may be removing the strip before blood is totally sipped or there is not enough blood there to sip and fill up strip.
Click to expand...
 
Megan Rizzo said:
Did you see the pictures I posted? That seemed like a lot of blood, but I could be 100% wrong. I know I didn’t pull the test strip out after testing because I kept messaging admin. lol

I’m going to contact and troubleshoot this AM with the company. Maybe I’m doing something wrong!
Also/ what does sip mean?
Click to expand...
Sipped up enough blood, this is really strange , hope the company can help you, yes I saw the pics you posted :cat:
 
Bron and Sheba (GA) said:
Thanks for the update. Sounds as if MC is doing really well.
Keep up the multiple meals and snacks and with water. He needs to be eating 1 and a 1/2 times his normal amount. It is possible he may need anti nausea meds again so any sign of him not wanting to eat…I would start them again. It is very common for post DKA kitties to be nauseated for a week or two afterwards.
I’m glad to hear he’s on an antibiotic for a UTI.make sure he finishes the course and you get his urine tested again to see it has resolved.

Could you do 2 things please?
  • Test every day for ketones. It is really important we can see there are no ketones at all. You can’t tell just by observing. We need to see test results as any ketones may mean the food and insulin need adjusting to keep him safe. It is much easier to deal with when the ketones are first found than later!
  • Try and get some tests in during the cycles so we can see how low the dose is taking MC. Lantus dosing is based on the nadir (lowest point) in the cycle, not the preshot BG.
Keep posting with updates and any questions. We are here to help:)
Click to expand...
@Diane Tyler's Mom


Here is the latest ketones test. He is on 1unit of Lantus every 12 hours.
upload_2024-4-10_10-1-53.jpeg

This was the ketone test right before taking him to the VET ER for his 2 day hospital stay. At this point he wasn’t on any insulin.
upload_2024-4-10_10-5-8.jpeg
 

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Diane Tyler's Mom said:
Sipped up enough blood, this is really strange , hope the company can help you, yes I saw the pics you posted :cat:
Click to expand...

We got it figured out. She wasn't letting the strip "do the work". She was flooding it on top instead of just barely touching the tip of the strip to the blood and letting it suck it up itself.

She finally got a legit reading! 233
 
Megan Rizzo said:
Yep, I replied to you in this thread earlier with the tests!
Click to expand...
Sorry, I looked at that and thought it was from earlier in the journey.
Did you read the result exactly 15 seconds after dipping the strip Into the urine.? And how long after did you take the photo? The strip goes darker after 15 seconds.
That test looks like moderate ketones which is a big concern.
I think you need to increase the dose of insulin to 1.25 units at the next dose. We need to get rid of those ketones. You also need to increase the amount of food.
Can you test the BGs more often so we can keep an eye on them? A couple of times during EVERY cycle would be very helpful. If the BGs drop low we may need to feed some higher carb food so we can give the higher dose of insulin.
Do you have any gravy lovers fancy feast canned food?That is high carb. Can you get some if you don’t have any?. And do you have any honey or karo at home?. You will also need to have that on hand.
I would also ring the vet and tell him MC has moderate ketones. He might suggest some sub Q fluids to flush them out. please do all this today. Don’t leave it. Having moderate ketones is very concerning.

How does MC seem? lethargic? Eating well?
Can you get another urine test asap please?
Can you also get back to me about the timing if the test. If it was 15 seconds please?
 
Bron and Sheba (GA) said:
Sorry, I looked at that and thought it was from earlier in the journey.
Did you read the result exactly 15 seconds after dipping the strip Into the urine.? And how long after did you take the photo? The strip goes darker after 15 seconds.
That test looks like moderate ketones which is a big concern.
I think you need to increase the dose of insulin to 1.25 units at the next dose. We need to get rid of those ketones. You also need to increase the amount of food.
Can you test the BGs more often so we can keep an eye on them? A couple of times during EVERY cycle would be very helpful. If the BGs drop low we may need to feed some higher carb food so we can give the higher dose of insulin.
Do you have any gravy lovers fancy feast canned food?That is high carb. Can you get some if you don’t have any?. And do you have any honey or karo at home?. You will also need to have that on hand.
I would also ring the vet and tell him MC has moderate ketones. He might suggest some sub Q fluids to flush them out. please do all this today. Don’t leave it. Having moderate ketones is very concerning.

How does MC seem? lethargic? Eating well?
Can you get another urine test asap please?
Can you also get back to me about the timing if the test. If it was 15 seconds please?
Click to expand...


No problem, thanks for the reply! This test was read right when I dipped it. I’m wondering if bc his ketones was super high Saturday prior to ER vet and he only stayed 2 nights maybe it’s coming down but slowly now that we’re home. Since his previous vet kinda left us to fend for ourselves after his diabetes dx and we wound up in the hospital it was suggested we get a new vet. So our new vet appt is on Monday. He is eating very well, acting good, moving around the house, and acting normal. I’m feeding often mixed with water. His PMPS was 206, which was the lowest since he’s been DX. I can increase his insulin.. and test more often now that I have it down pat and it works! I do have Karo/honey.
 
Bron and Sheba (GA) said:
I think you need to increase the dose of insulin to 1.25 units at the next dose. We need to get rid of those ketones. You also need to increase the amount of food.
Click to expand...

I agree that you should go up to 1.25. Test again at +2 to start and let us know.

Did the ER offer to send fluids home? It would be great if you could give subq fluids to help flush any remaining ketones out.

As long as he's still eating great and acting fine, those are very good signs but we do want to keep a very close eye on him in case he starts to go downhill again. They can be fine one minute and very sick the next, so be sure to let us know if his behavior or appetite changes.

Food is almost like a medication when it comes to DKA recovery, so you need to feed him 150% of his regular amount of food (so if he ate 2 cans of Fancy Feast per day normally, you'd want to get him to eat 3 cans per day)
 
Chris & China (GA) said:
I agree that you should go up to 1.25. Test again at +2 to start and let us know.

Did the ER offer to send fluids home? It would be great if you could give subq fluids to help flush any remaining ketones out.

As long as he's still eating great and acting fine, those are very good signs but we do want to keep a very close eye on him in case he starts to go downhill again. They can be fine one minute and very sick the next, so be sure to let us know if his behavior or appetite changes.

Food is almost like a medication when it comes to DKA recovery, so you need to feed him 150% of his regular amount of food (so if he ate 2 cans of Fancy Feast per day normally, you'd want to get him to eat 3 cans per day)
Click to expand...

the ER did not send us with fluids. I’m going to start 1.25 in the morning since I already administered his dose tonight. Then do checks +2 and I’ll post back. Thank you guys for all the help! I definitely don’t want him declining again!! He didn’t eat FF prior so this is new to us… but I’ve been letting him eat whenever he wants.. I’ll give him food and it’s usually small/med amounts every couple hours mixed with water.
Any other suggestions please let me know. I’ll also check for ketones daily.
 
Don’t forget to get some higher carb food asap in case we need to feed him that.
I’m glad he is eating well and seems ok.
I’ll be interested to hear the next ketone result. Good idea of @Chris & China (GA) to ask the vet for sub Q fluids.
 
Megan Rizzo said:
He didn’t eat FF prior so this is new to us… but I’ve been letting him eat whenever he wants..
Click to expand...

I was just using that as an example. What's most important now is that he eats!! Preferably low carb, but if you have to feed something higher carb to get him to eat, that's what you do.

Just FYI....I'm in Missouri, so on Central time but my mornings are my time to get stuff done before I get online (since once I'm online, I'm online for a long time...lol)

@Bron and Sheba (GA) is in Australia, so it's afternoon? for her right now so if you need help late at night or early in the morning, tagging her will help her know you're looking for her.
 
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Chris & China (GA) said:
I was just using that as an example. What's most important now is that he eats!! Preferably low carb, but if you have to feed something higher carb to get him to eat, that's what you do.

Just FYI....I'm in Missouri, so on Central time but my mornings are my time to get stuff done before I get online (since once I'm online, I'm online for a long time...lol)

@Bron and Sheba (GA) is in Australia, so it's afternoon? for her right now so if you need help late at night or early in the morning, tagging her will help her know you're looking for her.
Click to expand...
Yes it’s 2.18 pm here so I’ll be around for the next 8 hours.
You might also need the higher carb food if the BGs are dropping lower as we can’t lower the dose with ketones around.
As Chris said eating any food is more important at the moment than trying to stick with low carb. The food can be sorted out later. With DKA kitties we are more concerned with eating any food than trying to stick with low carb if that is a struggle.
 
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