GA Urgent-kitty I. DKA

My sweet Sebastian is currently being admitted at the hospital due to DKA. Can anyone give me some background or advice if he makes it through this? He was diagnosed with diabetes in August when I forced a senior wellness visit. He had proved to be a difficult case when it comes to his levels. I am just a little overwhelmed and looking for any help and any prayers anyone can give.

 

Cheri posted on the FB page and we got her here ASAP. I know you'll need more background info. (I barely glanced through thread and don't know back story)....

But apparently she had a vet not versed or up to date with FD, received poor guidance....told Don't test, etc..

Can some of you w/ DKA experience take a look and help with some advice??

Tagging a few I can think of: @Jill & Alex (GA) , @Sienne and Gabby , @Dyana ...
Eta: @Wendy&Neko , @Marje and Gracie , @julie & punkin (ga)
Who else???

Cheri not sure who is on board, will try to get some eyes for you.

 

In the meantime, if you can put together as much history as possible...like when DX, dose(s) he was on and for what period, what you are feeding, and any/all BG readings you have, I am sure that would be helpful

 

Hi Cheri, I don't have any experience with DKA, but wanted to offer support and prayers for you and Sebastian.

 

Hi Cheri, I just wanted to say I know how upsetting this must be. I don't have any experience with DKA but I am sure some of the peeps that do will weigh in soon to give you some information. Keeping good thoughts for you and Sabastian.

 

Sebastian is 16 and an underweight diabetic. He has never had weight issues so my ignorance in this disease doesn't know what triggered it. He was diagnosed in august and has had his insulin doses all over the place. At the time of DKA he had 5 units in the am and 3 in the pm. The ER states his ketone level was 7.1 and body temp very low.

 

DKA, diabetic ketoacidosis, happens when fat is broken down for calories. A by-product of this is ketones, which may be used for energy. Too many ketones shift the pH of the body to a more acidic state and sickens the cat. Treatment involves stabilizing the cat, hydrating, giving insulin via IV, plus glucose or dextrose as needed, and monitoring the mineral levels. It can be very expensive to treat due to hospitalization.

 

He is currently in the hospital being treated. Yes it is costly, but I have to pray this treatment will work. After that I want to ensure I do the right thing to keep this from happening again.

 

Here is some info on DKA

http://www.felinediabetes.com/ketones.htm

 

My vet has him on human insulin and he eats fancy feast classic for the most part. Could this be an issue?

 

Hi, Cheri. Betty asked me to stop by.

In most cases, DKA develops due to a combination of factors all of which occur almost simultaneously. Typically, the cat has some sort of underlying infection or inflammation, isn't getting enough insulin, and there's a loss of appetite. As ketones develop (and there's a difference between ketones being present and DKA), the kitty's metabolism shifts from using protein to metabolizing fat. Using that stored fat is what produces ketone bodies. Under ordinary circumstances such as in human weight loss, drinking a lot of water and having protein as part of your diet, prevents this from getting out of control. With a diabetic, though, the situation is much more complicated because insulin isn't getting nutrients into the cell which can then shift everything into a a dangerous situation. Once the line between ketones and ketoacidosis is crossed, metabolic factors are seriously out of whack. Electrolyte levels can get to seriously scary levels requiring on-going careful monitoring in the hospital. The vet will monitor this regularly, will probably have your cat on two types of insulin (fast and longer acting) to help drive the blood glucose numbers down, a fluid drip and likely a dextrose drip which will provide nutrition and prevent blood glucose numbers from dropping too low.

Once Sebastian is home, it's important to keep an eye on his BG levels. You can also monitor for ketones at home either using a blood ketone meter or you can test for urinary ketones. Some cats are more prone to developing ketones than others.

Many of the cats here, mine included, have survived DKA. Admittedly, it's scary. I'm hoping Sebastian's vet keeps you informed of his progress and everything is back to normal quickly.

 

((( Cheri )))

Sebastian is in the best place he could possibly be. Alex was also a DKA survivor. Many of us understand what you and Sebastian are going through. We'll add our thoughts and prayers to yours. Keep the faith!

We will make suggestions and help as best we can once the vet has him stabilized and he's getting closer to coming home...
post updates when you can.

Ketone/DKA info: Ketones, Diabetic Ketoacidosis (DKA), and Blood Ketone Meters

 

Once he comes home we can help you with suggestions to keep ketones from developing again. Generally speaking, the three most important areas to address once he's home is to make sure any health issues (infections, disease, etc) are addressed properly as well as making sure he's eating well (getting enough calories) and getting enough insulin. We can get into specifics once we see where he's at later.

Edited to add: Post DKA treatment *may* also include syringe feeding, administering subcutaneous fluids, and/or using a bolus insulin in addition to the basal insulin, but let's cross that bridge when or if needed.

The basic recipe for developing ketones = an insufficient supply of insulin + inappetance + infection OR other systemic stresses.

 

Cheri, which insulin is he on? Both Lantus & Levemir are very good human insulins many here use. You said he was diagnosed in August. What doses has he been given? For how long? Were the doses adjusted frequently? What were his blood glucose readings? The more BG readings you can provide us the better.

Most fancy feast classics are low carb and very good option for diabetics. It helps to feed frequent small meals over the course of the day...add water to make it kind of soupy. Mini meals are easier on their pancreas, plus tend to keep them more satisfied and also helps to keep their levels more even. Are you still feeding any dry? You really want them on an all canned low carb diet.
Sounds like you likely have him on good insulin and food, but as you see home testing is a critical component. You will be able to 'see' if he is not getting enough insulin, or too much, so you can know when to adjust.
Looks like some folks who have dealt w/DKA are dropping by, so that's great and they are your best resources on that part

 

Hi Cheri. I've never had to deal with DKA but my heart goes out to you, how terribly worried you must be for your sweet boy. Sending prayers and healing vibes for Sebastian, and you too. Please keep us posted on his progress.

Hugs,
Lucy

 

Cheri- please provide any updates you have. Several people are keeping an eye on your thread. It may be helpful for them to suggest questions for you to ask the ER vets to get a clearer picture of how Sebastian is doing.
I am not a good resource for DKA as I have never experienced it personally. But both Jill and Sienne have and several others who have been tagged who hopefully will pop in at some point.

Had he not been eating at all prior to going in? I am sure they will be giving fluids and a fast acting insulin drip to get his BG's down.
Do you know what his numbers were and what their treatment plan is?

 

I get to go see him this evening. When I called to get an update, they had an emergency, so I am being as patient with them as possible. Sebastian has had a healthy appetite all week and yesterday he just didn't want it anymore. He started to lose strength in his legs so I called my vet for help. He stated to stop his insulin for 24-36 hours and give him 3 tablespoons of karo. I thought this was odd as he was not showing signs of low blood sugar. This morning he vomited and refused anything to eat and proceeded to urinate around the house. I know these are bad signs so I immediately got him to the ER.
They did not give me his BG, but the ketone level was 7.1 and his temp was dangerously low. They have him on a jugular iv and are giving him fluids, medications, and working on his temp. He will have to stay for 2-3 days and then being transferred to an internist to help with the diabetes.
He was diagnosed on 8/20 and started with 2 units 2xs/day. We did weekly curves and each week those units went up. The last sessions instructions were 5 in the morning and 3 in the evening. Even at that his BG 5 hours after the shot was 380. I also forced a urinary test on 9/28 as I thought he had a uti, and I was right. They gave him fluids and antibiotics. He has also been on thyroid meds for 6 months.
I am hoping that there was nothing on my end that I did except follow a vets instructions that were not right for my cat.

 

You are doing great Cheri, getting you cat to the ER is exactly what needed to be done with DKA. When he gets ready to come home, the board can help you with a good dose to start with, home-testing, and how to work the dose up at a good pace. Many vets just aren't current on feline diabetes and take a lower is safer route and when ketones are present, that can be the exact wrong answer. Right now, the ER needs to get those ketones down, temp up, and make sure he is eating and it sounds like they are working on that.

Prayers for your Sebastian.

 

Prayers for you and Sebastian. I love that name for a cat.

Please keep us posted when you can.

 

Cheri, you're doing amazingly well already. You've got Sebastian to hospital, found support on Facebook and are now thankfully here.
My boy Murphy got through DKA. It was terrifying, but we got through. Rest assured Sebastian is in the right and best place at the moment. They'll get him regulated and keep in check those all-important electrolytes.
You must be very overwhelmed; I know I was. So I'll keep my advice simple. You might want to take in (if you've not already done so) an item of your clothing or anything that smells of you for Sebastian to have next to him and help calm him.
Thinking of you, hold tight.
Amy.

 

Just an update for the evening, he is being pumped full of fluids and monitored through the night. The first dose of insulin will be tomorrow morning once he meets with the internist.
Thank you to everyone for your kind words and the support you have given to a person in need. It was very difficult to see him tonight but I can only hope and pray my baby is a little better tomorrow. I will update as soon as possible.
Thank you again!

 

If you haven't already done it, take something you sleep in with you when you go visit tomorrow. Night clothes are the ones that smell the most like mama and home!

Sending prayers for your sweet Sebastian!

 

I will definitely have to do that! Thanks for your thoughts and prayers!

 

So we just got a call that he is more lethargic now and they are putting in a catheter and injecting a bicarbonite in him. I am not sure what that means, but it doesn't sound good. Big prayers needed more than ever!

 

Sodium bicarbonite is used in the treatment of metabolic acidosis.
Intravenous sodium bicarbonate therapy increases plasma bicarbonate, buffers excess hydrogen ion concentration, raises blood pH and reverses the clinical manifestations of acidosis. Here's more info: Intravenous sodium bicarbonate

It sounds like they know what they're doing.
Sending more prayers and positive thoughts...

I hope you can get some rest tonight.

 

Thank you for the information. I don't know how much sleep I will get but all of the information given helps me understand. Many websites just start to confuse me, but everyone here has made it a little easier.

 

Cheri i am so sorry you are going through this. Lots of us here sending healing vines to Sebastian. Like i mentioned i am not personally familiar with DKA, but do wonder why they have postponed getting insulin in him. @Jill & Alex (GA) do you have any idea why they would not start insulin right away in ER.....or wait for/refer to an internist?

 

They stayed he was dehydrated and couldn't start the insulin until he had more fluids.

 

No, I don't. I'm puzzled by that, but I'm not there and do not have access to Sebastian's current or past medical history. Perhaps there's a reason for that??? It's also possible they've been giving Sebastian "Regular" insulin, but will wait to give him his usual insulin til tomorrow (I don't know what insulin Sebastian usually takes --- Lantus? Levemir?).


Edited to add: Cheri replied while I was typing.
I'm not a vet. I can't say if withholding insulin because he's dehydrated is standard practice.

 

Cheri

Just sending prayers for your boy. I'm so glad you got him to the ER. I also don't understand why they wouldn't give him insulin because he is dehydrated. I'd ask the vet to explain that in detail because we all might learn something.

 

Hi Cheri. Thinking of you and Sebastian today. Wondering if there were any updates. Continuing to send tons of healing vines and support your way

 

Hi everyone,
So today is definitely a rough day for my boy. He is still quite dehydrated and the levels are not getting better. He is in a critical state, so they are working on him to the best of their ability. It is heartbreaking to see his sweet face, but not be the kitty you know. He did try and lift his head a bit and meowed when he saw me, so that gave me a little hope. I am curious as to how long of a hospital stay that many of you experienced. Any thoughts on how to make the best decision for your kitty? Also, for the cost of these visits, what is the best way to pay for these. I have heard of care credit, but is there any alternatives people have used?
Thank you again for everyone's help on this. I am just praying my little guy makes it through.

 

Care credit is great for situations like this. Make sure the hospital accepts it. I applied at the hospital when my civvies was there. It went through immediately and gave me the number and authorization the hospital needed on the spot. Depending on the charge amount you will have minimum of 6 months to pay it off interest free. The more that is charged the longer the pay off term. If the balance is $200 or less you need to pay in full or interest is charged.

You can also use it for your own dental and vision if your provider accepts it. I now have a Honda care credit card for my car.

I don't know any other way except charge card for situation you are dealing with.

 

Cheri thanks for the update. I am so glad you got to see him and at least got a little meow. I know how how torturous this must be. Did you get any clarification on why they had not started insulin? (or have they now?) It is typically such a critical component in these situations. It couldn't hurt to try and get a clearer understanding of what they are doing and why to be sure you are satisfied. We're thinking of you and pulling for him!

 

They finally started a little insulin last night. They stated that they were fearful in the insulin with how dehydrated that he was and it possibly shifting his levels in a bad way. They called a bit ago and stated he was anemic also and will decide if he needs blood this evening. They have been able to get is body temp and blood pressure up, which is a start. The internist is also doing an ultrasound and some additional blood tests to ensure there are no other issues.

 

Getting him re-hydrated will drop his glucose and ketone levels, possibly considerably. Its one of the 1st steps in treating DKA, according to the Midwest Vet Expo lecture I attended winter 2015.

 

Alex was hospitalized for 5 - 6 days. I wasn't sure she'd make it, but then all of a sudden she turned around and was released a couple days later. I couldn't believe it! They might have kept her for another day or two, but she started fighting them and refused to eat for them. The vet and I thought she was well enough for me to take her home after receiving specific instructions for at home care (foods, meds, monitoring).

This one is tough and there is no right or wrong answer. Sometimes it comes down to balancing quality of life with reality (family finances). It's a personal decision that only the family can make. The info in these links might be helpful:

Financial Help Links
Making "The Decision": Help to know when and how

I'm so sorry to hear he's having a hard time. I'm so glad you were able to take him in to get the help he needs. Sending positive thoughts that there aren't any other issues...

 

My kitty J.D. had DKA soon after he was diagnosed, back in 2005. He was admitted to the University of Pennsylvania School Of Veterinary Medicine on December 22nd. He was in critical condition. I was amazed he even made the long drive to the hospital. I just kept praying and talking to him. I remember all I lived for each day was when I could leave work and go visit him, and taking the long drive to see him for 20 minutes each day. And each day he got just a teeny bit better. He had two transfusions while in the hospital. I don't remember what for.
He was hospitalized for 8 1/2 days. He was finally released on New Year's Eve and came home with a feeding tube because he would not eat at the hospital.

I had a line of credit account and was able to pay it off in about 6 months. The cost for his hospitalization was nothing compared to a human's bills in the same situation. If your cat is a fighter, keep thinking positive thoughts. I was able to visit J.D. everyday. He went from barely holding up his head the first day, to laying with his head up the next, to bathing himself the third day and sitting up a little bit, and then on the 4th day crawling weakly into my lap with tubes attached to each leg.
J.D. was 11 when he had DKA and lived to be 20. I have seen lots of cats make it from DKA in the years that I have been on this board. Food, Insulin, Fluids, and veterinary hospitalization if at all possible. Keep praying hard. I will keep Sebastian and you in my prayers, too. Keep fighting Sebastian.

 

This kitty of mine just will not give up and I love him even more for it. He has been diagnosed with pancreatitis, but they feel they are working on getting control of his issues. He is still looking at a 50/50 chance, but he tried to get up when he saw me and attempted to get his nose in a water dish. They are doing a blood transfusion as he is anemic and they have him on a consistent insulin mix with his fluids. I just hope that this upward trend continues and my fur baby can come home soon.
Thank you again to everyone out there. Any prayers are still appreciated

 

Thank you for your story! It gives me so much hope!

 

Oooooh, now that just made me smile. It's the best news I've heard all day!!!
More positive thoughts and prayers...

 

Sending you strength...I know how hard it is. Glad you caught it quick. Glad you are getting to visit. Sounds like he is getting really good care. Napa was three days in ICU with DKA not long ago. She looked terrible but pulled through. When she came home she needed sub-q fluids for a few days and her BGs were through the roof for several days, but things settled down in about a week.

 

This sounds good and hopeful Cheri. At least that explains his sudden loss of appetite. Pancreatitis is a very common secondary issue with diabetic cats, and it can be quite painful. There are tons of kitties here who deal with it and caregivers who can share their knowledge with you when the time comes. So glad you got a visit in today, I'm sure it was good for your soul and his too. And grateful to hear of some progress however small. Continuing to keep you and Sebastian in our thoughts. We're all pulling for him.

 

. Sebastian has had a healthy appetite all week and yesterday he just didn't want it anymore. He started to lose strength in his legs so I called my vet for help. He stated to stop his insulin for 24-36 hours and give him 3 tablespoons of karo. I thought this was odd as he was not showing signs of low blood sugar


This may be out of line, but if your vet told you to stop insulin and give Karo without knowing whether Sebastians's levels were too high or too low, it seems to me that your vet has some responsibility here for your high ER Bill. Without insulin if his levels were high could have pushed him into DKA. It seems like rather irresponsible advice.

It sounds like the ER bill will be high. It might be worth talking to your vet about?

I so hope Sabastian continues to fight and improve. One thing you can do to make him feel happier is to take a unwashed tee shirt or pillow case in for him to sleep on. It will smell like home.

 

Hi everyone. Sebastian lost his battle this morning and is now frolicking with those who have gone before him. I want to thank each and every one of you for your support and prayers. This is definitely going to be a tough one to get through but I know he is at peace.

 

Oh Cheri I am so sorry for your loss. Please know you did everything you could and that Sebastion really is at peace

 

So very sorry to hear of your sweet Sabastian's passing. You were a great bean and did all you could. Wishing peace for you.

 

I am so sorry to hear you lost your sweet Sebastian, Cheri. He was a lucky, lucky kitty to have someone who cared so deeply about him. A life full of pets, snacks, delicious food and a comfy bed - what more could any cat desire?

 

My heart sank with this tragic news. You really did everything you could and it's clear how much you loved him. So very sorry for your loss.

 

Oh Cheri- I am so, so sorry. I know your heart is breaking. Just know you did your best for him and he knew how much you loved him. I know you are relieved he is now at peace and out of pain. It's just we never have them long enough, and I know how terribly you will miss him. I am so sorry for your loss. Fly Free sweet Sebastian.

My sympathies to you,
Betty

 

Dear Cheri, I'm so sorry for your loss.

Fly free dear Sebastian... land softly.

 

I'm so sorry for your loss. You did everything you could. He is peaceful now.

 

I'm so sorry for your loss. ((((((((((((((((((BIG HUGS)))))))))))

 

I am so sorry to read about Sebastian. The two of you sure did put up the best of fights to win the battle. May your memories brings smiles through the sadness.

Land softly Sebastian

 

I cannot thank you all enough for your kind words and thoughts in this difficult time. To have so many reach out that don't even know me or my sweet boy is a blessing. It is going to be a long healing process for me, but your outreach has helped. Thank you all for everything. Sebastian and I appreciated it!

 

So welcome. Keep in touch with us.

 

I definitely will, even if it is to offer prayers to others in need. I am also going to start telling others about this message board. It is a wealth of knowledge and support that I wish I knew about when this all first started. Thank you again!

 

I didn't know about it either. Labor day weekend I started googling hypoglycemic symptoms. When I found it I read through it for about 2 days. Then I 'introduced" myself and within 2 hrs Smokey had a hypo episode. Which I think is what's been happening, hence the Google search. 3 days later it happened again. With all the help here, I understand diabetes better. Smokey is getting better help from me because of FDMB.

 

So sorry to hear Sebastian lost his battle, but you did everything humanly possible. With deepest sympathy.