UTI, not eating, when to restart insulin? --post ICU update

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ebuckley

ebuckley

Member Since 2014
Hope all the kitties here are doing well today.

Poor Napa is a mess. She was doing well until about 3 days ago despite roller coaster BGs :-/
- Saturday peed outside the box.
- Sunday night off food and blood in urine. Withheld insulin.
- To vet Monday am, confirmed UTI, got subq fluid and started antibiox.
- Barely eating Monday. Did a bit of syringe feeding. Low energy. Withheld insulin.
- Tues am a bit perkier, but still low energy. Ate a few bites (offered usual wet/low carb dry/?carb treats/chix meat) and a bit of force feeding. BG 442. Withheld insulin.

If she isn't eating more this evening, I have to do more aggressive syringe feeding (kitty burrito time).
My question is: how much food intake is needed to restart insulin? Many thanks for any advice.
 
How much food is needed depends on the type of insulin you are using. For Lantus, they must eat at least 2 tablespoons of food before they can get the insulin. It has to be within a certain time period, but I don't recall if it's 30 minutes or 60 minutes.

When Tisha was ill, the vet advised us not to put her back on insulin until she was eating on her own. It is difficult to get enough food with syringe feeding alone. That said, they are at high risk of DKA if they are not eating, have an infection and are not getting insulin. I would monitor her BG pretty carefully. Also, our vet said that once they stop eating, any food is better than no food. Some ideas to try: dry food, treats, tuna packed in water, parmesan cheese on the food, yogurt, catsip (lactose free milk), plain vanilla ice cream, canned chicken in water, baby food meats without garlic or onions, plain boiled chicken breasts, rotisserie chicken with skin removed.

If she's not getting better, you might consider a follow up visit to the vet. Diabetic kitties are really at high risk for DKA and hepatic lipidosis if they don't eat for 48 hours or more.

We spent a year working through issues with food, so we had lots of practice. Good luck!
 
It's best to give some insulin when not eating, you want the BS to be in a good range, and even if not eating, the liver produces glucose. Also, cells need insulin to use the glucose in order to heal and for normal metabolism. High blood sugars + no insulin will make it difficult to recover from infection, will suppress appetite and can lead to complications like DKA. A small amount as suggested above is a good start, then adjust after a couple days based on the blood sugar.

For feeding, aim for a 5.5oz can a day if you are syringe feeding. Feed whatever your cat will eat, don't worry about carbs, you can adjust the insulin to account for them until she feels better. 300ml of fluids is also the typical intake, but this includes the fluid in wet food. Try a high calorie (200+ cal/5.5oz) kitten food or a recovery food like Iams Max Cal. You might want to ask the vet about an anti nausea medication.
 
What kind of antibiotics did the vet give? Is Napa dehydrated? Some kitties find some antibiotics to be harsh and stop eating while getting the ABX. How many days do you need to give the antibiotics? If you're nearly done, then I'd stick with the one you're on. If you have several more days on it, it might be worth switching to another antibiotic. And make sure she's hydrated. If she's mildly dehydrated, you can get her back on track with unflavored pedialyte (syringe it if she won't drink it on her own). If it's more than mild, she will need fluids.

My cat Marshmallow had a really bad reaction to Clavamox but was fine on Orbax. She needed fluids and an appetite stimulant on Clavamox but she was fine when switched to Orbax. If Napa is drinking, then maybe just ask the vet for an appetite stimulant. Ask for Cypro instead of Mirtazapine (this one makes some cats get spacey and weird and they seem to tolerate Cypro better).
 
Thanks so much for the advice--it seemed to me important to get the insulin back on board to keep that glucose out of the litter box.

She is much weaker this am. I managed to get a couple of tablespoons of her usual food in her and a small piece of chicken. BG was 380. I gave her 1/4 unit and will keep forcing small meals throughout the day. She is drinking and getting fluids with the syringe slurry. She just started Baytril while awaiting urine cultures--she tolerated it fine when she was on it this past June. We didn't have much success with appetite stimulants in the past. Very sorry to note Tisha's GA.
 
I'd ask about the anti-nausea medications. They work right away as opposed to the appetite stimulants that can take weeks to work. Also, they work differently and help when a cat feels sick to their stomach which happens when ill. You may want to home test for ketones using a ketone urine strip. You may also want another followup if there are signs of dehydration (sticky gums, scruff that doesn't spring back when you lift it) so she can get more subQ fluids.
 
ebuckley said:
Thanks so much for the advice--it seemed to me important to get the insulin back on board to keep that glucose out of the litter box.

She is much weaker this am. I managed to get a couple of tablespoons of her usual food in her and a small piece of chicken. BG was 380. I gave her 1/4 unit and will keep forcing small meals throughout the day. She is drinking and getting fluids with the syringe slurry. She just started Baytril while awaiting urine cultures--she tolerated it fine when she was on it this past June. We didn't have much success with appetite stimulants in the past. Very sorry to note Tisha's GA.
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If she is getting much weaker, and still not eating, I might be inclined to take her to a 24 hr vet clinic if you can or at the least, call your vet again and perhaps, bring her back in if she still doesn't pick up with the Baytril. That's just me though. I know it's expensive BUT...I think, knowing my anxious self, I'd much rather have the vet handle this at this point. I know others may disagree with me on this and would be better equipped to handle this type of situation but....I think, personally, I'd be feeling much better about a vet dealing with these types of issues where the medical equipment and "know-how" are there, at their fingertips and they know how to easily deal with most situations.

Don't get me wrong...I think you are doing a fab job at helping her BUT...I think that there may be a point at which vets are much more able to deal with these types of situations and save their lives than we could do at home...even syringe feeding with food and water. And, while an anti-nauseau drug may help/appetite stimulant...I, personally, would let the vet do it and decide. That's just me though. I always feel most comfortable in these situations where needed and when things are getting worse, in having a vet deal with them properly and thoroughly. Just my 2 cent's worth and doesn't make me right. Just my personal preferences. And, just to edit to add that while a LOT of members have some pretty phenomenal knowledge....none of us are vets so, we can all only give our personal comfort levels and experiences.

:bighug: :bighug:
 
Thank you very much for the replies. Right after my last post I fed her some more and was then able to get a urine sample...and it came back positive for ketones. I was already leaning your way, Louellen, and that pushed us right out the door. She's checked into the hospital. Hopefully, DKA didn't set in. Her urine was negative for ketones at the vet 2 days ago. I guess this is a classic case of too little, too late.
 
I'm sorry to hear she got worse, but I'm also really glad you whisked her off to the vet. When I saw your post just now that she was weaker, I thought uh oh, it's back to the vet they go.

Sending healing vibes, hugs and pets. Let us know how she does.
 
Heartfelt thanks all. I sure, sure, sure did not want to join the DKA "club"...alas :(. And, of course, hind-sight is biting me in the behind right now. Wish I could have caught her in the litter box the day before. Wish I was more aggressive with feeding earlier and hadn't held the insulin.

If anyone in the future reads this, she crashed fast. So glad I had keto-strips...that probably saved her.
 
@ebuckley I am SO glad that you got her to the vet's and whatever needs to be done to save her...WILL be. You have my good wishes, well wishes, prayers and everything good being sent for a speedy and great recovery. Please don't beat yourself up though. You did what you could at home for her and possibly, kept her alive by what you've done for her. Pat yourself on the back. She's now in good hands and expert care with equipment and knowledge that is what she needs.

I know this is SO hard but, hang in there and know that you're doing all that you can do and let the docs take over now.
All of us are pulling for you all! Sending GREAT and HEALING vibes!!!

HUGS :bighug: :bighug: :bighug: :bighug: Keep us updated, please...when you can.
 
Thank you all for the vines and vibes. They are working! I couldn't visit her today but this afternoon's report was very positive. The ketones are already (!) flushed out. She's eating and back on her normal Lantus. Vet is keeping her another day to watch curves. She might come home tomorrow. I can't tell you how much it means to have a community that understands. Thanks all...hope all the kitties here are doing as well.
 
Yay!! That's great news! What a relief for you! I'm sure your quick thinking with the ketone strips contributed to her getting over the hump so quickly!!
 
Just for the record and for any interested readers :bookworm:...

She is home. Understandably wobbly. Not understandably very interested in the water fountain. Ate a bit of food. Keto-strip indeed negative. Alert, preening, and here for "family time".

BG is not good. Her BG was high once she went back to Lantus. Vet dropped her to .5u yesterday (for some reason--I had her at .75) of my Lantus - flat highs. Next cycle (this am) .5u of their Lantus - still flat high. +12 when we got home was Hi.

Vet wants me to a 24-hour cycle today (no pm insulin) and shoot 1u tomorrow and do another 24-hour cycle with frequent monitoring. Vet seems to want to switch her to Levimir if she doesn't respond.

It seems to me....given the stress of ICU (not to mention death's door step), resolving UTI, and high carb recovery food (per vet tech that's all she has been eating)....she needs a several days at home with her low carb food (plz eat!!) and BID insulin at her last known dose to refill the depot. Then consider dose or insulin changes.

So my dilemma is (that so many here have known) respecting vet recommendations versus going with the gut. I can understand stalling and ~18-hour cycles if the numbers dictate, but I feel like she needs the pm dose with flat high readings. Plus I am haunted that holding insulin is what got us into trouble. I think I have 2 more tests in me tonight tho don't expect anything other than high readings.

(side note ughs--civie Nomi went in today too with suspected UTI and we have travel coming up. :confused:)
 
Good news that Napa is back and is negative for ketones and eating a bit!!

I can't give Lantus advice but if you post the above of the Lantus forum I'm sure you'll get some intelligent answers.

Sorry Nomi may now have a UTI. Maybe she didn't want Napa to get all the attention. ;)
 
Dosing once in 24 hours will not offer full days coverage in most cats when using lantus. Therefore, she'd have time where she didn't have enough insulin in her system, which could possibly lead to recurrence of ketones. If she's not 100% back with the appetite yet, I'd continue with the high cal foods, and not switch back to the usual food just yet. Transition it slowly as the appetite returns. If it were my cat I'd just split the dose the vet wants in half and shoot twice a day, then make adjustments per the TR protocol.
 
Ugh. Flat black all day despite going to 1u this am -- even broke out a fresh pen (the previous one had spent one hour on the counter about a week ago).

Fortunately, she is eating several small meals. I'm offering her usual friskies pate as well as a grain-free kibble--and some of her favorite, pork. Ketones were negative on a midday clean catch. She's still understandably "off" and weak but up and around, alert, and even went straight into hunter mode to chase after a bird in the yard during an outside amble.

But dang her 500+ BG is not budging AT ALL. Worried. Decided to give PM insulin despite the vet's recommendation to watch over 24 hours.
 
I'm so glad Napa responded quickly and is back home with you!

On the Lantus questions, it really does take about 2 weeks for her system to adjust to a new dose, so her numbers will likely be wonky for a while. The high calorie food will also throw them off, but it's what she needs. I would keep monitoring closely for problems and stay in touch with your vet. Keep trying her normal food until she eats it again, but recognize it may take some time. It took Tisha over a month to get back to FF after one episode. During that time, she would only eat the Wellness food, which cost us a fortune! Patience is key!

It sounds like the worst part is over at least, but I know you will be relieved when BG and food are back to normal.

Thank you for thinking of Tisha. We still miss her terribly. BUT we are adopting a pair of kittens next week & looking forward to kitten antics!:cat:
 
Are you using Marin or Denamarin? These products both contain milk thisle extract which helps support the liver.
Providing insulin will allow the glucose to be used. This will reduce fat breakdown for calories. Since the broken down fat goes to the liver, this will reduce the workload on the liver.
 
Thanks for the reassurance Lisa. She's eating pretty well still letting her have her 15% kibble but only after she finishes friskies. BJM, no, wasn't offered that. I was looking at some milk thistle I have in vitamin drawer just yesterday.

Time to pull out the patient pants. Have fun with the baby kittehs when they arrive, Lisa!
 
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