Vesper, 1/18 - trending towards DKA

Kelly and Vesper

Kelly and Vesper

Member Since 2025
Hi all,

I have been very neglectful about checking in and haven't posted for about 4 months. Hope everyone is doing well.

Vesper was thriving and very stable this past fall. We traveled with her over the holidays, and ever since we got back, she has been very unstable in January. I think she might be having pancreatitis flares. I thought I managed the first one, but she's having another one, and it seems to be quickly spiraling so I need help. Her ketones just reached their highest in a year (0.3).

One thing to note, and I'm so ashamed to admit this: We stopped giving Vesper her budesonide in October sometime. She was previously on it after back to back DKA episodes last January. She had no flares while on it, but also no flares from Oct-Jan when she was off of it. The vet did not tell us to stop, we simply got neglectful in the process of buying/renovating a home that left us insanely busy. So my first question--should I restart her budesonide? If so, when? Is it safe to restart now?

Second, I have been checking glucose/ketones and giving her cerenia. Her appetite is very low and she is EXTREMELY aggressive with the blood checks, so I've been trying to balance not stressing her out with getting the information I need to keep her safe. I've been doing all the tricks to get her to eat (fortiflora, a buffet of options, warming food, etc). I. know any food is better than no food right now, so I've even offered dry food etc. She will nibble, but probably only ate about 1/4 cup of dry food (tiki cat carnivore -- which i think is low carb) today and zero wet food. What else can I do? Do I need to adjust her dose?

I will also call her vet tomorrow, but they have never been that helpful with this stuff, and I trust this board more.

Please help me keep her out of DKA!

Vesper FDMB US 12/12 Insulin Spreadsheet Template
 
Hi Kelly, the ketones at 0.3 are ok.
I am concerned about the low appetite. Keep offering what ever she will eat at the moment. Don’t worry if it is not low carb. As you know eating anything is more important than just eating low carb.
If you think she is having a pancreatic flare I would go to the vet asap and ask for a fPL test to see if it is in fact pancreatitis. If it is, Vesper will need some pain meds, and ask for some ondansetron for the nausea…that can be giving with cerenia as they work on different pathways.
And she may need some sub Q fluids as well.

While you are at the vet ask about restarting the budesonide.
I would find out a diagnosis first before looking at increasing the dose.
Keep testing or ketones and also try and get a few more tests in during the cycles if you can including the pm cycles.
Bron
 
Bron and Sheba (GA) said:
Hi Kelly, the ketones at 0.3 are ok.
I am concerned about the low appetite. Keep offering what ever she will eat at the moment. Don’t worry if it is not low carb. As you know eating anything is more important than just eating low carb.
If you think she is having a pancreatic flare I would go to the vet asap and ask for a fPL test to see if it is in fact pancreatitis. If it is, Vesper will need some pain meds, and ask for some ondansetron for the nausea…that can be giving with cerenia as they work on different pathways.
And she may need some sub Q fluids as well.

While you are at the vet ask about restarting the budesonide.
I would find out a diagnosis first before looking at increasing the dose.
Keep testing or ketones and also try and get a few more tests in during the cycles if you can including the pm cycles.
Bron
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Thank you so much for your help. Every time we bring Vesper to the vet, they have to fully sedate her (with an IM injection) because even gabapentin is not enough to handle her. Do you think the stress of that is worth it for the diagnostics? I will obviously take her if that's what's best, it's just so hard to know how much damage the stress of that will do in these situations.
 
Kelly and Vesper said:
Thank you so much for your help. Every time we bring Vesper to the vet, they have to fully sedate her (with an IM injection) because even gabapentin is not enough to handle her. Do you think the stress of that is worth it for the diagnostics? I will obviously take her if that's what's best, it's just so hard to know how much damage the stress of that will do in these situations.
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Two more questions: (1) she was not thirsty when this happened a few days ago. Is the dramatically increased thirst indicative of anything? She has been noticeably thirsty today, more so than I've seen in a year from her; (2) I have gabapentin, mirtazapine, and ondansatron on hand from her DKA episodes last Jan. Should I try those?
 
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I would try the ondansetron. You can give that 3 times a day as well as the daily cerenia.
The increased thirst is a concern but I’m not sure why it is happening. It could be that she is dehydrated from possible pancreatitis. And of course DKA has increased thirst but so far the ketones are OK. Keep a close eye on them.

Is she peeing more frequently? Could she have a UTI?
Her BG is up the last couple of days so I think something is going on.
Do you have sub Q fluids to give at home?
Maybe ring the vet in the morning and ask him about bringing her in. I understand the concern about having to sedate her but the risk of it being something which could develop into something more serious may outway that concern. I’m sorry I can’t give you a more definite answer than that.
Keep us up to date. And I hope she improves for you.
 
Bron and Sheba (GA) said:
I would try the ondansetron. You can give that 3 times a day as well as the daily cerenia.
The increased thirst is a concern but I’m not sure why it is happening. It could be that she is dehydrated from possible pancreatitis. And of course DKA has increased thirst but so far the ketones are OK. Keep a close eye on them.

Is she peeing more frequently? Could she have a UTI?
Her BG is up the last couple of days so I think something is going on.
Do you have sub Q fluids to give at home?
Maybe ring the vet in the morning and ask him about bringing her in. I understand the concern about having to sedate her but the risk of it being something which could develop into something more serious may outway that concern. I’m sorry I can’t give you a more definite answer than that.
Keep us up to date. And I hope she improves for you.
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Very helpful, thank you. Will do, and I'll keep you posted.
 
Bron and Sheba (GA) said:
I would try the ondansetron. You can give that 3 times a day as well as the daily cerenia.
The increased thirst is a concern but I’m not sure why it is happening. It could be that she is dehydrated from possible pancreatitis. And of course DKA has increased thirst but so far the ketones are OK. Keep a close eye on them.

Is she peeing more frequently? Could she have a UTI?
Her BG is up the last couple of days so I think something is going on.
Do you have sub Q fluids to give at home?
Maybe ring the vet in the morning and ask him about bringing her in. I understand the concern about having to sedate her but the risk of it being something which could develop into something more serious may outway that concern. I’m sorry I can’t give you a more definite answer than that.
Keep us up to date. And I hope she improves for you.
Click to expand...
Update at +3. Her glucose has risen to 341. She is averse to even more foods. I tried testing ketones, but got 3 dramatically different numbers. The first was 0.8, the second was 0.5, and the third was 0.2. The first two were stickier blood, so I did a new poke on the other ear for the 3rd reading. She's VERY angry and hiding, so I'm going to try again at +6. She ate a churu (and I slipped an ondansetron in there) but won't eat anything else.
 
Bron and Sheba (GA) said:
Maybe she will eat when the ondansetron kicks in.
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I was so tired at +6 that I forgot to update. Both her BG and ketones improved. BG was 290 and ketones were 0.1. She also ate some food, so I think the ondansetron helped. Her AMPS numbers were: BG = 255; ketones = 0.2. She's still extremely aggressive and distrustful of me. She's attacking me during blood checks and growling/swatting when I try to give her any food. It was difficult, but I was able to get another ondansetron in this morning, so hopefully she'll eat enough to keep the ketones at bay. I have a call in to the vet to ask about restarting the budesonide etc.
 
Kelly, FWIW, Jude's Ondansetron is what the vet calls "quick melt," and I am able to melt it (1/2 tab) in a few drops of warm water (enough liquid to induce a swallow or he'll spit it out), pull it up into a small syringe, and insert into the corner of Jude's mouth. I can't pill him, so this alternative works for us. I mention this because I'm not sure if the pilling is a struggle for Vesper, and if it is, the syringing might be less of a struggle 🤷‍♀️ I will tell you, though, it tastes nasty to Jude, so we have some frothing going on, but it's such a small amount in the syringe (but, again, enough to cause him to swallow), that the weeping and wailing is over rather quickly. Here is what our quick melt pill looks like.

IMG_7751.jpeg
 
Bron and Sheba (GA) said:
How are things going?
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I think we're on the other side!! Things got worse yesterday--she stopped eating all food except churus, and I had to pill her to get the antinauseas in. Weirdly enough, her behavior seemed the most normal yesterday though. She wasn't hiding, and she was walking around like normal (just refusing food). I added an appetite stimulant, and she started nibbling on food around midnight. We skipped night checks to let her eat and rest. This morning, she woke me up begging for food. She is now back to eating all her normal foods, and her AMPS was 207 and ketones were 0.1.

I contacted her regular vet yesterday, but they want us to consult with the internal medicine specialist who treated Vesper for DKA last year. That vet was not working yesterday, so hopefully I can get in touch with her today about a plan. I am worried about this repeatedly happening, so I definitely want to talk about restarting the budesonide and/or getting additional diagnostics now that she's more stable.
 
Mary & Jude said:
Kelly, FWIW, Jude's Ondansetron is what the vet calls "quick melt," and I am able to melt it (1/2 tab) in a few drops of warm water (enough liquid to induce a swallow or he'll spit it out), pull it up into a small syringe, and insert into the corner of Jude's mouth. I can't pill him, so this alternative works for us. I mention this because I'm not sure if the pilling is a struggle for Vesper, and if it is, the syringing might be less of a struggle 🤷‍♀️ I will tell you, though, it tastes nasty to Jude, so we have some frothing going on, but it's such a small amount in the syringe (but, again, enough to cause him to swallow), that the weeping and wailing is over rather quickly. Here is what our quick melt pill looks like.

View attachment 76555
Click to expand...
Oh interesting! That might actually be the kind we have. Vesper is not easy to pill (I have scratches ALL over my arms right now), so good to know that this is an option. Thank you!
 
I’m so glad Vesper has improved. Well done!!
I would ask the internal med specialist about having sub Q fluids, anti nausea meds and pain meds at home so you can start them if needed instead of having to sedate to go to the vet.
 
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