Vet Visit for Linus and not sure about the outcome.

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Susan Jacobson

Susan Jacobson

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I had Linus into the vet today, he has had diabetes for 4 years, we switched to pro zinc in July after using Novolin for all the past years. For the last 2 days he has acted very odd. He started walking around the house yesterday and would never lay down to rest, he sat a couple times but only briefly and staring into space. I have yet to see him lay down and close his eyes to rest at all. We have been trying to get his insulin regulated since July but his numbers are up and down, some days the pro zinc works great, others not so much. Today Linus is still hanging his head over his food and water, he had a BS reading of 328 at 8 am so we gave him 1U of Prozinc, 4 hours out we are at a BS reading of 163, so his numbers are good. The vet had to manually extract a urine sample which is odd, his bladder was extremely full, this may be due to use doing some remodeling lately and moved the litter boxes upstairs, wondering if the extra walk was not good for him. We have now brought one back down to the main floor for him. He seems like he is gazing all the time, not very alert, walks like he is weak. The urinalysis showed a high level of keytones, some high protein but no crystals, no high white blood count so no infection, but I wonder about this last part as I gave him amoxicillin yesterday because I thought he was acting like he had a touch of something, but 4 hours after the amoxicillin he seemed to get much worse. I know this post is all over the place, I am sorry about that, some advice would be great! Thank you.
 
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If there is a high levels of ketones he needs to be at an ER and treated for it. DKA can be deadly!!
 
All she told me is to up his insulin, and she gave him a shot of vitamin B, he is starting to eat now and drinking a little water.
 
If the ketones have caused the body to go into DKA (diabetic ketoacidosis) he needs to be on an IV getting the elecrolytes back in balance. They may need to give a rapid insulin to keep the glucose levels down quickly and then a glucose drip if they fall too low. This would have to be done at a place that know hows to treat ketones and DKA and he would have to be closely monitored
 
At the very least your kitty should have had a blood draw which also tests for ketones in the blood.

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

Treatment
If the cat is bright, alert, and well-hydrated, the cat will not require intensive care. Your cat will require insulin, food, constant access to water, and close monitoring for signs of illness such as vomiting, anorexia, and lethargy.

Treatment of cats who show signs illness require inpatient intensive care. The goal of treatment is to correct dehydration, electrolyte depletion, to reverse the high ketones in the blood and the metabolic acidosis that is present, and to increase the rate of glucose use by insulin-dependent tissues.

Veterinary care for DKA involves intravenous (IV) fluids, usually supplemented with potassium, monitoring by observation and urine and blood tests, and sometimes feeding by a tube. Treatment may involve a hospital stay of five days or more and often costs about US$2000. Without treatment, "sick" animals with DKA will die.
 
I have put a caay. he did say by the amount of urine he had in him that if he was dehydrated, it was not much dehydration. I am wondering though, we have a bill at the vet office but we keep paying on it, I hope this is not the reason for her sending us home today. She said no need for blood as the urine told her what she needed to know. hmmm.
 
Susan Jacobson said:
I have put a caay. he did say by the amount of urine he had in him that if he was dehydrated, it was not much dehydration. I am wondering though, we have a bill at the vet office but we keep paying on it, I hope this is not the reason for her sending us home today. She said no need for blood as the urine told her what she needed to know. hmmm.
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He should have had bloodwork to see if the electrolytes were out of balance which happens in DKA and also to see what the blood levels of ketones were. The level of ketones in the blood is more important than the urine..it tells how serious it is getting
 
Your kitty needs to be seen by a vet who knows about the risk of DKA, ketones are an emergency so if your vet says otherwise you need a different vet, do you have a ER vet near you?
 
Also dehydration is not measured by how much urine is put out...it doesn't work that way...the more urine that is ouput the more chances of dehydration. You can do a scruff test...pull up the loose skin on the back of the neck and release it. If it snaps back in place right away then there is not much dehydration. If it takes more than a few seconds to flatten out then there is dehydration. Also check the gums,...if they feel tacky at all then your kitty is dehydrated
 
I just spoke with the vet she said his keytones were not that high, and he did not display signs of DKA, she says this is mild and thinks he willl continue to improve as he eats and drinks water, he has his insulin and his blood sugar is closely monitored. He has now drank a great deal of water, no vomiting, he has also eaten half a can of cat food , you can tell he does not feel well, but she said he should continue to improve. She would have done a blood panel if he displayed more signs. I will conitnue to push the food and water and monitor his BS.
 
Susan Jacobson said:
I just spoke with the vet she said his keytones were not that high, and he did not display signs of DKA, she says this is mild and thinks he willl continue to improve as he eats and drinks water, he has his insulin and his blood sugar is closely monitored. He has now drank a great deal of water, no vomiting, he has also eaten half a can of cat food , you can tell he does not feel well, but she said he should continue to improve. She would have done a blood panel if he displayed more signs. I will conitnue to push the food and water and monitor his BS.
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Anything over a trace on a ketone test strip means a person should take their kitty to the vet.

What did he means when he said not that high?? If they showed in the urine then a blood test is the next right step to see what level the ketones are in the blood and how the electrolytes are. Once ketones start showing in the urine they are already higher in the blood/
 
She said the keytones were not that high, I asked her if that was in his blood as well because it has to hit th blood stream before it goes to the urine, she said there probably is but he is not sick enough for this to be DKA, she thinks we caught it before it got too bad. The blood will clean itself of keytones as long as we keep his BS at good numbers. She is an excellent vet, look up Dr. Shirley Kittleson in Sherburn MN
 
excel-urins-vs-blood-ketones-1024x642.png
 
At the very least you should get some urine test strips and monitor the ketones in the urine carefully

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The chart above will tell you what you should do about the results of urine testing
 
She also said his PH is normal and his kidneys were functioning very well. I have these test strips you posted, when he urinates I will check again.
 
He finally urinated and I checked it as best I could as he tries to bury it, how in the world do you collect a sample when they use a litter box? The other vet called me back, she said Dr. Kittleson's logic made sense in that Linis would have been super stressed if she tried to hook him up with a catheter and IV, she did say if we don't see any improvement we need to call her back in the morning. He has been eating a great deal of wet food tonight, and has been resting a bit instead of walking around constantly like he did last night. He still sits by the water fountain a lot, he hangs his head in front of it but for some reason he won't try to lap it up with his tongue so I give him a few syringes full. He was down to 6 lbs 1 oz today which is not good, but hopefully bumping up the pro zinc and getting his numbers down better will get him on the right road. One vet says just to keep him below 300 BS, the other says to try for a 150 BS. Conflicting information is confusing.
 
I think I need a spread sheet, someone offered to help me with that in another thread, if I supply the information can someone walk me through it or use your creative genius to do this? I have done some curves, but they are not the same thing.
 
When checking the urine if you could either keep an eye on him and catch him when he uses the litter and just stick the strip under the urine flow. You have to read the results in 15 seconds for ketones and 30 seconds for glucose if using the Ketodiastix or whatever times are in the instructions if using another brand so have something to monitor the time ready at hand. A small long handles spoon can also be used..you only need a small amount to test.

If ketones are showing up see the chart that I posted earlier. If it says small to moderate readings would need you to take him to ER. Once DKA sets in it can get critical very quickly. Having your kitty stressed out for being hooked up to an IV is a better alternative than letting ketones build up and having a full blown DKA episode.

I will tag @Marje and Gracie to help you set up your spreadsheet.

Sending prayers for you and your kitty

:bighug: :bighug:
 
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Fresh stream is by far the best way !!! JUST IN CASE THO', check this before his next pee: Put a bit of your litter in bowl/hand, wet with water and dip strip, reading at 15 seconds. If zero, your litter won't react. If you miss fresh urine stream next time, as quickly as possible dip the stick in the still very wet litter ball removing after a couple of seconds that should wet the pad. Check at 15 seconds. If medium or higher are present, they'll show....tested this personally with 4 litters and a ketonic cat.

HUGS and PRAYERS!
 
I have been giving him syringes of water but he gets irritated quickly. I can't figure out why he wont use his tongue to lap water up. He sits by the fountain and lets it run over his front of his head and all over his nose. He is trying to drink from our dogs water bowl but paws at it and just hangs his head nose first in it. I know he cant possibly get enough water from the wet food alone but afraid to give too much with syringe as well.
 
Getting adequate fluids is necessary to help flush the ketones out. If Linus is not drinking much then syringing extra is the next best choice. Even if it annoys him it is to try to keep him healthy. Sometimes we have to do what is best even if they don't like it. Often a kitty will hang their head over the food or water dish when they are not feeling well. Please keep trying to get a urine ketone test done. :bighug:
 
I have been adding a spoon of water at every feeding and getting a half teaspoon with the syringe as well. The vet did give him a vitamin B12 injection which has helped with his eat a great deal. His BS was 263 tonight so we gave him .4 of a unit for his ProZinc. He still seems weak, but is resting more often.
 
Sorry for the susiecat name, I tried signing in with my phone and for some reason it would not let me with my name Susan Jacobson, I think I have it fixed now.
 
@Susan Jacobson

If you can send me a private message, I’ll be glad to do the Spreadsheet for you tomorrow. To send me a PM, please click on “Marje and Gracie” to the left and then click on “Start a Conversation”. There’s a little info I need to get from you and then I can do it really fast.

Thank you.
 
How is he today? Any improvement? I'd be sure to get a ketone test as soon as possible to see where you are.

Sending healing vines!
 
Squeaky and KT (GA) said:
Fresh stream is by far the best way !!! JUST IN CASE THO', check this before his next pee: Put a bit of your litter in bowl/hand, wet with water and dip strip, reading at 15 seconds. If zero, your litter won't react. If you miss fresh urine stream next time, as quickly as possible dip the stick in the still very wet litter ball removing after a couple of seconds that should wet the pad. Check at 15 seconds. If medium or higher are present, they'll show....tested this personally with 4 litters and a ketonic cat.

HUGS and PRAYERS!
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Excellent hint!
 
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I use a long handled spoon under Teasel's backside as he pees to get a small amount of urine to test. He tolerates it well. Something you could try?
 
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I squat down and when they are ready to pee I put a dixie plate underneath and don't touch them so they don't stop peeing:rolleyes:

The lost art of catching pee:smuggrin:
 
I have a small, low kitchen storage container...it hold 4 ounces when full. Not only can I catch a fresh urine for testing I can also get an estimate of how much "output" my kitties are doing.
 
I have my 'pee catcher' sitting by the litterbox ready to go. When Colin gets in the box and starts I stick it under him. I had to do this when he was young to make sure he was actually peeing since he was prone to blockages. That training has been useful!
 
Sharon14 said:
I have my 'pee catcher' sitting by the litterbox ready to go. When Colin gets in the box and starts I stick it under him. I had to do this when he was young to make sure he was actually peeing since he was prone to blockages. That training has been useful!
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I have 2 of my 4 ounce "catchers" on a ledge right by the kitty boxes. If both kitties decide to both go at the same time I can get a 2 for 1 :D
 
I also have a long-handled spoon and strips by Hermione's favorite litter box. I have 5 cats, so there are several litterboxes but everyone has their favorite potty.

I hope Linus is feeling better!
 
I called the vet this morning because Linus was so off balance he fell over a couple times, she saw him right away. She gave him a large amount 60 cc of fluid under the skin and another B12 shot. She again expressed some urine which had some blood in it so she instructed me to give him Amoxicillin for 10 days in case it is a bladder infection, but she thought it was more likely from having hos bladder expressed which happens sometimes. The ketones in his urine are GONE :) She sent me home with a bag and syringe with needles to give him another 60 cc at 2 am ( 12 hour intervals until he drinks water on his own). After she injected him with the fluids he rubbed his head on my hand like he use to do before being so ill. He has gained 5 ounces in the last day, he has been licking little amounts of water and has had his amoxicillin today. He has eaten like he use to, I am sure it is due to all the prayers that he is doing better, he is still weak and a little bobbly, but I think he will continue to improve. His blood sugar has been staying in the upper 100's to lower 200's which the vet says are good numbers. Thank you all from my whole heart for the prayers and well wishes, the kindness and love at this forum is beautiful. :) I will update again tomorrow as well.
 
So glad to see that the ketones are gone. What a relief!!! Hopefully the fluids and B12 will help Linus get back to his normal self. It would be a good idea to test for ketones when you are able to get a sample, just to make sure the ketones don't come back.

Sending more prayers and healing energy for Linus and :bighug: :bighug: for you.
 
Linus has been resting more today, I'm sure this has tuckered him out, so nice to see him sleeping well. I had a hard time trying to get that huge needle in him for the fluids, but was able to get a different needle from another vet and that worked well, he has been drinking great from the fountain, I have watched him 4 times today, plus adding more water to his wet food. Linus is gaining his weight back fast, weight on Wednesday was 6.1 lbs, Thursday was 6.6 lbs, and now today 7 lbs, although I think some is water from fluids, he is eating like crazy, it's great! No ketones in the urine last night, will repeat as often as I can. I'm going to ask the vet about a vile of the vitamin B12 as she said he could have it everyday. I am hoping Linus will keep improving, thank you all for the wonderful prayers and excellent advice. :)
 
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