Whitey has gone into severe ketoacidosis

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ryanms3030

ryanms3030

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It has been a while since I have posted. Life has been busy, we have a new baby at home, many good things but unfortunately our diabetic Whitey is not doing well right now. He is about 15 years old and we have been treating his diabetes for nearly 5 years with thanks to all of the incredible knowledge here. And seriously, the people here have been so much more valuable than any vet when it comes to expertise in this realm. He has been on Lantus since he was diagnosed and it's been a battle. He will be on 1 unit doses and ok and start to get higher readings and go up to 1.5 and then all of the sudden he would start dropping into the 40s +4,+5+6. Then we'd go back down and he'd start getting back to 400 and 500s at some points during the day. But I have done my best with diet and monitoring daily and trying to adjust doses here and there. As recently a 12 days ago he was dropping into the 100s and lower. But for the past 10 days he's been in the 300-500's pre shot and with the baby, work and everything else I haven't been able to get as many spot checks as I should.

Last night he tried to jump up on the couch about 2 feet off the ground and didn't make it and bounced off onto the ground. This morning he vomited and wasn't eating. Tonight when we got home he was hiding in a cat house that he never goes in and when we got him out he could barely use his back legs or stand up. My wife is at the vet with him now and they said he is in severe ketoacidosis. Two days ago he seemed fine and active and suddenly we are here. The vet said he is critical but hopefully not too late. I just wanted to share mainly to get it off my chest to some people who understand
 
Thank you. It will be $3000-5000 to try to save him. We certainly don't have that money to burn with the baby now but we aren't going to let him go. Thanks for the thoughts
 
ryanms3030 said:
Thank you. It will be $3000-5000 to try to save him. We certainly don't have that money to burn with the baby now but we aren't going to let him go. Thanks for the thoughts
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I feel for you. My own little is in a bit of a crisis right now (Saoirse). I'm glad that Whitey has such loving beans. One of the greatest lessons I've learned from my little ones is how unique and precious each living being is. I know exactly what you mean about the money. I've starved in order to get my girl help in the past. Wouldn't occur to me to do anything else if the situation called for it.

Congratulations on your new baby, BTW. I wish your baby a long, happy, healthy and fortunate life.

We're all here rooting for you. Be sure to post updates of how you're all getting on.
:bighug:


Mogs
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Sending lots of vines for your sweet Riley and prayers for a quick recovery!!

Does your vet take Care Credit? It would let you pay it off over 6 months or more (depending on the deal they give you ...if you pay it off in time, it's 0% interest....higher if you don't)
 
The hospital wanted to keep him for 3-4 days which would be $6000. We really can't afford so we are opting for plan B right now which is overnight stay with fluids, short acting insulin, monitoring for about $1800 and then pick him up and take him to his regular vet in the morning because it will be less expensive. They are saying his kidney is shrunk and he has a heart murmur and they are pushing for euthanasia if we can't pay for the full hospital visit. And of course they can't guarantee he will make it even if we pay $6000 for the full treatment. He's in grave condition We have been through so much with him. This is a difficult and painful night

The vets at the hospital don't seem to be able to fully explain treatment options and possible outcomes which makes it so hard.
 
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I think intensive care is the best solution but if that is absolutely not an option, they may be able to keep him for a day, use short acting, and subQ fluids to get him a little more stable. If you have the time to invest it's possible to do the intensive care at home. Have them check labs before he leaves for electrolytes. Have them teach you how to do subQ fluids and send you home with some. Get the high-cal recovery food like Iams max cal, or similar recovery food.

Home care consists of:
SubQ fluids per vet recommendation
Syringe feeding every 1-2 hours, at least 1-5.5oz can/day
Oral fluids once able to tolerate (can use plain pedialyte)
Supplementation of potassium and other electrolytes based on labs.
Nausea control - anti-nausea medication
4-5+ times a day glucose checks.
adjusting insulin to BS levels (goal is 150-200 - higher than normal for a "buffer")
1-2X per day ketone checks.

It sounds like you have what is called a brittle diabetic. That is a diabetic that actually needs more insulin for the metabolism, but when you give the increased dose, the BS tanks. This usually happens when there is an element of malnutrition. When feeding a very low carb diet, it's possible that due to their metabolism that they are malnourished. Other diseases can contribute as well (IBS, etc). One approach is to increase the carbs so you can balance out the swings. While your cat is in DKA let her eat ANYTHING even if it is high carb. You need to be able to give the insulin. Even if you gotta mix honey in the food in order to raise her BS so you can give insulin, you do it.

I wouldn't worry about the kidneys/heart just yet. DKA can cause acute kidney injury from the dehydration, which can resolve once dehydration is improved. Both things she mentioned are symptoms of this.
 
Praying for Whitey to make it through.

My J.D. was a DKA survivor. It was expensive, but I thought not nearly as expensive as compared to a human having to be hospitalized which made me feel better. He lived 9 more years after his episode, and passed away at 20.
 
@Meya14 Thanks so much for all the advice! We are picking him up in about an hour. We paid about $1800 for overnight stay last night to do fluids etc. We plan on taking him to his regular vet. Even the emergency vet said it would be cheaper if the regular vet can do the treatment. But knowing there is home treatment possibility is great. As luck may have it I just started a planned 2 week vacaction/staycation so I will be home for the next two weeks so we have time to do this kind of care at home

Thanks everyone else for thoughts, prayers, kind works and hope
 
I can't add anything to the care aspect of this situation, just wanted to let you know that I'm hoping Whitey will be ok. I can relate as I'm dealing with the possible loss (trying to give her more time to see what the new meds do but can't stand to watch her suffer) of one of my civies, Mouse, to chronic respiratory infection, laryngeal polyps and possible squamous cell cancer. :nailbiting: The cost is staggering and I just retired a month ago due to health problems. I guess we'll both due what we can and what we think is right for our babies. Best wishes for you and Whitey. :bighug:
 
Checking in to see how Whitey and all of you are doing, and to send more prayers and healing thoughts. What serendipity that you'll be able to home nurse if you need to. :bighug:

Be sure to let us know later how your little fella is doing.

Mogs
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Thanks everyone. Whitey is now at vet and staying all day. As of this morning he seemed to be much more alert and bs was 150 when he left hospital. He still isn't eating. We found another hospital that is much more affordable so he may go there tonight for another night of IC
 
I'm glad you found a hospital that is less expensive. :bighug:
This was back in 2006, but J.D. was hospitalized for 8 1/2 days at the University of Pennsylvania School of Veterinary Medicine and he was admitted in critical condition. He very slowly improved every day. His electrolytes were all off, and he had some anemia and had to have a couple transfusions. The total bill was about $4800, and that was with round the clock monitoring and the best of care.

More vines being sent for Whitey. It's good he's more alert today.
 
Very glad to hear that Whitey's improving. Also that you've found another option for IC.

ryanms3030 said:
He still isn't eating.
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What are they doing for that? (If you search Meya's post history you might find some useful info there.)

Sending more prayers and :bighug::bighug:.


Mogs
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Critter Mom said:
Very glad to hear that Whitey's improving. Also that you've found another option for IC.


What are they doing for that? (If you search Meya's post history you might find some useful info there.)

Sending more prayers and :bighug::bighug:.


Mogs
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The vet was trying to syringe feed him but said he still won't eat. We're on our way to pick him up from the vet and discuss next steps.
 
I don't know enough about DKA to say whether or not it's possible to give appetite stimulant and anti-nausea meds. Ask the vet about whether it's possible to give any of these commonly-used meds:

Cerenia for nausea (injectable - may get into system faster than ondansetron
Generic ondansetron for nausea (NB: Zofran, the branded version, is insanely expensive - more than 10x the price of a generic in the UK. Ondansetron is a human med and an Rx can be filled at a regular pharmacy)
Cyproheptadine for appetite stimulation

Anti-nausea meds need to be given a little bit before the appy stimulant.

If you're planning to home nurse, it might be worth enquiring whether a feeding tube is an option for a kitty with DKA, and if yes then get very comprehensive information on the risks involved (e.g. anaesthesia, infection). (NB: I have no idea if this is possible or even sensible. I'm just brainstorming on this one.)

Also see:

Persuading Your Cat to Eat

Nausea Symptoms and Treatments



Mogs
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We just dropped him off at hospital number 2 for tonight. The vet there is suggesting that we might want to switch off Lantus and go to the faster acting insulin. Because his levels are hard to control on Lantus. Does anybody have an opinion on that? Obviously he's been on the fast acting for past two days in hospital and they have him constantly around 150 right now
 
ryanms3030 said:
The vet there is suggesting that we might want to switch off Lantus and go to the faster acting insulin. Because his levels are hard to control on Lantus. Does anybody have an opinion on that? Obviously he's been on the fast acting for past two days in hospital and they have him constantly around 150 right now
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Might be worth also asking the question on the L&L board. A lot of Lantus users don't post on Feline Health and you might get additional input.

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Sending prayers and healing vines for Whitey! So glad you found a less expensive alternative for treating him. Please keep us posted on his progress! :bighug: :bighug: :bighug:
 
ryanms3030 said:
The vet there is suggesting that we might want to switch off Lantus and go to the faster acting insulin.
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Because Lantus has a hard time pulling down higher numbers many of us with cats prone to developing ketones have experience using Humulin R or Novolin R (same insulin, but different brands of "Regular" insulin, fast-acting) as a bolus insulin (in addition to Lantus).

Novolin R can be purchased at any Walmart without a prescription for around $25 a vial. Last time I checked, Humulin R was $95 a vial at my local pharmacy. If you go this route, PLEASE post in the Lantus & Levemir Insulin Support Group for help and guidance. Don't try it on your own! Using a bolus insulin such as R is a great tool to have in cases like this, but can be downright dangerous if not used properly. A tiny amount packs a big punch!




Some links you might find helpful:

Ketones, Diabetic Ketoacidosis (DKA), and Blood Ketone Meters

Syringe/Assisted Feeding (Video and Tips)

How to Give Subcutaneous Fluids (Video) --- Be sure to check out the info on BBraun DEHP free bags at the bottom of the post. An FDMB member explains how to cut the price of a case of bags to $31.80 ($2.65 a bag)!



If you need help, don't hesitate to ask.
Good luck!
:bighug::bighug::bighug:


 
Jill & Alex (GA) said:
Because Lantus has a hard time pulling down higher numbers many of us with cats prone to developing ketones have experience using Humulin R or Novolin R (same insulin, but different brands of "Regular" insulin, fast-acting) as a bolus insulin (in addition to Lantus).

Novolin R can be purchased at any Walmart without a prescription for around $25 a vial. Last time I checked, Humulin R was $95 a vial at my local pharmacy. If you go this route, PLEASE post in the Lantus & Levemir Insulin Support Group for help and guidance. Don't try it on your own! Using a bolus insulin such as R is a great tool to have in cases like this, but can be downright dangerous if not used properly. A tiny amount packs a big punch!




Some links you might find helpful:

Ketones, Diabetic Ketoacidosis (DKA), and Blood Ketone Meters

Syringe/Assisted Feeding (Video and Tips)

How to Give Subcutaneous Fluids (Video) --- Be sure to check out the info on BBraun DEHP free bags at the bottom of the post. An FDMB member explains how to cut the price of a case of bags to $31.80 ($2.65 a bag)!



If you need help, don't hesitate to ask.
Good luck!
:bighug::bighug::bighug:

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Thank you and thanks for links. The vet actually recommend NPH which I guess is Humulin but maybe not same as Humulin R? I think we will stay with Lantus for now and try to monitor more. The hospital is going to switch him back to Lantus tonight. I have always been doing pre shot check and injection before feedings per info I had gotten here. But the vet at the current hospital is telling us even with Lantus to feed him first, wait a while and make sure he doesn't vomit then check his blood and then give Lantus. He also said not to shoot if he's below 150. That seems to be in line with some info here although I usually was using 100 and have gotten to the point where I would shoot if he's around 80 if I had enough data for the day to believe he was on the way up. If I shoot below 100 I always check every hour for 3 hours at least. But I hate to have to skip a shot because that always seems to guarantee a major yo yo effect for a couple of days.

Thanks everyone. He is in good hands and we plan on taking him home tomorrow night
 
Humulin is Eli Lilly's trade name for a family of Recombinant DNA origin insulins. They include N (sometimes called NPH), and R (very fast actions) and mixture of the two.
Novolin is Novo Nordisk's trade name for a family of Recombinant DNA origin insulins. They include N (sometimes called NPH), and R (very fast actions) and mixture of the two.
Novo Nordisk's Novolin insulin is typically less expensive that Eli Lilly's Humilin
Walmart also the same insulin under there house brand of Relion and it less expensive than Humulin and Novolin

I have used R for special situations but more frequently use N/NPH. Since your vet recommended NPH I would go with that and get the N/NPH fro Walmart.
 
So sorry to hear about Whitey's DKA.
Sending prayers that he will very soon be well again.

Huge (((HUGS))) to you and your family, and gentle head scritches to Whitey. :bighug::bighug::bighug:

Eliz
 
Because your cat is not eating, its artificially lowering his BS. In DKA, even if the blood sugar is lower, the body still needs the insulin (and food) to convert the metabolism away from producing ketones. So the best approach is to use higher carb foods to "steer" the blood sugar above 200s in order to be able to give the doses. You may need higher doeses as she starts to eat on her own when you are using higher carb food. That is ok. -**Do whatever it takes so you don't have to skip insulin**-, even if this means feeding her straight honey every hour or mixing it in her food to syringe. Target BS at this point is >150 but less than renal thresh hold (about 200-250?) so you have some wiggle room.
 
ryanms3030 said:
I think we will stay with Lantus for now and try to monitor more. The hospital is going to switch him back to Lantus tonight.
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See how it goes. You can incorporate the use of Novolin R at any time if Lantus alone isn't doing the job.

Your vet's recommendation to go with NPH is also a good one given the circumstances. N/NPH can be doses more frequently than Lantus. Again, you'll have to see how things go.

Meya14 said:
Because your cat is not eating, its artificially lowering his BS. In DKA, even if the blood sugar is lower, the body still needs the insulin (and food) to convert the metabolism away from producing ketones. So the best approach is to use higher carb foods to "steer" the blood sugar above 200s in order to be able to give the doses. You may need higher doeses as she starts to eat on her own when you are using higher carb food. That is ok. -**Do whatever it takes so you don't have to skip insulin**-, even if this means feeding her straight honey every hour or mixing it in her food to syringe. Target BS at this point is >150 but less than renal thresh hold (about 200-250?) so you have some wiggle room.
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Meya14 offers some excellent advice!

Update when you can. Let us know how we can help.
Good luck!

 
Thanks for all the thoughts and info everyone. We just talked to the vet at the hospital. They started him back on Lantus today and his blood sugar was 450. He has eaten a little bit of baby food but they said he hasn't had enough food to raise his blood sugar that much. Blood work also shows he has pancreitis.
 
ryanms3030 said:
Blood work also shows he has pancreitis.
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Poor Whitey. :(

I don't know how concurrent DKA and pancreatitis should be managed. Perhaps other members can chime in on that.

Solely with regard to pancreatitis, when Saoirse was at her most inappetent she got a Cerenia injection and a B12 injection (cyanocobalamin) plus an appetite stimulant. It helped her to start eating a bit within a few hours (but obviously she didn't have the DKA imbalances in the mix). The B12 really seemed to help her.

For information, here are the IDEXX pancreatitis treatment guidelines. Again, not sure whether any of these treatments can be used when DKA is present. Sorry I can't be of more help.

Are they assist feeding or leaving Riley to eat from a dish? If it's a dish, ask them to raise it a few inches when presenting it to him (can help a lot when a kitty is nauseated). Feeding very small, very frequent micro meals can help a lot for the pancreatitis side of things.

Sending more prayers for Riley. :bighug:


Mogs
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Critter Mom said:
Poor Whitey. :(

I don't know how concurrent DKA and pancreatitis should be managed. Perhaps other members can chime in on that.

Solely with regard to pancreatitis, when Saoirse was at her most inappetent she got a Cerenia injection and a B12 injection (cyanocobalamin) plus an appetite stimulant. It helped her to start eating a bit within a few hours (but obviously she didn't have the DKA imbalances in the mix). The B12 really seemed to help her.

For information, here are the IDEXX pancreatitis treatment guidelines. Again, not sure whether any of these treatments can be used when DKA is present. Sorry I can't be of more help.

Are they assist feeding or leaving Riley to eat from a dish? If it's a dish, ask them to raise it a few inches when presenting it to him (can help a lot when a kitty is nauseated). Feeding very small, very frequent micro meals can help a lot for the pancreatitis side of things.

Sending more prayers for Riley. :bighug:


Mogs
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Thanks. They have been feeding baby food with a syringe. They are trying to leave food for him to eat on his own. They said he's smelling and showing interest but not eating on his own yet
 
That's really encouraging - he's getting some appetite back. If they could leave the food dish propped up on a couple of books or something similar in the cubicle with him it could help him a little if he tries to eat under his own steam. Pancreatitis can make a kitty really nauseated. I hope that they may be able to give him something to help with the nausea. If they manage to keep at least a little food in his tum it will be a help against tummy acid build-up.

Sending more prayers. :bighug:

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When Max had DKA, I used dry kibble and placed it in some warm water so it turned into a mushy soup. He was able to lap it up, and it provided some extra calories/carbs/fluids.

Are you doing subQ fluids at home? The dehydration can weaken them and fluids can help them have more energy to eat.

Do you have an anti nausea?

Did your vet check labs including a potassium level?

For fluids, consider getting plain pedialyte instead of syringing water. This will help replace some of the electrolyes that are lost in DKA. You may have to get potassium tabs from the vet as well if he is low. Low potassium is deadly, and very common in DKA, please ask about it.
 
I'm so sorry to read about your kitty. Wanted to let you know that we are dealing with the exact same thing right now, as of today! Tigger was fine the other day, then wouldn't eat yesterday and threw up. Tried to hide too. Just not him! Took him to the emergency vet this a.m. Where he will stay the night. $1800...so far Could be looking at more, depending. She said he has promise...he wasn't terribly bad, and we may have caught it in time. I'm hoping!! Now I'm dreading the phone ringing.minthought we were doing ok with him..he's been diabetic since last April. His numbers appeared to be coming down, and I wasn't getting that "ketones?" Message on the monitor, so I was stunned when she said it was DKA.
Hope Whitey continues to improve!!
 
Sorry to hear that your kitty is sick too.

The "ketones" indicator on home meters is just a warning for human diabetics to check their ketones, the home meters are not actually testing for ketones. This is a very confusing message that most home meters have. In cats (and humans), ketones and DKA can happen at any blood sugar levels depending on the cause, so it's very important to test urine or buy a meter that does actually test for ketones. This is especially true for cats who've already had an episode.

After DKA resolves, most kitties are no worse for the wear. There are many DKA survivors on this board, including my kitty Max. Getting through that critical period is the hardest part.
 
CarolandTigger said:
I'm so sorry to read about your kitty. Wanted to let you know that we are dealing with the exact same thing right now, as of today! Tigger was fine the other day, then wouldn't eat yesterday and threw up. Tried to hide too. Just not him! Took him to the emergency vet this a.m. Where he will stay the night. $1800...so far Could be looking at more, depending. She said he has promise...he wasn't terribly bad, and we may have caught it in time. I'm hoping!! Now I'm dreading the phone ringing.minthought we were doing ok with him..he's been diabetic since last April. His numbers appeared to be coming down, and I wasn't getting that "ketones?" Message on the monitor, so I was stunned when she said it was DKA.
Hope Whitey continues to improve!!
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Sorry to hear about Tigger too. I'm sending him good vibes too. These things are so difficult
 
Meya14 said:
Do you have an anti nausea?
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I was wondering about whether or not anti-nausea and appy stimulant meds might be contraindicated in cats with DKA, Meya. Is it OK to give anti-nausea and appetite stimulants to cats with DKA? If yes, which ones are suitable? (Trying to learn so I might be able to help a bit more in future.)


Mogs
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Anti-nausea are very helpful in DKA to help the cat start eating again, and that's usually the first sign of recovery once they start eating. The appetite stimulants usually take 1-3 weeks to work (they work on the serotonin/norepinephrine and histamine systems) and therefore they aren't as useful in DKA unless there was an underlying appetite issue that led to the DKA.
 
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Whitey is back home relaxing. They gave us appetite stimulant. They said his potassium levels looked good. They put him on 1 unit of Lantus now. They told us to give the appetite stimulant wait 30 min and test BG and then feed him then give him his shot 15 minutes after he eats. And they told us not to give you shot if he's below 150. His shot timing is about 2 hours later than normal but luckily I'm on vacation for 2 weeks so we can slowly bring it down maybe 15 minutes per day to get back on schedule but we will stay on this schedule for a few days
 

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Happy to hear Whitey is home. Poor little guy, that face says it all.
I'm sure he's feeling better now that he's back home.
Wishing him a quick recovery.
 
Welcome home, Whitey! :bighug:

I'm so glad you posted his picture. :)

@Meya14 - Thank you for telling us about the suitability and usefulness of anti-nausea and appy stimulant meds in cases of DKA. That's a great help, and much appreciated.

@ryanms3030 - If Whitey doesn't start eating straight away at home go back to the vets immediately and insist on an anti-nausea med. Certainly in cases where pancreatitis is in the mix it's the nausea that's the main problem. The appetite stimulation may be necessary for a while but nausea management is the key to successful treatment.

Fingers and paws crossed that Whitey will eat well.


Mogs
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I'e been trying to check Whitey's BG every couple of hours since he's been home. I've got 6 tests and he's been 291-410 and most in the upper 300's That is on 1 unit of Lantus and not much food. We had to force feed him a little last night but this morning he's looking for food. But vet said no feeding in between meals and next meal/shot is 3 hours away. He is alert and walking around, cleaning himself, going over to food bowls etc this morning and he was able to jump onto the couch on his own so these are all good signs to me.

My question is for Lantus should I stick with 1 unit (vet recommended) or maybe bump to 1.5 for his next shot. I will be around all day with him and know how to handle if he drops low. But seems like he is staying around 400 all day with 1 unit and very little food
 
Bump up to 1.5, and PLEASE feed every 1-2 hours a small amount if you are syringing. Allow him to eat as much as he wants if he's eating on his own. If you are able to test and intervene if your cat goes lower, there is NO reason to only feed twice in the day. Feeding only 2x per day prevents the cat from getting enough calories and will definitely make the DKA worse. Also, if you are feeding baby food, it doesn't really have enough calories. Consider asking your vet about a high-calorie food (IAMS max cal, royal canin recovery) or feed an over-the counter food with 200+ cals per can (most wellness brand foods are high cal).
 
Also, is it possible for you to check the ketones at home. Most pharmacies sell the ketone urine strips in the diabetes section. Place a little bowl or something under him when he's using the box and test. This will give you a baseline and tell you if he's improving or getting worse. Its hard to tell from the BS alone if the ketones are getting better or worse.
 
@Meya14 Thanks so much for all of your ongoing advice! The vet gave us a few cans of recovery food. I just gave him some and he ate a few mouthfuls on his own but not much. He is drinking water. I have ketone strips and just tested him and it showed Small/15 range so I'm guessing that is pretty good sign.
I am going to up his next shot to 1.5 units. Do you think some dry food for a couple of days is worth it at this point because I am pretty sure he'll eat all that I give him of that? Or just keep with the canned recovery food and force feed that if needed? One of us will be here with him at all times for the next few days so we will constantly monitor BG and ketones
 
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