Whitey has gone into severe ketoacidosis

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Critter Mom said:
I did not know that. Meya, why do diabetics need more?


Mogs
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Sorry, should have qualified that a little better. -Uncontrolled- or -poorly controlled- diabetics need more calories because they can lose quite a bit of calories through the sugar that ends up in their urine when hyperglycemic. Also, because they don't have enough insulin, cells have a harder time actually using or storing the sugar, and it can hang out in the blood stream and even be converted into triglycerides and stored in places it shouldn't be (liver, arterial walls, etc).

Also, due to the wasting that happens in diabetes, there can be cortisol issues, which affect the liver's ability to release sugar back into the blood when needed. This is where the brittle diabetes comes in. Basically, the body is afraid it is starving, so shuts down the cortisol/adreneline/glucogon release so the body doesn't break down any more fat. This can lead to severe hypoglycemia with even a small amount of insulin.
 
ryanms3030 said:
Generally we split 2 cans of Friskies between the 3 cats twice a day.
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Most of the friskies Pates have about 170-185 calories/5.5oz can. Each cat should have at least 1.5cans a day assuming they are average size. More if they are larger or more active, less if they are obese. So perhaps increasing to 5 cans a day may help? My problem with having multiple cats is that I have a old lady skinny grazer, and a chubby diabetic scarfer. Guess who gets more food.
 
Meya14 said:
Most of the friskies Pates have about 170-185 calories/5.5oz can. Each cat should have at least 1.5cans a day assuming they are average size. More if they are larger or more active, less if they are obese. So perhaps increasing to 5 cans a day may help? My problem with having multiple cats is that I have a old lady skinny grazer, and a chubby diabetic scarfer. Guess who gets more food.
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Whitey is not only our diabetic but he's also an old skinny granpa grazer. The other two cats are around 8 and 10 years old. One weighs about the same as Whitey (7.5 lbs) but she is much more petite so not skinny like Whitey. The other cat is much bigger (not fat just big all around) and she is what I would call a pig. She definitely scarfs. Interesting thing is the biggest cat has no interest in the dry food and only wants wet food but Whitey and the other smaller cat now only want to eat dry food since it's been out. I want to get Whitey back over to wet but when I put some out without any dry he just sniffs it and walks away. At this point I don't want to risk starving him by trying to only give him wet. I was wondering if you (or anyone) has opinions on the Young Again zero carb dry food. Apparently is zero carb or close to it and seems to have no starch or veggies in it. I was thinking of trying some at least as a better dry option I was also thinking about trying raw food but I did try some of that a few years ago and none of the cats had much interest.

Still showing negative ketones today but BG is still all over the place from 100s to 500s. He looks like he's starting to constantly get to 100s or lower nadir and bouncing up high. For whatever reason he seems to hit 500s AMPS much more than at night and PMPS has been in the 300s
 
Whitey's BG is still all over the map. He was in 500's two days ago and started dipping into 100's after his PM shot last night. He was at 110 AMPS and decided to stick with 2 units as he is still free feeding dry food. But +3 he's dipped to 45. I gave him corn syrup and wet food with gravy which he ate. He's cleaning himself now and I'll check in 20 minutes. I guess he's earned a reduction back to 1.5

I am ready to transition back to wet but its clear that it's going to be harder then last time. Per other recommendations I ordered some Fortiflora which I am going to sprinkle on wet food and hope it makes it more enticing to him. I've also read to stop free feeding for now and put out wet food 2-3 times per day and eventually he'll get hungry enough to eat it. But I also know with DKA I can't have him skipping meals.
 
Meya14 said:
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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Hi Meya,

Is the lower limit you mention above 150 on a human meter or a veterinary meter? (I need to get an idea of a target BG range for Saoirse at the moment. She's in hospital with a suspected infection and I'm worried the vets may not give her enough insulin to keep her safe. For info, she's being treated with Lantus since coming out of remission.)


Mogs
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Mogs: 150 is for human meter. When they are sick, you want to use food to increase the #'s so you can get enough insulin to keep the ketones away. You don't want to be having to go into the 50-70 and reducing insulin if you can avoid doing that. Are they testing for ketones while she is in the hospital?

Ryan: As you return to wet food, keep a VERY close eye on the sugars, and only reduce by 0.25U at a time if she goes low (below 50). For the next few weeks, test daily for ketones to make sure her food intake remains sufficient. Once we were able to get to an insulin dose that actually did something for my cat Max, I found that it was actually EASIER to keep Max's sugar flat by feeding wet food at AM/PM shot times, and giving him a handful of kibble treats at about +6. After a few weeks of very flat curves in the green numbers, we stopped the kibble treats, and it was on our way to remission from there. Remember, it's the flat curves in good numbers that really help that pancreas heal, not necessarily the low carbs alone. With the big swings, sometimes it's easier to use the food to feed the big drops and even everything out instead of taking the reduction.
 
Meya14 said:
Mogs: 150 is for human meter. When they are sick, you want to use food to increase the #'s so you can get enough insulin to keep the ketones away. You don't want to be having to go into the 50-70 and reducing insulin if you can avoid doing that. Are they testing for ketones while she is in the hospital?
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Thanks for coming back to me, Meya. Rather than hijack Whitey's thread, I've replied to you in the following post on Saoirse's latest thread:

http://www.felinediabetes.com/FDMB/...updated-monday-gmt-23-30.153064/#post-1611517


Mogs
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@Meya14 Whitey has been back to strictly wet food (topped with fortiflora) for the past 3 meals. And has been reduced back to 1.5 units for the past 5 shots since he dropped into the 40's a couple of days ago. He is still hitting 500s by end of the cycle and even higher as my ReliOn meter has just read HI a couple of times . But 1.5 unit seems to be quickly dropping him from 500s to 200s in a couple of hours and he as 149 PMPS tonight.

My question now is nutrition. He is eating some wet food when I put it down and going back to graze later but I think he's eating about 1/3 of 5.5 oz can of Friskies per meal. He is a only about 7.5 lbs so not a big cat. Does that seem like enough food to keep him out of DKA? I really don't want to give him any dry because I feel like he'll stop eating wet if he knows he can hold out for dry food.. If he needs more is there anything that is more calorie dense than Friskies but still low carb?
 
Assuming friskies have between 150-170cals per 5.5oz can, I'd aim for at least 1.5 cans a day. If he is underweight (you can feel ribs), then 2 cans per day. Are you currently feeding the smaller 3oz cans or the larger 5.5oz cans? If he's only eating 1/3 can per meal for a total of 2/3 of a can a day, this is definitely not enough.

There are some higher calorie foods out there, generally, these are labeled as "kitten food". Some canned food has the calories listed on the can.

The wide swings/sensitivity to insulin also are typical of inadequate calorie intake. If you add more calories, you'll be able to give more insulin overall and even out those numbers. Right now you can't because of those big drops. Consider feeding a dry food "snack" about an hour before the lowest point of his cycle until you even out the numbers. Dry food isn't necessarily bad in your case if you are using it as a tool.
 
It looks like Whitey has cancer and we will probably have to let him go soon. He bounced back from DKA and we have had two good months with him but we noticed a marble sized lump on his throat a few days ago. We took him to the vet today and it's already more than doubled in size. We are forgoing the biopsy as the vet is 99% sure it's cancer and said that with his frail health, diabetes and heart murmur he is not a good candidate for treatment even if we wanted to.

I am starting a new (better job) on Monday, we are in the middle of closing on a condo (our first home ownership) and my mother had a stroke last Sunday and it now appears that she has new cancer after being in remission from breast cancer for the past 13 years. Needless to say we have a lot going on in our life at the moment on top of taking care of our 10 month old daughter.

We have had plenty of time to think about this since his DKA episode and we plan on have final care at home with his family and his cat siblings. I wish I had a happier update to give but I wanted to let everyone know and thank everyone that has helped him over the past 5+ years living with diabetes.
 
Oh, Ryan. :(

I'm very sorry to hear about all that is happening with you right now. Sending prayers for you all and some scritches for Whitey.

:bighug:


Mogs
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Last night Whitey let us know he was ready. It was 8pm on Friday night so I had to take him to the animal emergency hospital so they could help him along to the other side. I held him through the entire process and he went peacefully knowing he was loved until the end.

Thank you to everyone who has helped us manage his diabetes over the past five years. We can at least say he did not die directly from diabetes. He was approximately 15 years old (we adopted him as an adult so not 100% sure). I had him in my life for 10 years, the last 5 with diabetes. He was a huge part of our lives and he will be missed. RIP
 
I am so, so sorry for your loss. My heart breaks for you, I know how painful it is to lose a beloved family member. (((Hugs)))

Fly free, beloved Whitey cat_wings>o
 
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