New Member, New to diabetes, Need advice | Feline Diabetes Management Board

New Member, New to diabetes, Need advice

Chris and Biscuits

Chris and Biscuits

New member
Hi, I'm Chris and our cat is Biscuits (info in signature). A week ago Monday Biscuits started showing signs of being sick, lethargic and wouldn't eat. We took her to the vet Tuesday and after running tests she was taken to the emergency hospital in extreme DKA with a UTI. The first 3 days she showed little to no improvement. Ultrasound didn't show anything. They couldn't get enough potassium in through IV so they put in a nasal feeding tube. On day 4 she made a turnaround, started getting up and moving but her back legs would give out. She started eating a little. They took her off IV day 5 and we brought her home the morning of day 6.

At 8pm day 6 we were told to give her 1u of Lantus if she ate. She would not eat anything so we freaked out. I tested her BG and it was 129, which freaked me out even more because from what I've read that is too low for insulin anyway.

Day 7 she ate 1/4 wet food and would not eat any more. I tested her BG and it was 121, so i freaked out again and did not give her insulin. I tested 3 hours later and it was 135. We took her to the vet 3 hours later and ran a full blood panel - everything looked good...BG was 149. The only thing that looked slightly off was Potassium at 4. The primary vet gave us Lactulose to encourage eating and put on a libre 3 so they could also track her BG.

Day 8. She ate 1/2 last night and maybe 1/2 this morning. Her BG levels have been between 120 and 150 for 24 hours. She did go #1 and #2, but otherwise does not get up or move and her back legs severely struggle to make it 5-10 ft.

Day 9 (today) same as day 8.

So my questions are:

Is it normal for a cat with no previous signs of diabetes go into full on DKA and come out the other side with only slightly elevated BG levels?

What does the recovery typically look like after an event like this? Is it days/weeks/months to recover? How concerned should we be that she isn't fully eating? How concerned should i be about the back legs?
 
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Hi Chris and welcome. Folks will be by with some thoughts and advice soon, I’m sure.

One question I had - do you want me to change your username for you? Maybe something like “Chris and Biscuits”? Just so your full name and email aren’t visible. I’m the admin here.
 
Tim & Pookey said:
Hi Chris and welcome. Folks will be by with some thoughts and advice soon, I’m sure.

One question I had - do you want me to change your username for you? Maybe something like “Chris and Biscuits”? Just so your full name and email aren’t visible. I’m the admin here.
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Yes, please. Thank you!
 
Hello and welcome - looks like you and Biscuits have been through the wringer!

DKA is serious and the recipe for DKA is not enough food + not enough insulin + infection or systemic inflammation. Has Biscuits been on antibiotics for the UTI? If so, for how long and which one? That still leaves the concerns of lack of food and no insulin.

While they get over DKA, you want them to be eating 1.5 times their normal amount of food. So not just two meals a day. How many calories per day is Biscuits eating now? Was Biscuits eating Fancy Feast before diagnosis? DKA kitties are often nauseous. Did the clinic send you home with either ondansetron (best choice) or Cerenia to help with that? Or even Mirataz which is an appetite stimulant?

Are you home testing Biscuits for ketones? You can get urine testing sticks to do that, information here: Tips to catch and test a urine sample and here: Ketones, Ketoacidosis and Diabetic Cats: A Primer on Ketones You can also use a blood glucose meter to test ketones. Anything above trace is a concern and a call to the vet.

The back legs are one of two things. Diabetes can cause neuropathy where they only walk on their hocks, information here: Feline Diabetic Neuropathy The other thing that can happen is potassium being too low, a common issue with DKA. Did the clinic provide potassium supplements? Or suggest supplemental subq fluids with potassium? Not eating enough can cause potassium deficiency, but 4 is low normal, so they might not have suggested supplements.

Sorry for the million questions, but DKA can be life threatening. Every cat's journey through it can be different.
 
@Wendy&Neko thank you for the warm welcome! And thank you so much for your detailed response. We entered into this new world pretty quickly and are learning as we go.

We have been qiving her Zeniquin every 24 hours for the UTI.

My guestimate for calories is 100-150 / day so far. We have ondansetron but we only gave it to her the first day, so it sounds like we need to be more consistent. The vet gave us Mirataz yesterday and we are applying that as directed. Previously she was eating 2x fancy feast petite / day and free-feeding a ton of kibble.

We have not tested Ketones at all since we have been home. We just assumed since she tested negative for ketones before leaving the hospital and the BG has been low it's not necessary.

We do have a potassium supplement RenaKare Gel. It's been challenging to get it in the syringe and get it in her so she has not nearly had the prescribed amount (2ml) every 8 hrs. We asked the vet for another method and she recommended a potassium powder, but she isnt eating well so that seems like a lost cause for now.

The primary vet has told us to not start insulin. BG has remained 120-160 for 3 days.

She walked around a bit more today. Still having major trouble with back legs and eating but otherwise attentive, purring, cleaning herself, etc.
 
One thing that can happen with antibiotics is that they can also kill the good tummy flora, making them feel unwell and not like eating. If you can get a good probiotic (multi strain, not Fortiflora) and give it a couple hours apart from the antibiotic, it might help her feel better.

Ketones can rise very quickly. You might want to pick up something like Ketostix as a kind of insurance and early warning of worse things brewing.

I've had to give potassium supplements and used Thera-K. It is a liquid, not a gel, Unfortunately, as with many meds designed for dogs so bacon flavoured. But at least easier to give than a gel.

The Biscuits report sounds pretty good in that she's doing cat things. Is the vet having you come in again and retest the potassium levels?
 
Welcome to FDMB! It really does sound like you and Biscuits have had a time of it. When my cat was diagnosed, I don't recall seeing any obvious signs of diabetes. At the point that I brought her to the vet, I noticed an acetone smell on her breath. I knew what that implied and she was in full blown DKA. In retrospect, I suspect she may have been off her food but I have 2 cats and the other kitty may have been eating Gabby's food when I wasn't around to see what was going on.

I'm glad Wendy did the heavy lifting of filling you in on some of the basics. We tend to be pretty aggressive about helping caregivers who have a kitty that has had an episode of DKA. I'd likewise encourage you to pick up some Ketostix at a pharmacy so you can monitor ketone levels. Unfortunately, there are some cats who are very prone to redeveloping ketones after an episode. The Ketostix are for measuring ketones in your cat's urine. In other words, you will need to stalk Biscuits to the litter box and either swipe the strip through her urine stream or use a spoon/ladle, etc. to get a sample to test. The alternative is a blood ketone meter. You would test the same way as testing for blood glucose. A pharmacy may stock the meter or they are available online.

It sounds like you're home testing Biscuits' blood glucose. If I'm reading your signature correctly, it looks like you're using both a Libre and an AlphaTrack. If no one mentioned this to you, the Libre tends to give false low readings if numbers are at 100 or below. It's very helpful to test with your AT meter if you are concerned about low numbers to be sure you're getting an accurdate reading from the Libre. Also, our dosing information is based on using a human meter and not a pet-specific meter such as the AT. It's not a matter of accuracy - it's a matter of cost. The strips for the AT cost about $1.00 each. Many members here use the Walmart Relion meter. The strips are among the least expensive available -- around $0.17 each. Over time, it's a big difference in your costs.

It would also be very helpful if you could set up a spreadsheet. The spreadsheet will allow you to track Biscuits' progress and allow us to follow along. The experienced members who can lend a hand with dosing or spot irregularities in Biscuits' numbers are very dependent on the numbers. This post on helping us to help you has information on how to set up your spreadsheet and link it in your signature.
 
We've managed to find a decent method for getting the Potassium gel down. Yesterday we ran the full course of antibiotics as well. Her appetite is picking up a bit - getting down a reasonable amount of calories. We have picked up the Ketostix as recommended.

Yes, she has the libre 3 and we are spot checking with the AT meter. The hospital vet along with the primary vet are stumped by the BG numbers - as they seem to have settled in to a normal range 80-150 for several days. Neither one have seen a kitty go from DKA straight to remission before. So bizarre! We'll definitely get a human meter (cheaper strips) if we need to continue daily monitoring in the future.

Our next vet appointment is Thursday. We'll do bloodwork to check all of the levels and do more inspection on the back legs.

Thank you so much @Wendy&Neko @Sienne & Gabby (GA)! It means the world to have this group.
 
Getting a fructosamine level may help to answer some questions. If you're not familiar with the test, it's similar to a hemoglobin A1c which is used to diagnose diabetes in humans. It gives what amounts to an average of blood glucose over several weeks. If Biscuits wasn't diabetic in the first place or if the level isn't high and your kitty was pre-diabetic, the infection may have elevated the blood glucose level in the vet's office. Stress and an infection may have elevated the blood glucose reading. If you ever have known someone who went on a keto diet, there's the potential for throwing ketones. If that was the case and the UTI put all of the planets into misalignment and Biscuits developed ketoacidosis, maybe that's the explanation. Your cat wasn't/isn't diabetic but was metabolically out of whack. Non-diabetic ketoacidosis can develop as a result of fasting.
 
Chris and Biscuits said:
Our next vet appointment is Thursday. We'll do bloodwork to check all of the levels and do more inspection on the back legs.
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The calcium and phosphorus levels are both on the higher side on the bloodwork you posted. Hopefully they will drop down as Biscuits begins to feel better, but they are worth monitoring. Calcium x phosphorus should be under 60; higher than that there’s a risk of organs mineralizing (especially kidneys).
 
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