DKA again :(

My poor Arthur in in the middle of another DKA episode. The new stove runs hot, and his insulin pen went bad, I think (we will be keeping it in the fridge from now on, regardless of manufacturer instructions).

We just do not have any money for another hospitalization. So I am having to do the less-ideal job of treating it at home with vet advice. So far:

1. Ketones in urine - started at "small" and are now up to "large." Not good.

2. Glucose - was in normal range yesterday (mid to low 100s), but jumped to 420 by evening. I gave him insulin then. Reading was 252 this morning, gave more insulin. Then 330 a few hours later, gave another unit of insulin.

3. Eating - refused to eat dinner two nights ago and breakfast yesterday (before vet visit). I syringe-fed a quarter of a high-calorie can into him, and after that (and probably with the help of the cerenia shot at the vet), he ate properly on his own the rest of the day. But today he refused food again, and I'm syringe feeding him again.

4. Fluids - sub-q fluids yesterday and today. We went through half a bag yesterday and a quarter bag so far today.

Yesterday he seemed to be getting a bit better by evening, he was more alert. Yesterday he was also still walking around a lot. Today he is clearly sicker, I am sure from the glucose and ketones. He is curled up on my shoes right now, sleeping.

I don't know what else to do, or what I can do. I wish I had any money at all to even get some more testing and some IV fluids or something, but I have been out of work due to carpal tunnel.

Any advice is appreciated!

Are you on the FelineDiabetes.com message board? If not, join and post there for more help on dealing with DKA and how to treat at home (not recommended to do but members can help) and how to prevent future episodes of DKA. Of course, always double check with your vet to be sure that what FDMB members suggest would be ideal for your cat.

Here are some resources for how to afford vet bills: http://www.thecatsite.com/a/no-money-for-vet-care-how-to-find-help-and-save-your-cats-life

There is also an organization called Diabetic Cats In Need which may be able to offer some assistance: http://fdmb-cin.blogspot.com/

What insulin are you using? Insulin should always be kept in the fridge or cool spot to help it last longer. Diabetic Human typically need to carry their insulin pens around in a pocket or bag but for cats, just keep it in the fridge. How long has the current insulin pen been in use?

I am sorry to hear this. I am still learning about diabetes since Wellington was diagnosed 3 months ago. So far it is going well, but I am very scared of the numbers going haywire again. The vet told me I must always keep the insulin in the fridge. I hope you manage to stabilise him again.

He is getting better it seems. Yesterday was pretty rough - his ketones soared sky high and he was really lethargic, plus he stopped eating on his own all day. But sometime in the evening, he seemed to turn a corner. He started flushing the fluids I was giving him, and each one was a little better on the ketone measurements. His blood sugar was mid to high 200s all yesterday, but this morning (just prior to another does) it was down to 213. He even carried around his favorite pipe cleaner this morning. This morning he also was looking for food, and he's eaten on his own all day. He is far more alert and is walking around maybe 90% like normal.

However, I just tested his glucose and I got a reading of 714. That seems...off. I would think if it was that high he wouldn't be walking around, acting mostly normal. So I don't know if it was a bad reading (not sure why it would be), and I'm going to try again in another hour and check all the settings.

I can't get vet care from the charities, because I have already gotten help from them in the past. I'm starting to wonder why he has so much trouble with his regulation. He has a major DKA episode about every 1-1/2 years. Perhaps there is something that I am missing?

I don't think meters can even read that high. Most only read up to 600. Definitey check the meter and run the test using both control solutions. The instruction booklet that came with the meter has info on how to check that the meter is working correctly with the control solutions. If you don't have the instruction bookklet, you can most likely find a copy online. I don't think control solutions are sold in the pharmacy, though. You'll probably have to buy them online. Are the test strips still good (unexpired)? If the meter uses a code chip, does the number on the code chip match the code number on the bottle of test strips? It's good to have a back up meter and test strips (make sure to check regularily and use the strips up before they expire) on hand just in case you get a strange reading on the meter you most frequently use.

Are you checking the urine frequently for ketones?

Were you able to post on FDMB for additional help on your cat's DKA? I've never had to deal with DKA with my diabetic cat so I can't offer much help other than to you and your cat.

I'm starting to think that Arthur's issue is chronic pancreatitis. A vet during his first diabetes diagnosis said they found diagnostic signs. But he crashes every year or two, and most if the time he needs an increased insulin dose after recovery. All of that would be consistent with pancreatitis flareups.

I'm going to speak to the vet tomorrow and see if I can get him some anti-inflammatories. He's refusing to eat yet again after being fine most of the day. I think he needs a higher insulin dose.

Pancreatitis is fairly common in diabetic cats. Have you ever had the fPL test done to diagnose the pancreatits?

This has general info on treating pancreatitis: http://www.idexx.no/pdf/en_ie/small...pec-fpl-treatment-for-feline-pancreatitis.pdf There used to be a great article on the FDMB on treating / managing pancreattis in diabetic cats. If you do a search on the FDMB board you may be able to find it or threads on how to manage a diabetic cat with CP. I think treatment is mostly supportive such as feeding low fat foods and certain supplements.

He has been diagnosed with pancreatitis in the past during another DKA episode. They had done blood tests and an ultrasound to try and figure out what was causing the second recurrence. Apparently low-fat food isn't indicated anymore in cats, due to their specific nutritional needs. Basically, I'm supposed to make sure he eats, give him lots of fluids, and keep testing his glucose so I can keep it at a normal level. He's already on antibiotics for potential infection. The only thing she might want to add is a short-term corticosteroid.

It would have been nice if his last vet discussed with me the possibility that pancreatitis will flare up again and again, complicating his diabetes. I shouldn't have to figure it out on my own. This vet is much better, but she hasn't had him for very long. If I had known, I would have been aware of the possibility of insulin resistance during and after the episodes, as well as maybe giving him an anti-inflammatory earlier.