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Severe DKA and Severe Financial Constraints – What are the Options?

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Ms. Smith brings in her 14 year old cat Mama Cat. The cat is a diabetic who receives twice daily insulin. Ms. Smith tells you that she hasn’t come back for a glucose curve for the last year because she couldn’t afford it. She thought Mama Cat was doing OK on her dose of insulin. The cat started vomiting a few days ago. Ms. Smith came home from work today to find that Mama Cat can’t get up. She wants to do everything possible for Mama Cat, but wants to do it inexpensively. And she promises to heed your advice on follow-up visits in the future.Mama Cat is hypothermic and obtunded. A blood glucose is >600 and the cat has 1+ ketones in her urine. Ms. Smith has declined referral to the local 24 hour clinic. You are uncomfortable managing such a sick cat. But Ms. Smith really wants you to treat her. You look in the fridge. Your bottle of Regular Insulin expired a month ago – a testament to the fact that it has been a long time since you have treated a DKA. What should you do now?

First of all, don’t worry. If you can get an IV catheter & fluids in Mama Cat, you have made huge progress towards saving her. The first thing Mama Cat needs is fluid resuscitation. You can worry about the insulin later, once she is better hydrated. That gives you plenty of time to send your assistant to the drug store to get some more Humulin R. Once you have that insulin, you can use the IM technique, which requires less monitoring for you & your staff and less expense for the owner. It works just as well as a CRI of insulin. Control her nausea with metoclopramide to get her eating (or put an NE tube in). You will find that her glucose, potassium, and phosphorus will regulate faster and with less need for monitoring.

We frequently receive calls like this at Veterinary Answers. We will talk you through the steps you need to take and send you a written report to use as your guide. We want Mama Cat to pull through just as much as you do. And we will be there for you every step of the way.

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