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I have a question about a cat that passed away today- I'm…

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Hi I have a...

Hi I have a question about a cat that passed away today- I'm feeling very guilty and would like to know if I contributed to the cat's death- I am a pet sitter and was in charge of giving the cat insulin injections (Lantis) 1 unit 2x/day- the cat has had diabetes for a couple of years and was also riddled with arthritis- he was older- I'd say about 14 or 15- anyways I wasn't able to give him his regular doses of insulin each day- due to poor weather and a crazy schedule, there were several days where he only got one injection of insulin- I did not notice any symptoms and he was eating wel l and acting normal all week... But then just yesterday he vomited and had diarrhea/peed on the floor...I gave him his insulin in the morning and his owner came back that afternoon- she said he still was t feeling well and wouldn't eat or drink...she gave him insulin last night but not this am because he hadn't eaten...she brought him to the emergency clinic and they said he was severely dehydrated and was in DKA- he had survived DKA before but it required 7 days of hospitalization, and because he was so skinny and riddled with arthritis, she opted to not put him through that again and euthanized him...

Veterinarian's Assistant: I'll do all I can to help. The Expert will know if the cat will be able to digest that. What is the cat's name?

I'm wondering if the missed insulin could have caused his DKA? He was also on new medication for arthritis so maybe that could've changed his insulin requirements?? Please I'd like to hear your insight so that if I did contribute to this cat's DKA and death, I will learn and never miss an insulin dose again- thank you! His name is ***** *****

Veterinarian's Assistant: Is there anything else the Veterinarian should be aware of about Mr.?

His blood sugar was very high and he was very dehydrated when presented to the vet today- also the vet said he was a tough case to treat- they had experimented with several different doses of insulin and changed types of insulin too- he survived DKA about a year and a half ago too

Submitted: 6 months ago.Category: Cat Veterinary
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Answered in 3 minutes by:
1/1/2018
Cat Veterinarian: Dr. Gary, Cat Veterinarian replied 6 months ago
Dr. Gary
Dr. Gary, Cat Veterinarian
Category: Cat Veterinary
Satisfied Customers: 20,006
Experience: DVM, Emergency Veterinarian, BS (Physiology)
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Hello, I'm Dr Gary. I've been practicing veterinary medicine since 2007. I look forward to helping with your questions/ concerns.

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Cat Veterinarian: Dr. Gary, Cat Veterinarian replied 6 months ago

I'm sorry for what happened.

One missed insulin dose would not cause him to go into DKA. If there were a handful of missed doses over the course of a week, then that could definitely lead to poor regulation and the development of DKA. The stress of the owners being gone was also likely a contributing factor.

I'm sorry for the loss. These diabetic geriatric cats can be very sensitive to changes in routine.

Let me know if you have any other questions.

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Customer reply replied 6 months ago
Okay so I think I did mess him up by missing doses...ugh I feel so horrible. I didn't realize how sensitive they are to the regulation- also could arthritis medication alter the amount of insulin they need? He was on that new medication for only a week or 2
Cat Veterinarian: Dr. Gary, Cat Veterinarian replied 6 months ago

In the course of a week, I would say any more than 3 missed doses would be considered significant.

It depends on the pain med- if it was a steroid then it can increase the insulin needs. If it was an anti-inflammatory or Gabapentin or Buprenorphine, then it shouldn't change the needs. Also, most cats are on 1 unit of Lantus twice daily no matter what.

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Customer reply replied 6 months ago
Okay- I wish I remembered the name of the arthritis medication- it starts with an L and it's a liquid oral solution- I'm not sure if it was a steroid or not-
Yes unfortunately over the course of 10 days there were probably 4 days where he only got one dose of insulin- I'm guessing that is what contributed to the DKA then- I have to somehow forgive myself about this- the guilt is killing me- the owner is not blaming me because she said he was in such bad shape already she knew he was already on borrowed time- but I am blaming me big time!
Anyways thank you so much for your insight!
Cat Veterinarian: Dr. Gary, Cat Veterinarian replied 6 months ago

It was probably Loxicam- that's one of the trade names for Meloxicam. It's an anti-inflammatory. It doesn't affect the insulin dose.

Don't beat yourself up over this. It was an accident and it doesn't sound like he had a ton of time left anyways.

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Customer reply replied 6 months ago
I think that is what the medication was-
Okay thank you so much for saying that- what's done is done I need to just learn from it...as a vet tech in training I'm guessing this will be the first of many situations where I'll feel guilty if an animal passes away on my watch!
This is tough...thank you so much again for your help!
Cat Veterinarian: Dr. Gary, Cat Veterinarian replied 6 months ago

You're welcome. Take care.

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Customer reply replied 6 months ago
Hi!
Are you still there?? So sorry I found out the name of the medication for the arthritis- Atopica- (not an L sorry I was thinking of the Insulin I think) Is that a steroid that could have affected the insulin needs?
Cat Veterinarian: Dr. Gary, Cat Veterinarian replied 6 months ago

Atopica is an immuno-suppressant. It's not typically used for arthritis pain in cats. It's used for auto-immune conditions. It could certainly make secondary infections and then the development of DKA more likely.

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Customer reply replied 6 months ago
Okay thank you- so maybe there were multiple factors at play here- it's hard to know for sure but at least the one important lesson is to not miss too many doses of insulin-
Okay thank you again so much!
Have a nice night and a Happy New Year ��
Cat Veterinarian: Dr. Gary, Cat Veterinarian replied 6 months ago

You're welcome.

Happy new year.

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Cat Veterinarian: Dr. Gary, Cat Veterinarian replied 6 months ago
Hi,

I'm just following up on our conversation about your pet. How is everything going?

Dr. Gary
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