? 12/25: MITTENS - Novolin N (TID) - Ketones Small - MDPS 223

Yep - but time is of the essence at the moment so let's get the insulin sorted out before kicking off the new thread.

Very glad to see you here, Kris! Will you be around for a while?

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Has Mittens been fed? If not, feed straight away.

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Yikes. Stinky pinks.

You have to make the decision but I think you should give the 0.50 IU dose. (I would if it were my cat.)

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NB - wait 30 minutes after food before giving insulin.

 

It was an hour and a half ago, I'll do it right now.

 

Good morning-- I am (finally) conscious again, so I am around too. Bah to the 365.

 

I recommend you get the litter box set up to collect a urine sample and isolate Mittens in the room with you and the box until she pees (she might pee after eating). Need to get that ketone test ASAP.

Do you have another litter box for your other kitty to use in the meantime?

 

OK. Let us know the EST time when you give the dose.

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Ok, she is fed. 7.5mL fancy feast

 

Did I misunderstand? I thought I was supposed to feed her right then, did you mean give her a dose of insulin right then? If so I messed it up and fed her, I thought that's what you meant.

 

Morning, Nan!

Hope you had a good - and well-deserved - sleep!

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Good morning Dan!

We just want to make sure that Mittens has food "on board" when she gets the insulin shot-- this particular insulin hits pretty fast, and especially with the larger dose we don't want it hitting on an empty stomach and possibly causing a crash in BG. The usual order is test, feed, shoot-- you're doing it in the right order.

So now, she's had breakfast, and it is shot time (if you haven't given it already)!

 

Great stuff! Sounds like the feeding is going a little quicker now, yes?

I understand it's 09:15 EST when fed. Give 0.5IU Novolin N at 09:45 EST. Post to confirm when dose has been given.

(Now the spreadsheet's up it's easier to update from the 'live feed'. I'll do the updates for now. Will give some hints 'n' tips to you after insulin is on board so that you can add stuff when you feel comfortable doing so.

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Not nice. Sending thermal .

@Kris & Teasel, @Nan & Amber -

Will you be able to keep an eye on Dan, Heather and Mittens during this cycle? I can keep going for the early BG checks but then I really need to rest.

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Yes-- I'm home today and will have stuff to do here but I can keep a very close eye on things while I do them. Get some rest, Mogs!

 

@Kris & Teasel, @Nan & Amber - Ladies, you are absolute stars!

Target range for BGs is 150-220mg/dL (human meter) per Meya14's advice.

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@Kris & Teasel, @Nan & Amber -

I suggest having a quick PM chat about where to put what in the spreadsheet so as not to clutter up Mittens' thread. Then maybe I can post a sort of crib sheet for Dan and Heather to use?

Thoughts?

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Yes, a good idea to get ourselves organized for the day!

 

.5u at exactly 9:45 EST

 

Okey doke. Will set up the PM chat. Looking to find ways to use the cell note function to make things cleaner. Will talk you both thru.

Mogs
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Good morning all! I slept past my alarm and just got up. Glad to see al the help and Mogs you are DA BOMB!

Just wondering if there is a plan to do another round of SubQ fluids today especially since it's been awhile since the last ketone check and the last "small" result. I realize Team Mittens is getting more food and hence more fluid into Mittens now but that still may not be quite enough. The creeping up BG, flatter cycle and possibility of less urine output right now suggests to me fluids may be needed. Perhaps a quick check of Mittens skin turgor and gums would give us a some additional helpful info. More fluids would help bring BG down and more flushing of any ketones.

 

Am I to be testing her at the same intervals that we've been doing (+1.5 +2.5 +4 +6 +7.5)?

I would like to give her some more fluids, Dan has been sleeping for about 6 hours now, so it shouldn't be that long before he gets back up. I'd like for him to be here with me while I do it.

 

Thank you!

Now eat something and grab some !

Will have a chat with Kris and Nan about spreadsheet now via PM but we'll be checking the thread at the same time so post when you need something. Next priority is getting a ketone test.

Also can you keep an eye out to see if Mittens has perked up any since getting her potassium supplement?



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Yes, the dose has been increased and we need to see how she responds. Other opinions?

 

Actually, I think that's a glitch on the spreadsheet-- the subQ were given in the early morning of the 25th, so the note should be in the box below.

 

@Kris & Teasel can I ask you to run with the SubQ timing along with Mogs and Nan. I am getting ready to go out but wondering whether to drive to Schomberg or not today given the weather so may abort the travel plan. Light freezing rain here too but worse up Schomberg way and I am NOT risking life and limb to go. To be completely honest, I'd really rather stay here and help out. Too many screaming albeit cute kids in the mix of company!

 

Will do. And I will get a keytone test at my first opportunity.

 

I'd suggest doing +1.5 and see where Mittens is at then review. (Otherwise keep to same schedule._

I think that's a good plan. I think you need to wait a bit after the insulin dose. (Tired so I can't remember the advice from the previous thread and I've not had to do sub-qs myself.)

Do you know how long to wait after insulin before giving the fluids or would you like help checking back through post history? (Think it's in the thread for 24 December.)

 

Will check. (It might be because the cycle started on 24 December and I'm recording stuff based on relationship to shot times.)

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I believe the recommendation was to do the subQ at least 1-1.5hrs before the shot, because the fluids might bring BG down artificially and make the shot hit on too-low BG. I don't know if there was a recommendation about how much buffer to leave when doing it in the opposite order.

 

This is the advice from Meya. I'd suggest giving the fluids 1.5 hours before the MD shot.

 

"The subQ can dramatically and temporarily lower the BS levels due to dilution. Once the water is processed by the kidneys the BS will start to rise again. I think probably best time to give is about 1-1.5 hour prior to insulin to allow time for blood sugars to begin to rise so dose can be given safely. Also, insulin should not be given in the scruff area as it won't absorb well with fluids, you can give it in the flank (side tummy near the back leg) on days you give fluids."

From Meya's post on the 24th.

 

Freezing rain is no joke! Snow is so much easier to deal with (well, at least for the first few inches!).

If she isn't having a super-active cycle, what do you think of possibly doing the fluids a bit earlier than that? She just got the AM shot, so 1.5hrs before MD isn't until 4:15pm EST, which is a ways away.

I'm very anxiously awaiting the next ketone test...

 

That could work. Any time there's a bit of a lull in the schedule is good I think because it's an as needed therapy, not a timed, regular med.

 

Here's the thread SITREP for that time, Nan.

The date the fluids were administered was 25 Dec, but they were given in the previous insulin cycle which started on 24 Dec.

I've clarified the spreadsheet Remarks for 24 Dec thus:

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Agree.
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Hi Linda,

Please be safe.

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Been rethinking and I think this is a suggestion well worth consideration.

I would suggest that you review how the cycle is going at +4 to see whether it would be safe to give fluids earlier.

Maybe Dan & Heather could try syringing some water in the meantime? (Not ideal but might help; throwing out ideas here.)

Ditto.

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+1.5 -269

 

She was 268 at +1.5 yesterday after the AM dose of 0.25 u. The dose is doubled today so we have to watch for a more active cycle.

 

Ok that's a big drop for the first 1.5 hours so we are going to have to watch Mittens today. I'd take another reading in 30 minutes to see if the drop is continuing.

 

I'm on spreadsheet update duty.


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I'm sorry, I just double checked, it was actually +1.5 -369 not 269. Sorry about that, unfortunate typo that I did not see before posting.

 

@Dan&Heather -

Has Mittens eaten anything since her preshot feed? If yes, can you let us know how much and how many hours after the insulin dose.

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And lower ketones hopefully!
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Not yet, I've been trying to give her 2-3 hours in between so it's still frequent but gives her a little time in between to rest. I planned on feeding her next right after the +2.5 test, in about 45 minutes.

 

Thanks for correction. Adding info to spreadsheet now.
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Do you think you might be able to keep to the same schedule but get her to eat a little extra at each feed - say, 10ml? (If it doesn't work, it doesn't work but perhaps worth a try to maybe get a few more calories into her for the insulin to work with.)
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@Kris & Teasel If you go through the email you can edit. If you just click on link in this thread, you can't. If you keep Teasel's sheet open and are signed into Google, you should see Mittens sheet in the list of sheets you have viewed or own or can edit. If you open Mittens' sheet from there, you should be able to edit. I had the same problem yesterday.

 

Has this been put on Dan & Heather's list of upcoming things to do?

 

All - please can we keep the spreadsheet discussions to the PM chat because it is cluttering up the thread and becoming very confusing for other readers.

We need to keep clear sight of Mittens' information and Dan & Heather's questions.

(I also suggest we all delete our own off-topic posts in this thread ASAP, please!)

Thanks,


Mogs
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I'm definitely in favor of fluids before +6.5, but I'd like to wait until we're sure we won't be administering while BG is already dropping in an active part of the cycle. So maybe hold off until the next test to decide where to put it on the to-do list?

 

@Dan&Heather -

Very sorry for the flurry of off-topic posts.

I think it would be helpful for me to kick off a new thread after you post an update after the next BG test. (I'll add a recap of key stuff at the top of the new thread.)

Is this OK for you two?


Mogs
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Done!

 

Yep that would be fine

Yes we did plan on trying to give her two syringe's at each feeding, roughly 15mL I guess, so that we can get more food and a little bit of fluid from the water we mix in. I am pretty terrible at feeding her by myself, so I know I cant get her to sit thru two syringe's, but when we're both awake for sure I think we can do it, Dan is better at getting her to open her mouth than I am.

I did get the BG on time: +2.5 -321
Then I fed her 7.5mL fancy feast
And I was able to get her to let me give her about 7.5mL of water from the syringe. I know it's not much, but I want to wait till we decide what time would be best for fluids, which I don't want to give yet because Dan is still sleeping, but I know she needs some. She has drank a little on her own but it's been very, very little. I'm still waiting for her to head to the liter box, but I do have plastic in there in case I don't see her in the process.

 

Every little drop helps, Heather.

If you did have a little bit of chicken to poach in a pint of water that might help. Doesn't have to be a big piece of chicken at all - it's just needed to give the broth a bit of flavour (a flavoured water with cat appeal, essentially). The little bit of flavour can encourage a kitty to drink more water under its own steam. As usual, raising the bowl and very slightly warming the broth can help (tepid to the fingers). If she likes the broth don't give it to her via syringe because that might put her off drinking the broth from the bowl at a later time. Stick with plain water if syringing fluids.

Re timing for fluids I think it looks like she needs them sooner than later. I suggest testing at +3.5 and doing the fluids after that if she is still high (and it's looking that way).

Please post the +3.5 BG result when you get it. Especially if number is under 220 - a safe number but in the target range Meya recommended.

Mittens needs to run lower. I am asking others for their input here.

@Kris & Teasel,@Nan & Amber,@MrWorfMen's Mom

@Meya14, @Jill & Alex (GA), @Chris & China: Please can you offer further guidelines to Dan & Heather for sub-q fluids and also dosing for the next insulin cycle to get BG numbers into a better range.


Mogs
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Good to hear that you're getting a decent amount of food into her, and every bit of water helps. With that 321, she's still running flat as she has previously on the insulin, but it's higher than we'd like.

Mogs, what say you to fluids? Should we do it when Dan wakes up, or wait until the next test? With Novalin N, we're still short of peak activity-- Mittens has been pretty flat overall, but her one dip below 200 was at +6, so it's still possible for her to drop. [edit: ok, this whole question just got superceded by your post above-- thanks, Mogs!!!]

 

I wonder whether the significantly high BGs so far at double the dose point to that dose being too high. Not sure how to dose between 0.50 u and 0.25 u though ...

 

As long as the numbers are high, you can give the subQ. So actually right now might not be a bad time. What you do want to avoid is giving them close to the peak if numbers are dropping rapidly, this can further tank the BS for a bit. Also want to avoid giving too close to shot time to avoid a diluted test. I'm not sure about how fast cat kidneys process the fluid but in humans it's about 30 min to one hour after you drink, fluids are eliminated. Given the fluids may take up to 30minutes to absorb, you are looking at 1-1.5 hours of potential dilution.

 

@Meya14 -

Thank you again for replying. What would your guidelines be for Dan & Heather do about insulin and food for the next two cycles?

Also would it be possible for them to tag you for help later today should they need it?

(I won't be here for much longer today, plus I don't have your knowledge or expertise.)


Mogs
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Just tested again: +4 -358 about 5 minutes ago

 

I'll be in and out all day today, so I should be able to reply, but it may not always be timely. I'll keep and eye out. As for insulin dose, i'd stick with the 0.5 for the next cycle and see what happens, especially if fluid is administered (the next cycle may have a lower start point). It'd be useful to know the current ketone status today to see if the dose needs to be higher as well.

If the vet is open today, is there any way to call and get a box of cerenia?

 

That's high enough to follow Meya's guidelines. Ready to give the fluids?

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I agree with both points.

I disagree with this point to a certain extent.

For some reason, many cats will show an interest in eating on their own immediately following the administration of fluids when sick/not feeling well. If your cat is one of them (Alex was), it's an unintended bonus! The order is fluids, test, feed, shoot. This is a technique that has been used favorably for years with cats. The trick is to make sure fluids and the insulin shot are given on opposite sides of the body to alleviate possible dilution problems.

 

Thank you so much, Meya.

FYI Dan & Heather aren't sure when Mittens last had a bowel motion. I don't know anything about hypokalaemia but I remember you recommending metoclopramide for Saoirse after her post-anaesthesia motility problems. Is this something Dan and Heather should enquire about with their vet?

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Also, what fluids did they give you, what does it say on the bag?

 

@Jill & Alex (GA) - Thank you very much for answering the tag.

May I also ask if you will be around later on? I'm trying to find out who Dan and Heather can ask for help today/tonight.

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I'll be in and out, but I'll check in as often as possible.

 

Metoclopramide may be useful to help with constipation induced nausea in this case, however, the mirtazapine can interact and I would not personally feel comfortable giving without a few days in between. Also, there is the rare chance of a bowel perforation if completly obstructed and given a medication to stimulate movement. Hypokalemia can lead to complete obstructions at times. The potassium alone should be enough to get things moving, and if not, I'd try a softener first like miralax. I would also consider going back to the vet if there hasn't been any bowel movements in a few days, in case there is a complete obstruction.

 

I'd also like to make a suggestion...
Getting enough calories into Mittens is important. A very rough guideline when exact number of calories is not always known is to feed approximately twelve 10 mL syringes of food over a 24 hour period.

When shooting TID, if at all possible, try to feed 20 mL prior to every shot and then another 20 mL sometime within each of the three cycles... a total of 12 10mL syringes.

 

@Jill & Alex (GA), @Meya14 -

Thank you both so very much for helping here.

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@Dan&Heather -

Have you given the fluids?

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I think that Mittens needs those fluids ASAP Dan/Heather.

 

I could. Dan is still sleeping and I don't want to wake him up as this is the first real sleep he's gotten in several days, he needs to sleep as long as he can. But I can try hanging the bag on something, I think if I can do that I could do the fluids by myself.

Says 1000ML Normosol -R pH7.4 multiple elecrolytes injection type 1, usp
Do you need all the specific things it has listed that's in there? I can copy them down if needed, that's what is says on the top of the bag though.

I don't think so actually. We don't have any money left. DCIN said they are sending us insulin, syringe's and a testing kit. But we ran out of lancets last night and we were on course to run out of test strips at some point today, I'm sure these things will be included in the package they send us, but they couldn't wait so I had to go get some a few hours ago and it took the last of what we had.

About how long would we want to wait for the potassium to help before we started trying other things? I've been concerned about this.

We will work on this for sure. When we're together feeding her I don't think it will be too hard and I'll just have to step my game up when I'm by myself with her.

Ok, I will get it ready and have it done very very soon. I'll be back when I'm done

 

Heather, I've seen the fluids bag hung over a towel bar or long loop of cord tied to the shower curtain rod.

 

Yes-- I think it's a pretty forgiving process. I used to give fluids to foster cats way back when. The memory is fuzzy, but if I remember right I used to do it entirely on my own sitting with the cat in the middle of the kitchen floor, not hanging the bag on anything just holding it. It does probably depend on the cat-- having one that will sit still helps a lot!

 

The higher you can hang the bag the faster it will run as it runs in gravity.
For 1 of mine I hung it on the bedroom drape rod and sat on the bed with her.
With dre I hang it on the highest part of the amour and sit on the floor. It takes about 6 minutes.

 

No, that's all I wanted to know, just checking what electrolytes are in the fluids.

As far as constipation, you can start miralax if you are nervous and think she is constipated. The potassium won't start helping until it's close to normal range, especially if she is dehydrated. I haven't used miralax personally, but there are others here that can help with dosing. Try to keep an eye on the litterbox, and if she is going, or if she is straining and trying to go. Also, signs of obstruction include frequent vomiting, signs of pain (howling), hissing or howling if you touch her abdomen, frequent trips to litterbox with straining, abdominal swelling. Get to the vet ASAP if you have these. Ideally, you could take her to the vet now to get an abdominal x-ray, but I know that is not possible. So keep an eye out.

 

I have been watching/reading Mittens' story over last few days and am AMAZED at the outpouring of love, devotion, guidance and care shown by the members of this board. You all are so wonderful and I am moved beyond words by how much support you have provided to Dan and Heather in what must be an incredibly scary and confusing time for them.

Dan and Heather- you guys are doing such an awesome job with Mittens and I know it probably feels like you are drinking info on here from a firehose! Keep up the good work!! Mittens is SO lucky to have you are parents. Your vet sounds like an ass btw..but I truly believe if Mittens pulls through it is due to your devotion and the help from the folks here. Good luck to you over the next few days as you support Mittens and eachother.

My kitty just survived a serious bought of DKA a few weeks ago. We also had to syringe feed for a few days. My hubby became an expert at this because it was so stressful for me to do. Ozzy acted exactly the way you are describing your kitty when syringe feeding. What Bob did was sit in the recliner with the chair reclined, place Ozzy on his lap with a towel beneath (you will need one because you probably already know it is messy), have kitty face you laying down and then point the syringe towards his back teeth and insert from the side under his lip towards his back teeth and throat. You may need to hold his head securely. This was the easiest way to get the food down. Hope this helps if you are still syringe feeding. Hope you are not though!

Good luck Mittens, Dan, and Heather!! We are all rooting for you! XO

 

Dan helped me, we got done with it about 5 minutes ago. I'm going to see if she's interested in food at all right now.

 

Dan & Heather, I've just posted a 911 message in the main health forum asking for more help with Mittens' treatment from people who have more experience than Linda, Mogs, Nan and I have. The 911 tag is aimed at getting attention. I'll remove it later. Please go read what I wrote and let me know if you approve.

 

Wow that's terrifying, should I be alot more scared than I am? I just got her to eat 7mL of fancy feast and gave her the fluids so I thought things were not great, but not 911..

 

Great job! As advised above, this might bring her blood glucose levels down for the next hour or so, so keep in mind that will affect any blood glucose tests you do in that period. You usually test at +6, which shouldn't be as affected, but just in case you were thinking of testing earlier than that.

What we really need to know right now is the ketone status, but that's on Mittens' to cooperate .

I hope she starts to get more interested in food on her own soon, but other than that, just keep doing what you are doing and getting as many calories as possible into her. Poor Mittens!

When you get a chance, could you get a count of what supplies you have on hand until tomorrow? Number of test strips and lancets, principally, but if you think you are running low on anything else, that too. Just so we know what we are working with.

 

I'm very sorry if I frightened you. The 911 is strictly to get readers' attention right away. I'll remove it and put in a question mark if you like. Let me know.

 

How is she behaving? Moving around? Interacting with you?

 

Not necessary to remove it, I read it, I thought it was going to sound a whole lot scarier than that. Thank you for doing that, anyone who has suggestions is appreciated, maybe someone will have some input.

 

The "911" tag is used to denote urgency.

In this case, Mittens is not presently in a life-threatening crisis, but you can probably tell from the anxious tone of some of us, she is in a very precarious position right now. With her blood glucose levels more elevated today and with her having some ketones in the past, we are worried that she is at risk for going into full-blown diabetic ketoacidosis (DKA), and that is a life-threatening situation.

The fluids should help, as will the insulin, and every bit of food you can get her to eat will also help.

 

Actually, the 911 is to be used for medical emergencies, not on a thread to round up extra help. If there is a medical emergency, the 911 prefix would be put on this thread. A question mark is appropriate for the other thread.

I know everyone's trying to help, but let's work within the guidelines set by the owner of the board.


Edited to add: Given the number of views on this thread and the ones before it, I believe many are watching, but are being respectful in not wanting to clutter up this thread with chit chat/non-essential posts. I have faith in my fellow members. If anyone can add to or has another opinion, I count on them jumping in to address issues at hand.

Great suggestion from Mogs, "ask for experienced members in different time zones to check in and keep an eye on Mittens' BG numbers over the next 2 cycles and to help Dan & Heather with general queries and perhaps pitching in if Mittens should need a bit of help staying in good numbers."

 

It could also be helpful to post the same message in the L&L board.

 

She's just kinda laying in the kitchen like she usually does, she's usually either in there or behind the couch lately.
er of 50 that I got from Walmart today, i bought the box of lancets earlier too

We have 2 more test strips in the container we've been using and a new container of 50 that I got earlier, and the box of lancets had 100 in there and I think I've only used maybe 3, we have 8 cans of fancy feast classics, 4 cans of fancy feast gravy lovers, 4 jars of baby food, some cat treats (that she hasn't been getting), honey, the bottle of insulin is still just about full because she's gotten such small amounts, I think 7 more treatments worth of fluids. I think that's everything.

Ok, I understand. I will watch her so we can get a urine sample to find out if there's any change in that. I test her BG again in 10 minutes, I'll post the results when I have them.

 

OK, great! I was worried that you were about to run out of something critical, but you sound quite well stocked-up for the time being!

 

Done!

 

Well done!

 

At Admin's request I've replaced the 911 with a question mark. The message is also posted on the Lantus/Levemir forum which has many members.

 

Have you tried giving her treats to see if she's interested? Treats sometimes are very palatable even if cat is ignoring other food.

 

Yes we've tried since they used to be one of her very favorites, but she has no interest at all unfortunately.

Just tested again +6 -331

 

Yes, treats! Or is there any "people" food Mittens likes? Alex loved Cheetos or White Cheddar Cheeze-It crackers! Sometimes I could get her eating if I crumbled a little bit and sprinkled it on her food. Sprinkling Parmesan cheese on her food also helped.

You may find a few other ideas that'll work for her here:
Suggestions on How to Stimulate Kitty's Appetite

 

Will update spreadsheet now.
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@Dan&Heather -

Are you keeping Mittens in the same room as the litter box with the plastic wrap ready to collect a urine sample next time she pees?

(Not meant to be naggy - just checking what's happening at your end. )

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No it's not in the same room, we keep it in the bathroom. I will suggest that we move it closer to us though so we don't miss our chance.