? 7/13 - Macka refuses to eat AMPS 403, +2 464, +4 441 PMPS 633 - What if Hypo but does not eat?

Yesterday: http://www.felinediabetes.com/FDMB/...1-5-pmps-508-2-447-4-268.216745/#post-2405248

AMPS 403, +2 464
I knew Macka was not in the blacks because this morning he was on the 2nd floor checking out our bedroom. He's been in the closet snoring since (it's 10:48am). He is in the reds, but that's improvement compared to the last days. Less bouncing less I guess?

Since he's not eating much at all, I decided to reduce his dose yesterday evening and this morning to kinda 1.5 (but honestly, it's so hard to see the difference with 1.75, these little syringes are really hard to tell. I use U-100 Ultra comfort syringes because they don't create air bubbles, anyone has a better brand to recommend?). So this morning looked like maybe a 1.6? we are talking about 1/5 of mm here. Should I be worried of him not eating much (1/2 of his usual intake) and still receiving the same dose?

I'm going to give him another Cerenia today at 4pm, hoping this will increase his appetite. It's not like him. *** UPDATE *** Gave Cerenia at 11:20 because he was lip smacking.

I was so nervous still from last night that I could not go back to sleep between shot time and now. Hopefully after lunch?

 

He ate 2 spoons of tiki velvet @2:10pm. He's lethargic and I believe, in pain I gave him just a little burprenorphine to see if it helps. He hasn't moved from my bedroom. Pancreatitis again?

 

I don't know much about pancreatitis, but it sounds like it. Hope the Burprenorphine starts working and Macka feels better!

 

Penelope,

Have you been able to check ketones today? I think he is still getting fluids, right?

Maybe put the blue question mark in title. Hoping @Wendy&Neko or @Bron and Sheba may check in sometime this afternoon since they are familiar with how things have been going the last few days with Macka and offer some guidance.

I don’t plan on posting much anymore, just wanted to make sure you are still checking ketones when I saw he wasn’t eating as much.

 

I was thinking the same Julie. When I hear of a cat that is lethargic and not eating much, and is in higher numbers, the first thing I think about is checking for ketones to rule those out.

 

Leo had low-eating / not-eating issues in his last 8 months. Cerenia helped. So did Ondansetron - both for nausea. We also used transdermal mirtazipine to stimulate appetite. The mirtz was effective around the 3 hour mark, with obvious hunger stimulated.

You do need to be worried about low eating and insulin. I had the same issue with Leo. So I was conservative on his dose, with a target to get him below 200 daily. Sure, not a perfect protocol. But he had a lot of hypos.

Hugs to you. Eating issues + diabetes are so challenging. I've been there.

 

You might want to see if your vet will give you a prescription for ondansetron. It tackles different nausea receptors from Cerenia, and sometimes it works better. It’s a human medicine so you get a prescription and take it to the human pharmacy. One other thought, how much does Macka weigh and what is the Cerenia dose? Sometimes vets underdose the anti nausea meds.

He is so high I worry more about the lethargy and possible ketones and not enough insulin at this point.

 

Get a ketone test done today. They are right, this is very important. Ketones can cause critical issues. I used Ketostiks - you dip it in the urine stream. Got them from Walgreens for $10. I also dipped them into the pee in the litter box just after he peed - since there was foam. That might be easier.

 

His ketones seemed NEGATIVE 2 hours ago.

 

I did not see Ketones in his strip. I test every day, sometimes twice a day.
But he is lethargic for sure. This makes me so sad. His condition has worsen since last week where he still had interest in things, wanted to go out, was hungry. He's been in my room laying on his side since this morning, only eating when i offer food in my hand.

 

A vet visit would probably be helpful at this point. It is unfortunate we are in the weekend.

 

Yes indeed. I will bring him first thing on Monday
He just drank tuna juice

 

How conservative compared to regular dose ?

 

Because I'm not mathematically inclined, I asked hubby...from 1.75U to 1.5U is a 15% reduction in insulin.

With love, Nikki

 

Probably it's good to stick to the protocol for 6 doses. Macka is mostly having pretty high numbers, and 1.5 units for a 6 dose period would be fine.

It looks like the 2.0 units on July 7 created a mini-hypo. We need some dose stability before more changes are made. As you mentioned, the most important item now is to get some food into Macka.

I agree the difference between 1.5 and 1.75 is very difficult to determine.

 

If it is pancreatitis many hugs

Just keep trying. If he drank the juice (water) will he eat any of the actual fish? Baby food (all meat)? Boiled chicken?

Ondan and Cerenia on hand at all times. Try warming the food up a bit. Put it right in front of his nose. Sometimes Gizmo wouldn't go to his bowl on his own but if I brought it to him he would eat. CBD (oil) helps with both discomfort and enhanced his appy.

 

Thank you all. I feel more comfortable with the 1.5 unit for the following reason: while I was giving him this dose, he was sort of ok, playful, alert, hungry. At the time I did not know I had to test during the day unfortunately. However, the pre shot numbers were lower than they are now. I don’t think there was as much bouncing. The vet said I should increase to 2 units, which I was reluctant at doing. This is why I increased to 1.75. I did not understand the cycles and dépôt of Lantus, so after only two days, with the vet approval we increased to 2. From there it was only problematic with lots of bouncing.
Have I known, I would have tested more, stayed at 1.75 for a while etc... I also did not test at night because I did not know I should. At least I had some more sleep and at 1.5 Macka was doing great at night too. I know these are not data driven and just my experience. But right now he’s not eating much and having highs every day, being lethargic, and nights are crazy and exhausting. I almost fainted an hour ago. I hear everybody’s encouragements, and so grateful for your help. The support is unbelievable. I know we don’t want ketones again. I also don’t want Macka to go in hypo because he’s not eating and the injection is a little too strong. I’ll see how he’s going to accept food tonight at 7pm.

Ketones still negative on the chart. Poop is pale and a little loose.

 

If he does not improve tomorrow, I will take him to the ER because it’s Sunday.

 

Tonight, Macka refused to eat anything. I still shot, and will monitor him, but very worried that because he did not get any food, he will go too low with numbers (although he is very high right now PMPS 633).

 

The plan to take him to ER is good. Sometimes it is worth spending a little more money to get a timely resolution.

 

There is an option if he goes hypo and isn't eating -- any mucus membrane will absorb sugar. That is why you might have heard that you can rub karo syrup or something like that on their gums.

Another very real option, although it sounds icky, is that you can squirt a little bit just barely inside the rectum with a syringe (like a feeding syringe, not one with a needle on it) or I have a baby's ball syringe in my hypo kit - the kind used for sucking boogers out of a baby's nose.

In an extreme emergency, icky doesn't matter, and if kitty happened to be seizing then it might not be safe to have your hands in their mouth but the mucus membranes in their hiney will serve the same purpose. Just wanted to make sure you knew about that option.

 

Thank you @Sandi & Whisper

 

His ketones were NEGATIVE at 9pm.

But still not interested in any food. I will test him for his +2 in 15 minutes.
Hopefully he does not drop.

 

Do you have small syringes without needles, that you can use for assist feeding if needed? Sometimes if Neko was off her food, getting a little food in via syringe helped her tummy, and then she would eat a bit on her own. Check out this post http://www.felinediabetes.com/FDMB/threads/syringe-assisted-feeding-videos-and-tips.144367/

Did you see my question on Cerenia dose and Macka’s weight? Too low a dose of Cerenia could mean it’s not enough to get rid of the nausea.

I am sorry you felt the need to lower the dose. We determine what dose to give based on how low it is taking the cat. So far this dose took him down to 138 which is still 70 points above our “take action” number. Note that I did not say hypo number. 68 on the AT or 50 on the human meter is the point at which we intervene with high carbs, cause we do not want a cat on insulin any lower. Non diabetic cats, including mine, can still test below those numbers.

It is also important that you determine how low this dose is taking Macka. Next time you see him dropping, try not to intervene with higher carbs, just feed low carbs -providing he is eating of course. Save the higher carbs for when he is much closer to 68. My concern about feeding higher carbs too early now, is that you don’t have a true picture of how low the 1.75 unit dose is taking him. If he would have gone below 68 without high carbs (and I don’t think this is true for Macka on 1.75 units), you want to know that so that you give a reduction when he earns it. Otherwise you could be stuck with an overfull depot.

And what was key to me, was knowing how low the dose took Neko meant I could get more sleep. Last night I suggested going to sleep if he was above 250 at +4. He was, but you stayed up, tested, didn’t get sleep, and he was safe anyway. These early days, when blood sugars are high, are not the nights to stay up worrying. Neko once cruised at 53 (human meter) for several hours, with no more than freeze dried test treats. That was a night worth testing frequently. At this stage, you also need to take care of you, so you can care for Macka. Compassion fatigue is real.

I too was a worrier, as were many here in the beginning, so I am going to give you a suggestion that worked for me. I spent hours staring at Neko’s spreadsheet, seeing if I could find patterns in her numbers. I did eventually start to figure out patterns across several cycles that told me when she was really going to go low. Before I went to bed, I spent time on the SS, trying to figure out if I could sleep. DH called it staring at the tea leaves. I even played “guess the BG” before each test, to see if I was learning those patterns. Knowledge of Macka’s patterns, and how he reacts to certain percentage of carbs, are what will keep him safe and give you sleep.

Good to see ketones remain negative. When kitty doesn't feel well, his numbers could stay high, even without food.

 

Oh well, that's exactly what I was doing right now Staring and trying to decipher the code... I am not sure I can see the pattern just yet. 2-4-7 cycles? I can see all sorts of connections.

Yes I have two kinds. I tried to feed him Tiki velvet mousse through it, and only part succeeded, not for long. I had to cover the smell with Tiki stix (the only food he will still eat, but it's not food).

I gave him 1/4 of a 24 mg cerenia pill = 8mg. He weights about 5.5 kg. It is written that for vomiting, it's 2mg/kg (for dogs). I guess it's an ok dose, isn't it?

yes, it was likely, but I was too scared to just let go.

You're absolutely right, I don"t have the real numbers, just an intuition, which is not data driven. However, without the food I gave him to slow down, I have the feeling he would have gone far. Which is also why it makes me suppose I should not stay at 1.75. I could very well be wrong, but it's a strong intuition.

 

Penelope, I just read your post on Rufus’s condo about red gum lines. It is worth talking to the vet about getting a dental done, especially at a place that does dental xrays. Inflammation or infection can contribute to both DKA and making kitty hard to regulate. Neko twice needed dental work where the problem did not show up on visual inspection, but did on X-ray. Cats can have dentals when they are in high numbers, and without dentals, many cats will not get out of those high numbers.

On Cerenia, he could get 2 mg/kg, so up to 11 mg. He is getting about half of that.

Guessing, even based on intuition, about what a cat will do, is seldom correct. Solid data is best. Based on data I see, he bounces the night after he sees blues, he is really high still, and he has a lower insulin dose in him, so you can go to sleep.

 

Hi Penelope, how are things tonight. I'm sorry Macka is not eating for you. Has he managed to eat anything since you last posted?
I like Wendy's suggestion of getting some ondansetron for the nausea. I found it really good and it can be given each 8 hours if necessary.
Also syringe feeding, as suggested, might be a good option if he is not eating.
I'm sorry he has some issues with his teeth, that would be uncomfortable for him.
Hopefully your vet will be able to resolve the current nausea and not wanting to eat.
Hope you are managing to get some sleep

 

Hi @Bron and Sheba and @Wendy&Neko ,

Thank you for checking in.
I tried syringe feeding him yesterday, he ate the equivalent of 2 spoons in the evening.
At midnight, he ate by himself 1/4 can of FF. Then I went to bed and slept more than I have in 1 month (but still woke up to check on him at 2 and 4).
This morning he ate 1/4 can of FF, but did not want more. There was diarrhea all night, so it's not just the teeth.
Now he's outside taking some fresh air, and when my husband comes back at noon, we will take him to the ER, to try to resolve the immediate issues

 

I'm glad he is eating a bit and you managed to get some sleep. Sorry he has diarrhoea and apply not great.
Please let us know how he gets on at the vet.

 

Since he ate a little today, I'll be taking him tomorrow morning to the vet. His BG is very high tonight

 

Hugs to you and Macka. I hope the vet can help you find some resolution.

 

Good luck at the vet tomorrow Penelope. I hope Macka is ok

 

Thank you all for your wishes. Macka is grumpy and not hungry at all. He still got his shot, but of course I worry it might be a lot for a cat that does not eat much. I'll monitor him at +3 tonight to see if it's an active cycle or not. New thread for Macka coming up tomorrow after work (yes, one day a week)

 

"Keep Leo safe", my vet told me during the initial diabetes diagnosis about 4 years ago. I always used that mantra with his different meds including insulin. You may not always get a perfect cycle. The goal is quality of life and keeping your kitteh safe.

I prefer one permanent thread per cat. The forum would be a lot less cluttered. And we would have an ongoing history in one thread for that cat.

 

Sorry to see he is still high, but I am happy to read Macka ate a little bit today. Good luck at the vet. I hope they find what is making him feel off, besides the high numbers.

He has high numbers because he isn’t feeling well, and the lower dose. Maybe even some bounce in there. Looks like you will get more sleep tonight.

I will look for your new post tomorrow. Posts get impossibly long if we don’t start a new one every day. If there was just one post for a cat, it would be intimidating to read. Including today, the last four days alone on Macka are 250 messages. This is not unusual for a new cat going lower than usual the first time. But if I saw a message thread of 250+ messages, I would stay away. You don’t want to scare away people who want to help.

 

One wouldn't have to read all the thread. The new posts would just appear at the end, as they do now. Clicking on the thread would take one to the current day. And it is easy to go to the end of the thread to find the current status.

At the vet office they keep a folder on each cat which includes the history. That is the more common form of a health log. And the continuous thread is used on other non-health forums as well.