Kaz AMPS 324 /PMPS 254 - Kaz Really Sick Need Help

@Suzanne & Darcy
@Bron and Sheba (GA)
@FrostD

Hello
I'm trying to reach out to people that have helped me in the past as I am having a bit of a bad 48 hours with Kaz.

Up till 5.45pm last night Kaz was 100% fine.
He ate all his meals and slept most of the day.

At 5.45pm I gave him his blood test before dinner and his number was 38 which is very low.
I got some high carb food out of the cupboard, but he refused to eat.

I rubbed honey on his gums and retested 15 minutes later and it went up by 1 point to 39. All the while he’s walking round the house and not responding to his name. He's sniffing the air walking close to the walls and trying to get into small dark areas.

Next I rubbed some Karo on gums and retested 15 minutes later and his number went up to 62 however his behavior was unchanged.

It looks like he’s looking for a place to be on his own and I’ was worried that he thinks he is going to die as this is what my other cat did.

As his numbers continued to increase and the appetite stimulant worked he ate. I fed him small amount every hour till 10pm and then left two small meals in his box both he ate during the night.

This morning he was ravenous and wanted to eat everything in site. Even though his number had now risen to 324 I still gave him DM Diabetic food at 10%. I stayed home and gave him this for all his meals. Gave him his insulin as normal this morning no issues.
Fast forward to this evening. Gave him his blood test and then some food (usual food) he ate couple bites then turned his nose up so I gave him a spoonful of the DM 10% food. Everything seemed fine (6pm at this point) Gave him 2 units insulin and thought the worst was behind us.

About 7.45pm he started making a noise that is familiar to me and I knew he was going to throw up. He appears to have thrown everything for the entire day. Obviously worried as he has had insulin.

He was still hungry so I offered him three different types of wet food he sniffed but would not eat.

Then brought out a handful dry food which he ate but 15 minutes later he has thrown this up.

He also has upset tummy now. I have seen him drink water about 10 minutes ago so that's good and he does not appear to be throwing up the water.

He's fast asleep on the floor but if i move he looks up immediately so is alert and his glucose levels are at 182 right now. Can some one tell me what the heck is going on here and what to do.

I would rather not take him to the hospital as the evening crew at Angel is not the best. Dr Brum my vet gets back from vacation tomorrow so I was hoping to take him as an emergency to see him tomorrow but any help would be greatly appreciated.

Sorry for long email needed to get it all out.

Claire

 

When he drops under 50 it's an automatic reduction no matter how long he's been diabetic. I'm no expert but I'm pretty sure you should have reduced him to 1.75 units maybe even 1.5 units. I don't see alot of testing so he could be dropping while your at work or sleeping as well. Also the dosing amount is all over the place.

I hope @Suzanne & Darcy or @Bron and Sheba (GA) see this & can help you @FrostD hasn't been on the board for awhile. I'm not on much either just decided to pop over here & see if someone from the FB group has posted over here yet & seen your post. I hope he starts eating normally & keeps it down for you from me & Panzer.

 

Hi Claire
It sounds as if Kaz had a symptomatic hypo last night.
Looking back on the SS I can see a few places where you have not taken reductions when they were earned. Always reduce the dose if the BG drops under 50.
Are you feeding dry food? If you are you should be following SLGS.
With TR you need to be testing at least once during every cycle as well as the Preshot BG. I know that can be hard sometimes but do try as you need to know how low the dose is taking Kaz.
Are you still testing for ketones when Kaz is unwell?
You dosing has been a bit all over the place lately with small doses, skips and full doses so it’s hard to say which dose you should be at.
If the ketones are negative AND you can’t monitor closely it might be a good idea to reduce to 1.75 until you can see how things are going.
do you have any antinausea medication such as cerenia or ondansetron to give him.

I don’t know what is wrong with him but I would keep a close eye on ketones and offer small amounts of food. If he gets worse you might have to take him to the ER.

 

@Bron and Sheba (GA)
Hi Bron, since Kaz is a long term diabetic and following TR doesn't Kaz have to drop below 40 and not 50? Or am I missing something?
Claire did reduce after that reading of 38 this morning

 

Hey Bron , at least I got something right

 

hey Christina ,Kaz is a long term diabetic so he had to drop below 40.
Clair did reduce to 2 units right after she got the reading of 38 this morning
@Chrispooky12

 

I have my hands full right now but I feel compelled to dip in with my two cents.

Since Kaz was showing hypo symptoms at 38 and 39 on Claire’s meter, I would NOT use 40 as a reduction point regardless of how long Kaz has been diabetic. I believe a higher reduction number is warranted. I realize 40 is stated in the TR protocol, but one has to “know thy meter” as well as “know thy cat” and Kaz has shown that 40 on that meter is too low. One shouldn’t hold a dose that takes a cat to within 1-2 points of a symptomatic hypo. @Bron and Sheba (GA) what do you think?

@Claire and Kaz I’m sorry Kaz is feeling so ill. It is very stressful, I know. A couple of suggestions:

1) Ondansetron is a great med for nausea and Cerenia is excellent to help with vomiting, but both are prescription. It’s not a good idea to give an appetite stimulant (such as Mirtaz) when nausea/vomiting are present, so I’d try to get some anti-nausea meds in Kaz first. If you absolutely can’t get anything from the vet in short order and Kaz is still showing signs of nausea and/or vomiting, I’d consider picking up some over-the-counter famotidine (brand name Pepcid AC). You want Pepcid A/C (NOT Pepcid Complete) and the 10mg pills. Dose for a cat is 1/4 pill (2.5mg) twice a day. Famotodine has fallen a bit out of favor in recent years but it’s an old standby and readily available at most pharmacies and grocery stores.

2) Cats can be extra sensitive to insulin after a hypo, so please be careful with the dose. You don’t want to be too aggressive until you know from testing that Kaz is doing ok on it.

3) Hypos can sometimes affect vision. Some cats will experience blindness—it’s usually temporary, but pay attention to how Kaz is acting. If he’s bumping into things to seems lost or disoriented but his BG is ok, that might be why.

4) As has already been mentioned, please continue to check ketones.

5) Please consider posting here regularly (it doesn’t have to be daily) and let us help you. I remember you well from when you joined, as well as how demanding your work schedule is and how daunting it was to post when the message board was new and confusing and you were being told that you had to follow a bunch of rules. It is not anyone’s intent to push you away or act like the Board police, so please stick around. If you have questions, ask. We’ll be here for you, I promise.

I hope you can get Kaz to the vet soon. There are many things that can be going on, and I hope you get to the bottom of it. Please come back and let us know what happens.

 

Very good points you bring up. I agree and think you should use 50 as your reduction point and put in your signature ‘custom dosing’.
And if anyone asks you why you have custom dosing and why you have 50 as a reduction point as a long term diabetic cat, tell them Kaz is symptomatic of a hypo around 40.

 

Hoping to take Kaz in today. Yes Kaz's numbers are all over the place because of the Thyroid issue we are having. Still trying to get the injection set up there is a huge back list. Because of this his numbers change dramatically and a shot of 2.25 or 2 would actually put him under the 50/30 more often than not that is why the insulin has been adjusted its to keep Kaz safe.
Unfortunately I don't have the luxury of working from home so I am not around to test as much as I would like and Kaz hates the blood tests. He's old and I don't want to put him under any unnecessary stress.
I always do what is best for Kaz.
Hoping that once the Iodine injection is given things will go back to normal.
Kaz will always be a diabetic its a matter of managing it and I spoke to vet about the adjustments and he agreed that this was the safest course of action as his numbers were so all over the place.
His Ketones are fine I check these regularly he only ever had this issue in the first weeks when I was clueless on diabetes as a whole. Not so clueless anymore.

I do have anti nausea medicine but this still does not explain the throwing up.

I still think he had a mild seizure which I can't prove but the behaviour kind of fits.

 

Thankyou for this. I have shied away as I always thought if I did not follow the rules set exactly I would be yelled at or struck off so I have managed on my own and we have done ok but the last couple days have scared the hell out of me. I really thought Kaz was going to die a couple days ago. I really needed help this time so I posted yesterday we muddled through the day before.
I also do believe he went blind for a while and that was the reason he was staying against the wall as he was disoriented and scared.

If 50 is not the right number for me to be gauging a reduction what is. I have kinda figured that out for myself as that's when I reduce the insulin is around 60-80 as I could see that if I did not it caused low drops. I do think the thyroid issue is not helping so its a juggling game with that as well. Hoping to se Dr Brum today and just have him checked out fully.

 

Thyroid issues can definitely complicate things. My Charlie had the I-131 injection to treat hyperthyroidism. Sometimes it really does help to take one thing off the radar.

I think if you feel 50 is too low, then you should pick a number you’re comfortable with, be it 60 or 80 or whatever. The reduction point for the Start Low Go Slow (SLGS) method is 90, and maybe given your work schedule and limited ability to test in the middle of the cycle on most days, that might work better for you. There’s nothing that says you have to stick with the more aggressive Tight Regulation (TR) protocol—it’s not suited for everyone, and there’s nothing wrong with that.

I’m sure you’ve had quite the scare. Please give Kaz a scritch behind the ear for me. I look forward to seeing more posts from you.

 

Sending prayers for Kaz ♥
Claire just a reminder don't forget to put Custom Dosing in your signature instead of TR and on your spreadsheet where you have TR
@Claire and Kaz

 

Please have them check Kaz’ blood pressure. Some of the symptoms/behavior you are reporting I have seen in my cats who have had seizures due to high blood pressure. And Kaz has multiple things going on at the same time!

 

And please do let us know about what Dr. Brum says. I am quite worried about Kaz now.

 

J

just have to remember how to do this I can't figure out how to update password.
Once I deal with Kaz I'll come back and try to figure this out.
Thanks Claire

 

Thanks Suzanne we are leaving in about 5 minutes so will ask.

 

The blood pressure is 170 which I was told was border line.

No other test results yet

 

As I guessed its the Thyroid that is causing this went from 5.7 to 7.6.
Tomorrow when Jen is back in the office I will ask for the test results to be emailed over to me and I'll add them to my sheet.

Dr Brum thinks that anything above 1.50 is too much for him and that I should think about reducing it over next couple weeks. .25 reduction per week.
I just reduced him to 2 so hopefully stay there till this time next week and then take it down. The gist that I got was that I needed to do this till the thyroid was treated then I can go back to my usual management which he says is fantastic. It just wont work right now and Kaz will continue to have the big drops till its sorted.
He said it was safer to keep him between 200 and 300 till this was sorted.
Any thoughts??

 

Kaz has a lot going on. I’d take the reduction immediately of course and then see how he does rather than deciding on a plan. If the symptoms were due to his bg under 40 he could be more sensitive to insulin. If my cat I would not want him to be hanging out too low (low to mid green range) or too high so as to result in insulin resistance. I’m glad his bp is normal.

 

No problem at all if you need help just tag me and I'll tell you how to do it

 

That is borderline and could be elevated from vet stress.

 

I would take the reduction (as you already have) and see how it goes. You will know if he needs another one. I don’t understand what reducing over the course of several weeks will do for Kaz, but the vet must have his rationale. If he needs to be at 1.5 (according to vet) then why not just do it? I mean, he’s had skipped shots periodically when it was necessary. Anyway, I am just thinking out loud here. On the other hand, by reducing him gradually you will be able to see his numbers and you may decide on your own that you don’t want to reduce his dose quite that low — or you may actually find that he needs a low dose until he can get the radioactive iodine injection. What is the timeline for that?

 

Did they check his BG today at all? I was just wondering how he did on 2 units today.

 

In reducing the insulin and keeping the BG between 200-300 as the vet suggested, I would recommend you test for ketones regularly as he has a history of DKA in the picture.

 

How is Kaz acting tonight? Does he seem better? I really hope so!!

 

May need help. I have Kaz's spreadsheet on two computers now its view only on this I have requested full rights but it's not coming to my Google email to accept so can't fathom how to get access.
Guess its not a big deal just means I can't do anything unless I am physically home.
I just assumed I had the rights to my own spreadsheet guess not.

Working on the signature sure I'll stumble across it soon.

 

Yes unfortunately I can't update spreadsheet from here have to wait till I get home. Believe the number was 254 and I gave him 2 units.

 

He had this twice once due to my lack of knowledge don't think he has a history of DKA but I do test him once a week and sometimes more depending if I think he's not acting normal.

 

I want to monitor this and reduce slow I think 1.5 is too low but I could be wrong I will most likely go to this at the beginning June anyway as I fly to the UK that month for 3-4 weeks. Id rather he was high than low.

 

Kaz was not happy with me yesterday due to the hospital trip also starving as I had to use appetite stimulant to make sure he ate. I got up throughout the night to check on him and he seems mostly normal and was fine this morning. Thank you for asking.

Claire

 

That’s true about your trip. I hope you have a good pet sitter. I remember you had a pretty good one before. It would be good perhaps if Kaz could have the hyperthyroid treatment while you are away as he would have to be in a special facility for two weeks. Then perhaps he could move to regular Boarding? Is he currently on Methimazole or Felimazole for his hyperthyroidism?

 

I have a tech from Angel look after my cat you can see from my spreadsheet that his numbers are terrible during this time frame but no one is going to look after him the way I do. I just need him to be alive when I get back. They both stay at her house so at least if something happens it should be picked up quickly. She does work but her husband is home most time.
There is no way he's having the treatment without me being here in case something happens. I already know they wont let me visit but I know Kaz. If he is in a cage away from me he will not eat been through this twice. Last time they wanted to hook him up and force feed him. I had a fit and made them allow me in. As soon as I went in he started eating. He's a funny little man that loves him mum. I'd also be worried every day and I have a lot to cope with during this trip.

 

Unbelievable but his number dropped again to 42. No insulin tonight and he starts Thyroid medicine tomorrow I believe.

Going to move the insulin to 1.5 tomorrow as I can see that its needed.

 

I’m glad you are doing this. He may just be more sensitive to the insulin after the hypo — and so needs a larger reduction than normal. That combined with the thyroid. I do hope he will start feeling better with the thyroid med. Will they recheck his levels in a few weeks? I thought usually they do it in 30 days, but you may be in the UK by then.

 

Due to what just happened my vet stepped in and called the head of the thyroid department himself that's what I'm getting the meds either today or tomorrow (Angel has a three day period now for filling meds) then on the 29th May I take him in for the consultation and blood work to get him ready for the injection.

 

I’m amazed at them having a 3 day delay to fill medication. I am so happy that your vet is advocating for Kaz. I guess there’s a downside to having it be a huge hospital. If he’s going in for consultation on May 29, what does this mean for your trip home? I know they need you back home as well. You must feel pulled in different directions.

 

Number dropping dramatically again??

Doesn't affect my trip he won't go in till mid to end July. My trip can't be changed as three things happening while I am at home all been scheduled that way. Think I mentioned this to you.

 

Your spreadsheet says you shot 2 units today. I thought you were dropping it down to1.5.

 

I will just not this morning I wanted to do a curve on Kaz today to see something and probably tomorrow and Sunday too at the lower rate. Want accurate picture before I drop.