11/29 PMPS 385 +2 220 +3 268 +6 289 +10 273 +11 247 ~ Hypo after going low

Sushi last injection was 10.75 hours ago at 5:35pm
He received 1 unit

AMPS 39

He eating his wet food
Wellness Complete Chicken & Herring
Wellness Sliced Turkey Entree

11/28 Post

 

+11 48 gave him some honey & is eating more on his own

 

+11.5 57 (5:06 am)

 

Hi.
Can you test him again please

 

We cross posted. I’m glad to see he’s up over 50. Just looking back over your posts
BRB

 

57 is good. Stop feeding and make sure he’s staying over 50 on his own.

 

Will do, my only concern is I have work to go to work soon
My mom can watch but doesn't test.

 

Looking back I can see this happened yesterday morning. I agree don’t feed any more just yet but do test again in 1/2 hour.
I’d skip the insulin dose this morning

 

Can you stay home for another hour. We really need to see Sushi is able to stay up over 50 on his own

 

How much time do you have? If you really can’t stay I’d skip the dose and leave her with low carb food to graze on.

 

i can stay an hour, just going to text my managers.

 

That’s good. Test half an hour after your last test.

 

+12 68

 

Because if the recent history of DKA it is really important to try and give insulin but he is too low this morning to give it. I think you will need to reduce the dose or give higher carb food to keep the BSLs up.
How is his appetite now?
68 is good but too low for a newbie to shoot snd you won’t be there to test

 

Make sure he eats well and drinks well today. It is important he keeps eating and drinking.
Also can you ask you Mom to test the urine for ketones please when she can get a urine specimen.

 

What are your thoughts @JanetNJ

 

I think the problem is that he's just not eating enough.

 

Sure thing.

 

After DKA it is really important that kitty is eating enough, drinking enough and getting insulin. Because his BSL is so low and you can’t test this morning we can’t give the insulin, but try and get him to eat as much as you can, put some warm water in the food if he will eat that, to help with the fluid intake.
Is he nauseated? Did they give him anything for nausea to bring home?

 

I do have Mirtazapine 15mg is time to give it to him? He was drinking this morning.

 

Any food is better than nothing, but low carb food is ideal. Will he eat some poached chicken?

 

Mirtazapine is an appetite stimulant. If he’s nauseated he really needs something for that. Does he sniff the food and walk away?

 

Here is your 2 posts for continuity
http://www.felinediabetes.com/FDMB/threads/sushi.207141/

http://www.felinediabetes.com/FDMB/threads/911-hypo.207142/

 

What dose is prescribed to give? Mine are 7.5mg and Gizmo doesn't tolerate but a sliver (less than an 1/8th of the 7.5mg). Less is better until you know how he will respond to it.

 

How much is he eating on his own?
if you think it will help him to eat I would give him a dose but I have never used it so I don’t know much about it sorry.

 

Sniff and looks away

 

The tabs were quartered for me by the vets.

 

That sounds like nausea. Can you ask your vet for some cerenia tablets and some ondansetron tablets as they will help with the nausea. Or the vet may give him an injection of cerenia. It is not good to give an appetite stimulant if the cat is nauseated.
The important thing is to get him eating

 

@LizzieInTexas I am glad you are here to talk about mirtazapine. I have never used it and don’t know a lot about it re doses etc.

 

Neg for ketone in urine.
He has a appointment tommorow. We are checking up on his anemia. Will have have to ask the vet for the anti-nausea meds. i cant go due to work and the location of the hospital. So im sending my brother with his testing supplies and log book. Is there anything else that need to brought to the vet?

 

That’s great no ketones in urine.
When you go to the vet tomorrow if Sushi were mine, I would ask for an injection of cerenia for nausea and some cerenia and ondansetron tablets to take home. Sushi does sound nauseated and cats won’t really eat much if they are nauseated. Both those tablets I mentioned are very good for nausea in cats.
Get the vet to check for dehydration as well.
Keep checking for ketones as often as you can.. at least once a day at the moment.
And get Mom to try and get him to eat and drink.
I am going to tag a couple of people about the dose of insulin Sushi should have considering he dropped low again.
You are doing a grand job looking after Sushi.
How’s the BSL now?
Would you mind taking down the 911 now that things have settled down please
Bron

 

+13 75
He feeling a little better moms brushing and hes loving it.

 

If you can’t go to the vet yourself I would write down everything you want the vet to address and give you and give that to your brother so nothing is missed.
I’m not sure what dose of insulin the vet will recommend but do check in with people here before you give a dose.

 

How is he being treated for the anemia?

 

Thank you.
Going to work but going to check his bg during my lunch.

 

Well by any of our protocols he earned a reduction.

 

He had a transfusion

 

@Wendy&Neko @Bobbie And Bubba
Sushi is a newly diagnosed FD on 11/20 and spent 5 days in hospital with DKA. Has been home 2 days on Lantus (sent home on 2 units and reduced to 1 unit the second day here on the forum). Dropped to 42 first day and 39 second day.....this cycle. Obviously needs a reduction. Suchi has had to skip 2 doses which is not ideal with a DKA history. . Sushi is not eating very well, sounds like he needs nausea meds which Kim is going to ask for at vets tomorrow. Ketones negative today. Can you have a look at the insulin dose please and see what you think? I was thinking going down to 0.5, what do you think?. Hopefully if he can start eating better the dose can be raised. Or maybe he needs some higher carb foods so he can get some insulin. Thanks.

 

Hi and welcome. When I read the last couple condos, I thought of 0.5u for the dose. Let's see what others think.

 

I agree - try 0.5 u.

 

Sorry, i have to post quick. Per mom he was eating at 11am. Went #2, runny.

11:50am 355

 

Plain boiled mashed pumpkin is good for loose poos. Nothing else added. A teaspoon in food 2 or 3 times a day. Or maybe you can buy canned plain mashed pumpkin. Nothing else added.
If you don’t have any higher carb canned food at home, can you buy some cans as Sushi might need to have some higher carb food for a few days til he starts eating well, to kept his BSL from dropping too low when he has insulin.
Are you feeding him during the cycle as well as at shot time?

 

A question about Sushi's diabetes diagnosis, did he have an infection or inflammation at the time? If so, did he get anything for it? Here is a great post on ketones and DKA. From that post "The basic recipe for developing DKA = an insufficient supply of insulin + inappetance + infection OR other systemic stresses". Mostly I'm wondering if addressing the underlying infection/inflammation is lower his needs for insulin.

 

+23 385

An ultrasound detected inflammation of the gallbladder and pancreas.
The first vet gave him Covenia, don't recall why.
Hospital gave him Doxycycline in case fleas gave him an infection and if that is causing his anemia.

Sorry, I forgot he on Ursodiol 30mg (sleep-deprived brain)

 

Sushi prefers to eat smaller meals, so he eats during the cycle and shot time.

 

I work 6am-2/3pm. What time is the earliest I can give his shot tomorrow?
Right now it's 6:06pm he ate a good portion ~1.5oz.
I'm giving him is 0.5 units now

 

It has to be 12 hours after the last shot. So 6am tomorrow is when the next shot is due.

 

Good luck with the 0.5 dose. With those two really low numbers two mornings in a row, I wouldn't shoot earlier tomorrow, rather keep it 12 hours later. Usually, to regain your schedule you can shoot up to 30 minutes earlier a day or 15 minutes earlier in each cycle.

 

You did well getting some extra tests in last night. If you can do that again tonight but also if you can get some later tests in at say +7 and +9 (you will have to set the alarm to get up) to try and catch any big drops.
If the +3 is lower than the preshot, that usually means an active cycle. Last night Sushi dropped a lot at +2 then stayed much the same for a few hours but dropped low in the early hours of the morning. So be aware of that tonight and give some food during the night. Good luck with the 0.5 dose

 

If Sushi has had pancreatitis, it is not unusual to have loss of appetite and that is another good reason to ask for cerenia and ondansetron for the nausea. Convenia is an antibiotic.

 

Okay, 6am it is. I'm going to inform my managers in advance I'm coming in later, maybe for a couple of days.

Gotcha

Thanks, I'm typing out questions for my brother to ask the vet tomorrow as we speak.

 

I will try my best to get those tests and to get some food in his belly.

 

+2 220

 

I'd give her some low carb food to slow the drop. Not too much...maybe 2 teaspoons

 

+3 268 He just ate a little more, nutrish tuna purrfection

Oh no, i didn't check the chart 37protien 45fat 18carb

 

Don't worry, we have all done that at times. It might keep him higher for a few hours which isn't a bad thing considering his track record over the past 2 days.
I'd test again at +6.
How is his appetite now?
When I bought the higher carb food, I always put the number of carbs on the tin with a texta so I could see at a glance what the carbs were.

 

Eating a little bit more.

 

That’s good.
He has had a lot to deal with, with having inflammation of the gallbladder and pancreas and DKA.

 

+6 289
Yes, I'm so proud of him he made it soo far. I was really afraid he wasn't going to make it last week. Aiming to get a +9 test next.

 

I am sure you were worried.
I think you could leave him now til +9 or +10. Will he eat some food if you leave it out?
Hopefully he will be high enough to shoot in the morning. Are you going to be able to test him during the cycle in the morning if you do shoot?
Test another urine for ketones when you get the chance.

 

If I'm Shooting at 6 am, the latest I can stay is 6:45 am
My brother has to get him to his 11 am the appointment and the hospital is about 50mins depending on traffic. Maybe I can test him before he goes to the vet if my brother comes to my work.
Just put some food out and he's eating it. (wellness complete health chicken & herring)

 

Let’s see what he is at AMPS first.
If you do shoot you can get an almost +1 before you leave, then a +4 if they go by your work and you test and if necessary your vet could do a test during the vet visit. Get your brother to take some low carb, high carb food and honey with him ( just in case it’s needed.. always good to be prepared). What time do you get home?
Make sure you are getting some sleep.. you must look after yourself too

 

Something you might think about...if you're usually home by 2/3, if you shot earlier, like 5am, you could get close to a +2 before you had to leave and you'd still be home in time to shoot the PM dose at 5pm. (4:30 would be even better but who wants to get up at 4 in the morning??? )

I know it sucks to get out of bed before you absolutely have to, but it can really help to get a +2 before you leave. It can act a little like a crystal ball as far as predicting how the rest of his cycle is going to go.

You'd have to gradually work your way back so it wouldn't work for tomorrow, but it's something you might want to consider.

 

Added them Sushi's bag.
I'll get home before 3:30pm today.

It is my goal to shoot earlier so I can watch Sushi. I'll get up at 4 am for my Sushi NP, is not much earlier than I used to get up at but I think shooting at 3:45 am would be ideal. I normally work 6am-2/2:30pm.

 

Sounds like a good plan.
In regard to feeding Sushi while she is travelling to and from the vet.. it sounds like sushi and your brother will be away from the house for probably a good three hours from about +4 to +7 which is normally over the lowest part of the cycle so I would get your brother to feed Sushi some food before he leaves, a little at the vet and then some when he gets home. How does that sound?

 

+10 273
Sound good, I'll leave a note for my brother.

 

It’s looking like you might be able to give insulin at AMPS. Is Sushi’s appetite improving?

 

He ate little when I offer it on a spoon, but he looks like he nauseous too. He was eating sitting up and a retching/burp just now.

Had a runny BM between +6 & +10
Neg for ketones in urine.

 

Mmmmm...room service!

 

Have you managed to get any sleep?

 

lol

Yes, I did sleep.

 

Do you guy think a med carb (14) is okay if he eats it? He's going on a vet trip that quite a distance, ~1hr each way.

 

I think given his history of DKA and low blood sugars, I think it would be fine to give him the higher carb food IF he has insulin this morning. It’s important he gets some insulin and higher carb food is sometimes given to cats that have had DKA so they can be given the insulin.

 

He eating on his own and I think he going to eat a good portion of it too. Looks he's going to get his insulin @ 6 am.

 

+11.5 247
Look like he ate half, ~1.4oz, and most of the gravy.
Is it okay to give the 0.5U?

 

Yes you can give the 0.5 units at 6am.
If you can get a test in before you go that would be great.
Then the plan is for your brother to bring Sushi to you on the way to the vet to be tested, yes?

 

Yes it is.

 

So that leaves about from 11am til you get home at 2.30 or 3pm without testing.
Could your brother call in to you again on the way home from the vet to be tested again? Is that possible?

 

Sure, I'll tell him to swing by so I can test him on the way home.

 

What I would also do if Sushi were mine, is ask the vet to check for ketones in the blood when he does the blood test for the anaemia this morning. Would you be happy to do that?
You are doing a great job looking after Sushi....he is lucky to have you.

 

Added to my "question/remarks for the vet" sheet. I'm trying to keep things simple for and easy for my brother.
Thank you, I'm trying my best and he's such a sweet boy

 

I will be heading to bed before long....I live in Australia and it is late in the evening now.
I hope the day goes well for you, Sushi and your brother.
Just keep feeding Sushi small amounts. I'm glad his appetite is improving. That's a good sign.
If you find he is dropping, you can always give some higher carb food to bring him up a bit. If you need help, just change your subject like and ask for help.
I will look in in the morning, my time, to see how you got on at the vet.

 

Hey there! You are doing an amazing job with your boy! He is lucky to have you an you are lucky to have a brother that is willing to help you out with Sushi! It sounds like a great plan to have your brother swing by your work after the vet appointment to test. Keep in mind that a lot of cats get very stressed going to vets so if his number is a lot higher when you test afterwards that could be why.

Good luck at the vets.

 

Great to see you @Bobbie And Bubba!
Would you be able to keep an eye out for Kim and Sushi today if you are around please?

 

+1 284

 

That's pretty good. Just a bit of a food bump which is not surprising after the higher carb food.
Well done for getting all that in before work!!

 

Hi Bron! Unfortunately, I won't be around today. My SIL is coming to be with my mom and I have lots of appointments and errands.

Looks like a bump up for the +1.

 

@Bobbie And Bubba
Never mind. I'm sure there will be others around to help if needed.
How are Bubba's ears? Are they improving?

 

+4 84 on the way to the vet given some high carb food

 

+7 54 on the way home from vet ate some food in parking lot, will get more at home.

No ketones in blood
Was given anti-nausea pills, cerenia tablets.

Continue giving 0.5u of insulin.

Theres more but dont remember off the top head my head.

She say im doing a great job and thats all because of you guys.

Thank you for help its greatly appreciated!!!!

 

Hi and good morning (my time).
I’m very pleased the vet visit went well. Great news there were no ketones in the blood, and also for getting the cerenia tablets.
That was good coordinating between you and your brother to be able to test on the way to and back from the vet.
Have you been able to get home and test Sushi’s BSL again?. 54 is pretty low (but safe) but we need to know he’s not dropped any lower.
ETA. Just rechecked the SS and I see he’s bounced up to 273 from the 54 today.

 

@Sushi
How did you go with PMPS?

 

PMPS 418 My mom let him eat the leftovers of the high carb wet food when I was out.

 

Never mind. If it was in the 2 hours before PMPS it would be food influenced so he could well drop in a few hours unless he is still bouncing. Could you put that he was given HC late in cycle in the remarks column of SS please. It all helps when we look at the SS overall.
What food did you feed during the morning cycle today?
And did the vet say anything else?

 

Done

Wellness complete health chicken & herring
Nutrish chix & salmon catterole (ate most of the sauce)
Nutrish chicken purrcata with low sodium chicken broth (Mom gave him this "ate a little")
FF gravy lovers Beef Feast(before vet)
FF gravy lovers Beef Feast (at home after vet)
Don't know if that was all, so many people feeding him. My mom doesn't quite understand when to feed low carb, high carb and how the effect the BG.

 

That looks like a mixture of LC and HC. I was interested because you may have to feed some higher carb food to ensure he can get the insulin he needs until his appetite improves. But with the high PMPS today I'd stick to LC unless he has a big drop, then you could give him some higher carb to slow the drop.......or if he goes too low, get out the HC.
Can you start a new thread for today please. On the Lantus forum we start a new thread each day and in the subject line we put the date, cats name, AMPS or PMPS and anything particular which needs attention. Thanks.
ETA we also link the previous day's post to the current one so people can look back on posts when helping