2:00 in the morning and in need of advice

If there is anyone awake with some advice, here is what's going on:
Took furbaby to the vet Monday morning because she was having trouble walking. Turns out she was constipated and had pancreatitis and high blood sugar of about 350. She was diagnosed as diabetic and given insulin and kept overnight for observation. She was picked up yesterday (at 5:30) and sent home with insulin, laxatone, methigel, carafate tabs, baytril tabs and metronidazole 250 mg. Upon arriving home, she walked around and would sit after a few feet; she walked to her treats and her food and ate like she was starving to death. We were not told when her last insulin shot was or at what time to administer the next shot, just the instructions on the label (2 units, once a day). Picking her up so late, we've assumed all of her meds have been administered and we'll start early in the a.m. We let her rest in our lap and she seemed loopy and was shivering. Doc said if she acted drunk or wobbly to feed her Karo (a bit on the tip of the finger). I read on here that shivering was a sign of too low of sugar and I gave her less than a tablespoon of Karo (dose I read on here somewhere).

I've been up monitoring her and I'm concerned and feel like I'm shooting in the dark here. I have no idea whether she needs insulin or sugar. She climbed up onto a zipped fabric suitcase she likes to sleep on (hind legs not much help) after eating some dry food (fed her to bring sugar level up that I am guessing was low) and some wet food. I checked on her at 11:00 and she was curled up and comfortable and purring when spoken to. I went to check on her 30 minutes ago (2:00) and she was sleeping really hard. I startled her and she struggled to sit up and then urinated on her suitcase while she was sitting there. I cleaned up the area, cleaned her up and she ate a little wet food and climbed back up on the suitcase and started grooming her front paws. Her neuropathy is much worse than it was and she doesn't even want to walk anywhere.

I'm wondering if I should go ahead and give her the insulin shot or wait. Doc has an appointment set for her in a week to check her glucose levels and questions if her diabetic diagnosis might be as a result of her pancreatitis and she may not have diabetes at all once she recovers from the pancreatitis. Of course, her worsening neuropathy just doesn't seem as if she's on the road to recovery to me and urinating where she sleeps as she lies in it has me very alarmed. I feel I need to do something now but am I going to kill her if I wait until morning to give her the insulin? Am I going to kill her if I don't wait until morning and give her insulin now and then she gets too low?

I have no knowledge of diabetes other than what I've read here (soooo much to learn) and I am concerned that I don't have the necessary information to treat her successfully. It seems to me that signs of instability and loopiness (what I have to go on) can be indicators of either/or. I obviously need to get her through the night. I do not have a way to contact my vet until office hours and emergency after-hour services are not an option. That is where I am.

Please, if you're up and reading this, share with me your thoughts on what I should do.

meds/dosages:
Vetsulin (40 units per ml) 2 units once every 24 hours
baytril (22.7 mg) 1 tablet once daily in the evening
carafate 1/2 tab every 12 hours
metronidazole (250 mg) 1/2 tab every 12 hours
Methigel 3 mls every 12 hours
Laxatone 5 mls every 6 hours

Thank you so much for your time.

 

OK, I got to tell you I've got no experience of Vetsulin and Rosa was only diagnosed a couple of weeks ago so I don't know much more than you do.

Can you put the 911 alert on the thread title so someone with more experience will see it. That should get some attention really quickly. I'd love to help more but I'm really not qualified to advise you on much here.

Do you have a blood glucose monitor at home you can try and get a test with?

 

I do not have a glucose monitor available to me tonight. It is definitely on the list of Must Haves (which I am in the process of trying to figure out which one is best so I feel like I'm doing something constructive while worrying away the night).

Thank you for the 911 advice and your empathy. I will try and amend the subject line.

 

If you click on "Edit Title", you've got a drop down choice of prefixes. Choose the 911 one and then save changes.

 

Oh, my goodness. I am so grateful you posted the "how-to". I don't know that I would've figured that out after not seeing anything on the "edit" section. I have flagged it as 911. You have been so very helpful!

 

No worries. I'm going to be around for hours yet - Rosa's numbers have been making me stay up until about 5am PST here for the last 3 nights. I'd still be happier if someone else can advise, but I'll be here if you need moral support.

In case you need it, have you got any high carb wet food (the in-gravy type is usually high carb). You have syrup, which is good. I've seen elsewhere on here that dry food takes longer to bring a cat up than high carb wet food does. And yes, I agree, shooting blind is way too scary - I bought Rosa a monitor the day after she was diagnosed because I just wasn't happy giving insulin when I didn't know what effect it was having.

 

Hiya,

Did the vet mention ketones at all?
Is there a pharmacy open where you could buy a tub of Ketostix or Ketodiastix (or the equivalent) and test your kitty's pee?
Does her breath smell normal? (And not like peardrops/acetone?)

Vetsulin/Caninsulin is an 'in and out' insulin. It typically does most of it's stuff in the first 4 - 6 hours of the cycle and then the blood glucose rises. Again, typically, it can be out of the system in 8 - 10 hours. So it would be unusual for any hypo symptoms to be seen after that time. Although residual effects from any hypo could remain.

(Just off to give my cats their breakfast (and meds) and I'll be back. (It's morning here in the UK).

Eliz

 

Gonna tag Sarah @phlika29 who has some experience of pancreatitis. I think she's online now; and also Aine @Critter Mom who may be online soon.

 

What a wonderful world we live in ... it's almost 4:00 here (in Florida) and I'm commiserating with a kind soul across the pond. Your support and thoughts are greatly appreciated. They're a wonderful addition/distraction to my own rushing thoughts that are bouncing around in my head while trying to retain everything that I'm reading/learning. It is definitely a comfort to know I'm not on here alone.

I really wish I had armed myself with a little more information before picking my furbaby up from the doc. I'm afraid they didn't give me enough information and I didn't understand enough about the diagnosis to ask the important questions: like, when was she dosed with insulin last. I don't think she's hypo now since she is no longer shivering, but what do I know. She did get up and urinate again. This time she got down off from her suitcase/bed and I put her in the litterbox. As an afterthought, I grabbed some ketostyx that I had in a closet from my low-carb diet days (they're expired 3 years ago) and put on the wet litter which was still wet. I realize this wasn't ideal testing, but it is what it is. The test strip showed trace elements (less than .5) of glucose. Again, the strips are expired and I had to shake the litter off from it; so other than giving me a visible band-aid to cover my worries with, I don't know that it is of much use. Zoey (my furbaby) loves wet food and she's eating that. She's a free-grazing kitty and we have 5 of them that eat that way so I'm not sure how we're going to stop that without mutiny and conspiracy from the others. We will do what needs to be done though, including sleeping with one eye open.

 

So happy to see you here @Elizabeth and Bertie - totally out of my depth with anything other than basics and moral support on anything like this!

And yes, I know the problems with food as we have 6 cats here too - all on different foods. It's tricky, but it can be done. I too forgot to ask most of the questions I probably should have done when Rosa was diagnosed - it comes as such a shock that all the questions go right out of your head until later. But there are so many wonderfully helpful people here who will give you guidance when you need it as they've been doing for me.

 

I'm not sure what's going on either, April. And never underestimate the value of moral support!

 

Well done for getting that test (although I do understand that the strips have expired and the test may not be accurate).
Did you mean trace elements of glucose or trace elements of ketones?

 

I'm sorry ... yes, I meant ketones. As of this moment, I am unable to measure her glucose. (And support is a very powerful remedy for mounting anxiety! ty, ty, ty!!)

 

Hi again Rose,

Just been having a read-through of your first post again.
Regarding the constipation; do you know if Zoey has pooped yet? Or did the the vet do anything to try to remove it? I'm wondering if her apparent 'worsened neuropathy' is actually discomfort connected to the constipation issue?

And it may be that Zoey's blood glucose is high now because of the insulin having worn off, the glucose and dry food she's had (and any discomfort from the pancreatitis and constipation). It may also be elevated if her blood glucose had dropped too low and triggered rebound (where the blood glucose swings up higher to compensate).
High blood glucose could have caused Zoey to urinate where she was sleeping. (That has happened with my own cat in the past.)
But all of the above is pure hypothesis. We don't actually know what the situation is...

Insulin is usually given twice a day. So I'm not sure why the vet prescribed it to be given once every 24 hours...?

How is Zoey doing now?

 

Just another thought for you - metronidazole can have some odd side effects in some cats. I doubt it's the whole story, and I certainly wouldn't assume it's the answer, but it's just possible it might be contributing to her being sleepy and possibly some of the other symptoms too.

 

Good thinking, April.

 

I am told that Zoey did poop since we took her to the vet on Monday and she was so compacted. They are confident the constipation is what caused her pancreatitis and hopeful that the pancreatitis is what is causing the diabetes diagnosis. She is still on Laxatone and I gave her a dose of that (5 ml) about 2:30 (two hours ago). I've almost convinced myself that I should go to Walmart and pick up a glucose meter (please advise which one is the best for an inexperienced diabetic kitty mama to use... so much literature to read through) before I give her the 2 units of insulin. I know that the protocols that I've read mostly talk about two doses daily and that the vet assistant said that originally the doc had prescribed 1 unit every twelve hours but that he had her change it to 2 units every 24 hours (and the dosage is marked through on the label). Zoey is resting at the moment (sleeping hard ... probably from the meds as manxcat has suggested) but not shivering like she was. She is very unstable when she's moving around and urinating anywhere but the litter box. She is definitely not stable enough on her legs to climb in and out of the litter box but she does manage to pull herself up onto her suitcase that she likes to sleep on. (We've suspected that is her favorite place due to the hammock-like effect that it gives her without the hardness of a firmer surface or the floor.)

 

Rose,

That is an excellent idea!
The fact is that there is no way of knowing what Zoey's blood glucose levels are without testing.
Quite a few US folks use the WalMart ReliOn Confirm or Confirm Micro (at least I think that's what they're called). But don't get any meter with 'True' in the name (they're not reliable for cats' blood).

I'm glad Zoey is resting now.

 

The antibiotic is the only other thing I can think of that might be contributing since the effect of the insulin should be leaving her system. It might be worth checking with the vet once they're open to see if they think it might be partly that and, if so, if there's a different antibiotic she could have instead.

As far as meters are concerned, I've been using the ReliOn Confirm from Walmart. The meter was about 15$. The strips are rather more expensive than that of course. I've been using the alternate site lancets - they're a 26 gauge which makes it easier to get blood to begin with than using the smaller ones. I believe the ReliOn Micro is also very good though I haven't tried one myself - I believe the meter itself is smaller so might be more difficult to handle without dropping if you're testing when you're tired or only just woken up. They both only require a small blood sample (in fact they use the same test strips) which makes it easier to get enough blood to actually get a reading. The Confirm is incredibly easy to set up and use - it took me less than 10 minutes and I can walk you through once you have the meter in your hand if that would help.

 

Here's a link to a page of pics and basic info about 'hometesting':
http://www.sugarpet.net/bloodtst.html

It is actually a very straightforward and painless process. But, like anything new, it might take a few goes to get the hang of it.
In a nutshell, testing involves pricking the outer edge of your kitty's ear to get a little blood droplet; transferring that blood droplet to a test strip in a glucose meter, and waiting for the meter to count down and give the reading.
Pricking the ear should not hurt the kitty. The outer edge of the ear has few nerve endings.
It helps enormously if the kitty's ear is warm. (Warm ears bleed more easily).
Most of us reward our cat's for each test (or attempted test) by giving a treat or a cuddle.

 

I've read Bertie's Blog and quite honestly, it sounds pretty much like the lead up to our cat's issues. I'm not so sure that the pacreatitis caused the diabetes and that undiagnosed diabetes didn't cause the pancreatitis.

Zoes is a "tuxedo cat." About eight or nine months ago her black hair starting turning to "ginger." We took her for blood work then to see if there was perhaps something going on that we needed to know about. That was in July and she tested wonderfully with no signs of anything that would cause alarm. We searched and searched for a reason that her coat was changing, both in color and in texture, and through a process of elimination we chalked it up to age and perhaps an ongoing battle we were having with fleas. Zoey has always drank a lot of water but she started eating a lot of food. So much so that she was gaining a great deal of weight but she always seemed hungry and would jump through hoops to get her treats. Her appetite never wained and she's never lost weight so there were no obvious signs that something was terribly wrong, other than the hair issues which we tested blood for and it all appeared good. Zoey is one of five cats and they have free run of the house and yard. They come and go at their leisure and let us live in their home with them. To say they're spoiled is an understatement ... but I must admit that due to the free range they had, we would see her go potty outside but did not realize she wasn't actually going. Of course, we knew she was peeing because she had started doing it in inappropriate places in our home but we explained that away by the arrival of a new cat to our home. Over the weekend she started walking like maybe she had arthritis (she's 12) but it got progressively worse. When I called the vet on Monday, they were busy and because she was eating and able to walk (but with rests) they wanted to put her off until later in the week. I insisted that she come in right away because something was just totally off and I couldn't put my finger on it. Well, that's the same feeling I have now with the insulin stuff. Something doesn't feel right and testing blindly makes me very uncomfortable.

I feel for each of you (and your babies) who has hoed this road; but am ever so grateful that you are sharing your experiences so that others can perhaps have a smoother go of it.

 

Aha, that rings a bell..
That 'black fur turning ginger' thing has happened to some other cats here. I'm pretty sure it happened to Aine's cat @Critter Mom and she may be able to tell you what she found out about that.

 

Bertie had bad neuropathy at diagnosis. The vet said it is usually a sign of a cat having been diabetic for quite a while.
Fortunately though, neuropathy can be reversed.
Getting the kitty into a better blood glucose range is a big part of it, but quite a few of us here have found that supplementing Methyl B12 (methlycobalamin) helped a lot. It helps to repair the nerve damage in the legs. Like many cats here, Bertie recovered completely.

There is actually a methyl B12 supplement made for cats. It's called Zobaline. But Dr's Best also do a methyl B12 supplement, and I think some US folks use a Vitacost version. It just needs to be a type that's free of any additives that might not be suitable for cats. And the usual dosage for feline neuropathy is about 3mg per day. Fortunately the B12 has little taste and can easily be put into food.

 

I'm definitely interested in the cause of the hair turning. We have another all-black cat whose hair is not as black as normal. Again, we've attributed it to the ongoing flea issues (we do EVERYTHING you can imagine to eliminate them but they have proven indestructible through this mild winter we're having here in Florida).

I am off to Walmart to buy a glucose meter ... looking for Relion Confirm or anything that doesn't have "True" in it. Also going to get some Alternate Site Lancets and extra glucose strips to fit the meter I end up with, and of course I'll get a new set of ketone strips. Is there anything I'm missing on my list? I'm wanting to get Zoey tested ASAP so I can give you wonderful people some real information you can work with.

 

Neosporin ointment with pain relief is good to put on for testing - just a dab can help the blood bead up to make it easier to get it onto the strip. And of course the pain relief is soothing for kitty too.

 

I now have a glucose meter (ReliOn Confirm) and it's all set and ready to go. I've used the lancing device to prick Zoey's ear ... but no success. I've heated her ear with a washcloth, I've massaged it. I've pricked it four times and the best I can get is a trace of blood. I've used the vaseline to help it bead ... no luck. What should I try next?

 

Sorry I have only just come back online so missed this. Hope all going okay and you managed to get so,e supplies from Walmart.

My cat had glucose in his urine when he had a bad pancreatitis flair and you are right this did resolve when he got better. It was a few years ago so I am not sure why my vet knew to just leave it. Do you know how your vet diagnosed pancreatitis? Did she have a spec fPL test? What are her main symptoms?

The lack of movement may be a sign of pain - but it doesn't sound like she is sitting in a meatloaf position? My cat's neuropathy actually got worse after starting insulin and was the result of low potassium. Do you have any other blood test results? I would request it when you go back. He has since recovered with a daily supplement.

Re the ears. Give a treat and leave alone for 20 minutes. Have you read the tips link? Are you using the lancet in a pen or free hand?

 

I might have missed it but what food do you normally feed?

 

I watched this video to help me learn
The video shows the lancet being free-handed, but I use the lancing device as I found it easier. Either way, the place to get the blood drop from is the same. You might want to try switching out the standard cap on the lancing device for the clear one that comes with the Confirm - it makes it easier to see where you're going to hit the first few times.

If you can't get blood from her ear, there is the alternative of using a paw pad instead - I change up what I do with Rosa at the moment as I'm having to test so often. She doesn't seem to object to me taking blood from either place.

 

Well done, Rose, for getting that test kit.

Some things I find helpful are;
Being sure to put a little pressure on the underside of the ear, opposite to where you're pricking. The lancet needs something to resist otherwise it can push the ear away rather than prick it. Some folks hold a wee bit of folded tissue or cotton wool against the inside of the ear. I just use one of my finger tips (though have occasionally taken a sample of my own blood in the process...)
Massaging immediately below where you've pricked can 'milk' more blood out of the ear. The blood flow runs from the tip of the ear to the bottom of the ear, so massaging below the prick site 'catches' a little of the blood that's on it's way down.
Quite often, two ear pricks close together will produce enough for a blood test where a single prick doesn't.

How is Zoey coping with this?
And are you OK? (You must be exhausted!)

 

Hi Rose,

I'm sorry to hear that Zoey's having such a tough time of it at the moment.

Re the fur rusting, that is usually down to a nutrient deficiency (one of which is tyrosine IIRC...). Saoirse's fur was very rusted when she was diagnosed, and this was put down to her age by the vet we were registered with at the time. Saoirse was also pulling fur out of her right side (pancreatic pain). Her tummy was also bald from overgrooming; something the vet at the time had repeatedly put down to stress/boredom. After Saoirse switched to wet, species-appropriate low carb food the fur on her tummy started to regrow, which points to her being allergic to something in her previous Royal Canin prescribed veterinary diets. Also, when the pain in Saoirse's pancreas eased as her treatment with insulin and regular vitamin B12 injections (cyanocobalamin) progressed, her fur started to regrow on her side as well. All of the regrowth was black. So much for the "old lady" opinion.

The nutrient deficiency may be down to malabsorption of nutrients - with pancreatitis the cat may not be producing digestive enzymes properly and/or there may be inflammatory bowel disease present (which could cause pancreatitis). Another possible cause may be down to insufficient insulin, since cells do not receive enough energy from glucose to enable proper metabolism of nutrients that may be available.

I'm glad you're getting a glucometer and learning to home test. I had to give insulin 'blind' for the first couple of weeks because I got no support for home testing from the vets we were registered with at the time. Thankfully, when we moved to a different practice the vets taught me how to home test. The peace of mind it gives is beyond measure.

Zoey is blessed to have such a loving mom.
.

 

Here's the link to the page of tips, tricks and videos:
http://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/
.

 

okay ... i took the blood from her paw pad. Didn't seem like a lot of blood, but it did give me a reading of 585 which I know is very high. Should I take it again to confirm that reading or go ahead and give her the 2 units as prescribed by the vet (one every 24 hours) and then take a reading again in a few hours to see how she's doing?

 

So is the shot due now? You are giving 2 units every 24 hours?

It is better to give insulin every 12 hours to provide better coverage so you might be better splitting the dose and giving every twelve hours.

 

When remi was first diagnosed we gave 1 unit every twelve hours and even that was a little high and dropped it back a little.

If you do give the shot I would test 2 hours after the shot.

When I say split the dose I mean 1 unit every twelve hours

 

Oh, well done for getting that test!
Yes, that is a very high reading (although entirely possible in the circumstances). If you can get another test to doublecheck the result that might reassure you that it is correct. (Or if not, you could always test that the meter is working OK by trying it on yourself...)
.

 

Answers to questions asked so far:
I do not have the blood test results, but will be requesting them when they open.

Zoey is on Purina Complete (dry -- free fed) and Friskie's Pate (various flavors, twice a day). I used to make Lisa Pierson's raw food recipe for a medical mystery cat that we had, but when he passed, I stopped. I didn't feed it to the other cats as their exclusive food, just as a daily treat so they could benefit from the beneficial nutrients that were added. I plan to re-adapt that feeding plan once Zoey's stable and I am more proficient with this glucose monitoring.

And the information provided on the change of color in coat is good to hear. Up until today, I've thought I was the crazy one since I keep insisting that there's something going on. Hopefully once we get this insulin stuff figured out and I switch to the raw diet, then her coat will return to the wonderful soft black that it was. Much of what you described is exactly what has been going on, all the while her tests were not showing anything awry.

 

I agree, Sarah.
It's not clear why the vet prescribed it this way. Apparently the vet was originally going to prescribe one unit twice a day but this was later changed to 2 units once a day. But yes, Vetsulin should certainly be given twice a day in normal circumstances.

 

Rose, did you manage to get some new ketone test strips? It would be good to get another urine test done if possible... (Sorry, we're asking a lot of you, I know....)

 

I did get new ketone strips and as soon as I see her moving about to possibly relieve herself, I will be at the ready.

I have tried drawing her blood yet again and I am having no luck getting a sufficient amount of blood. I feel that I am stressing her out. I am of the belief (but I admittedly know nothing) that I should give her 1 unit (based on 40 mls) and check her again in a few hours. How long I should wait, I don't know. She's got several other medicines I need to give her, as well, and I plan to go ahead and administer those so I can get on some kind of schedule. Do the collective minds of knowledge feel this is a good approach? Do I need to feed her the wet food or wait and see what goes on with the next reading?

 

oh, plika, you asked if the shot was due ... I was never told when the last shot was given to have a time schedule so we assumed she had had it when we picked her up last night at 5:30 and I was waiting until this morning's reading before I went forward with the prescribed dosage of 2 units once every 24 hours.
... so it is definitely due by now and has the possibility of being a little overdue or a LOT overdue. :/

 

This is the usual plan of action

Test, feed and give insulin. So you have one test under your belt so now you know she is high you give her some food and then give insulin. Then I would retest in 2 hours. Personally I would not give 2 units but stick with 1 unit now and 1 in 12 hours. Especially if that is what the vet originally said.

 

I agree.

Rose, how are you feeling?
.

 

I tried to feed her but now she just won't eat. I left food for her but I suspect she's wondering what I'm trying to trick her into eating since there's so much other abnormal stuff going on around her.

I went ahead and gave her the insulin (one unit). It doesn't seem like an awful lot in that little syringe. It's a syringe that has 20 on it, with 5, 10, 15, 20 being numbered and the other numbers in between being lines. The insulin is a 40 ml bottle ... although now I look at the prescription on the bottle's box and it says Vetsulin 10 ml bottle on the label they've applied. I gave only to the first line which would be indicating one unit. Did I do this right?

 

It sounds right. The syringes are designed for giving larger doses to dogs.

You might find that her appetite picks up in an hour or so as the insulin kicks in so keep her food available for her.

 

Did you manage to get a glucometer, Rose?

 

Yes she got her first test

Am ? pre shot was 585. She has given 1 unit and will be retesting in +2 hours

 

I have attached Zoey's lab results. I do not know what it is I'm looking at (yet, anyway) so if you don't mind, I would love to have it reviewed and teach me what it is that I need to know and look for. I did relook at the bottle and it is a 10 ml bottle of vetsulin with 40 units per ml. the dosage is 2 units for 24 hours which the vet confirmed for me this morning and said it was to the second line (on the 20 ml syringe). Based on the collective knowledge and experience here, with this type insulin being in/out, I have only given 1 unit and will redose the 2nd unit 12 hours from now. (That was the original prescription before the vet changed to current 2 units once every 24 hours).

I did test my own sugar and the reading was normal so I'm going to assume the first test was accurate. I also noticed, when doing my own test, that the prick the lancing devise administered was not very deep, even on the deepest setting. Unless I had it clicked to the deepest setting, the pin didn't even make contact. Am I doing something wrong? It is a ReliOn lancing devise that came with the ReliOn Confirm glucometer.

I was asked how I was feeling ... anxious but more in control of the situation than I felt before I had the home testing kit in my arsenal and the support of some tried and true warriors behind me. I can't say it enough ... thank you!

 

The high blood glucose could have been a rebound from a possible low blood glucose overnight with the 2 units. We will know more after a day or so on this new regime and a few tests under the belt .

Re the tests I can't quite read the second set. The ALP, etc. I think I can see a low potassium result but there is a black line running down it all. When you get time could you type them out. Sorry to be a pain.

Please try to get a reading 2 hours after you gave the insulin. Good luck

 

Hmmm... Is it possible that the lancet is pushed down too far into the lancet device?

 

@phlika29 - Thanks for BG info, Sarah.

Rose - well done on the home testing! I know from personal experience how much relief I experienced when I could finally check Saoirse's BG any time I needed to. Sounds like you're feeling similarly. The testing gets easier with practice, and in no time you'll have developed a routine that works well for you and Zoey.

 

I have taken another glucose test and it is now 407 after two hours. Is this good improvement to expect or should it have been more? She's not wanting to eat or drink, including ignoring her treats.

I will happily type out the blood results at first chance.

 

The blood glucose before insulin (what we call the 'preshot' test) was 585, so to see this 4o7 two hours later is quite a drop actually, even though the number itself is still high.
It could be that the high carb food Zoey had earlier is wearing off now too.

Well done, Rose, for getting that test. Was that on the ear or the paw pad?

And have you managed to get another ketone test yet? (Sorry, I don't mean to push you. But I think it's important to check given that Zoey seems off her food).

.

 

I did get Zoey to eat two of her treats, but she was greatly coaxed which is very out of the ordinary up to this point. I gave her a syringe full of water (need to do more) but other than that, I've not seen her drink at all.

She did just urinate so I was able to get another ketone test. It wasn't as bright as 15, but it was pinker than 5. (I had to walk through the house so it was a little longer than 15 seconds when I compared)

I am having to take the blood from her paws. Both came from her rear right pad. (Will use different foot next time) I've tried a few times in the ear and no luck getting "enough".

Do I leave her be for another two hours and check again? Force feed her several syringes of water? We moved her suitcase to the porch so she's found her way back to her comfortable spot and we are letting her rest.

 

I personally would give her more water with the syringe. I would aim for 10ml every hour or so. I would retest her blood glucose in 2 hours.

Can you explain that ketone test result. How does the scale go?

With regards the food ideally I guess you would be getting her to eat the wet food so it doesn't raise the blood glucose levels too high. You can also add water to this food.

Do you think she could be nauseous? Remi was really bad when he had his panc flair. Does she display any of these signs. Walking up to food and then turning away? Licking her lips? Grinding her teeth? Did they mention giving an anti nausea medication such as ondansteron. It might be worth getting this from the vets if you can or some cerenia if she is vomiting.

Can you edit your signature to include the insulin you are using, food, other medication and conditions. It will help others.

 

Hi, you are doing great so far. I'm glad that you got a meter and are starting to test. Knowing what the BG reading is is essential before giving insulin. It is also essential for you peace of mind. No parent would ever inject their child without knowing what the BG is. Why should we do so w/ our furbabies? Zoey will get used to testing and her ears will learn to bleed for you. Be sure to give rewards every time you test, whether you get a good sample or not. Many of our cats will purr through the whole process because they know they are going to get a treat. Try taking an old sock and put about 1/4 cup of uncooked rice in it and microwave it for about 20 seconds depending on your microwave. Use that to warm the ear and give support from behind when you prick. ALWAYS put pressure on the test site for 20 seconds after to stop the bleeding and any bruising.

It's nice to see that Zoe is coming down, but that could be from the carbs wearing off, that was a lot of Karo, we usually only give a few drops. The effects of Karo can wear off quite suddenlly. The preshot reading could also be a bounce from going too low earlier. The liver will sense low BG (or lower than it is used to) and dump glucagon and counter regulatory hormones into the blood to protect against hypo. Eventually it will learn what normal is again.

Giving half the insulin twice a day is a very good idea. Vetsulin is an "in and out' insulin, it doesn't have a long duration. Cats have a much higher metabolism and usually need insulin twice a day. The 40 on your syringe is because Vetsulin is a U40 insulin, there are 40 "units" of insulin per cc, so the syringes are always marked for the type of insulin. The measurements on the barrel are different for other insulins.

Those test results are hard to read, it looks like her potassium is low and her phosphorus? Low potassium can definitely show as muscle weakness. It also says "UTI'" hand written. Was she also dx w/ a urinary infection?

It's also quite a list of meds you were given;

Vetsulin - really a better insulin for dogs than for cats
baytril - anti biotic, for the UTI??? UTI can be infection or inflammation from crystals. Were bacteria found? If so, what type?
Methigel - for urinary ph, covering all bases in case it's crystals, but Ph was normal? Were crystals seen in the urine?
carafate - is used for ulcers
metronidazole - this is for diarrhea! and Zoey was in for constipation ?????????
Laxatone - for constipation (or hairballs) but it is really high in sugars, 3 of the first 6 ingredients are syrups, not good for diabetes!
​

I've put in links for you to check out for most of the drugs. Get used to researching and double checking everything.

You seem to be familiar w/ Dr. Lisa's site. She has a great list of most of the cat foods and their carb content. Ideally you want to feed foods that are less than 10% calories from carbs. Check out her nutrition page and you will want all your cats on canned food. Yes, it's more expensive, but a lot less than the vet bill for the conditions that dry food causes or aggravates.

 

There are lots of options for helping cats with constipation. For me changing remi to wet food helped a lot but before that I used miralax but have heard others mention pumpkin and a few other things. I guess it depends with how chronic it is. Getting her to drink more will help.

 

The ketone tests are sensitive on the timing. Try it on yourself and see how it will change over time.

Zoey really should eat w/ her insulin, could be another reason why there was so big a drop in 2 hours. You can assist feed by blending canned food w/ water in the blender and syringing.

Apart from nausea, pancreatitis can also be quite painful and so can UTI. You didn't get any pain meds? My Tess gets UTI infections, my vet has given me buprenorphine to have on hand ( it usually starts in the middle of the night ) She settles down and stops running to the LB, in the morning they can run the tests to see if/what anti-biotics she needs.

 

If all else fails just about any cat will eat baby food. Just get the kind w/ no onions or garlic, like Gerber Stage 2.

 

Here is a link to the IDEXX pancreatitis treatment guidelines. It covers all of the medications recommended for pancreatitis treatment. It also has food recommendations.

Inappetence and insulin treatment are hard to juggle. Saoirse was like Zoey in that she developed appetite problems not long after starting insulin treatment. It was a nightmarish time for us.

I'd suggest contacting your vet about generic ondansetron for nausea, an appetite stimulant such as cyproheptadine. I believe Cerenia helps with vomiting and and it also has an anti-nausea effect. It may be that you don't need the meds, but having a supply of them in Zoey's medicine chest could help you to manage her pancreatitis much more effectively. Without the cyproheptadine and ondansetron I would never have been able to manage Saoirse's treatment at home. Vitamin B12 supplementation really helped Saoirse greatly (vet gave those injections). I've actually started her on another B12 course recently. I think it's one of the best supportive treatments she has received (see IDEXX guidelines for further info). Last year it really seemed to give her whole system a boost.

 

I think I put the pertinent information in my signature line now. If I'm missing something, please let me know. I want to make everything as easy as I can for everyone who is so kind and generous for sharing your time and knowledge.

On the metronidazole -- I had looked that up and that is an antibiotic. One of the side effects (there are many) is diarrhea. Another is nausea and she has stood over her food and just looked at it.

Zoey is not throwing up and I've given about 5 syringes full of water since 10:00 but I obviously need to up that and will make sure to do at least 10 ml per hour. I feel she has a fever but for the life of me I can't find the thermometer to take her temp. I went ahead and rubbed the pads of her paws with some rubbing alcohol. (vet told me when all else fails, this will bring their temps down) Figured it wouldn't hurt her even if she didn't have a temp. I'm going to ask my husband to stop by store and pick up a new thermometer on his way home.

She absolutely has pancreatitis. I saw where it said UTI but I assumed this was part and parcel with the pancreatitis. I hate to hear that I overdosed her on Karo. I read somewhere on one of these forums that 1 T and I thought that was a little high so I did less than that, for sure.

As far as the ketostyx ... yes, I know they change depending on the time lapse. It probably took me 30 seconds to get from outside to the test bottle and grab my glasses. They recommend 15. That's why I gave the description that I did. I've been using those sticks for years when I used to low carb and the color never got all the way to 15 but it was definitely more than 5. As far as the scale, 5 is trace and 15 is small amounts. (The complete 6 color scale: negative, trace (5), small (15), moderate (40) large (80) (160) -- two shades in that large category.

I'm going to go ahead and mix up some wet cat food with some water and see if I can't get some calories in her. It will be taking care of both issues at one time. Love that I maybe won't have to shove stuff at her face as often!! (She's going to hate the sight of me! smh)

As far as her constipation .. we were not aware she was constipated and getting backed up. I had been giving her DE for worms (did I mention how bad the fleas are this year?!) and hopefully to help with the ginger coat that she had going on. I'm wondering if that didn't add to her dehydration (she was very dehydrated and they gave her fluids) and constipation. Only gave her a teaspoon daily for about 3 weeks and added to her food with extra water mixed in. (I take it and am loving what it is doing for me.)

Food ... we have a couple of cats that just will not give up their dry food. So, we do feed them all wet food but at night we usually have dry food down for the stubborn cats and the others who just want to graze. I will definitely be changing Zoey back to Pierson's plan.

If I missed something, please nudge me again. I'm trying to work from home while I pick your brains, nurse my sweet baby and pretend I'm being productive with the J.O.B. ... but we all know my mind's somewhere else.

 

Don't worry about the Karo, it wears off. Just good to know for next time.

You could try pro-biotic and pre-biotics ( fiber on which the pro-biotics feed). Pumpkin is good, but Tess won't touch it, you could try psyllium added to her food. I don't know if the constipation is a one time thing, but believe it or not there is a great website for Feline Constipation. We have crazy cat lady sites for everything!

Yes, metronidazole is an antibiotic, but it is also anti-diarrhal. Diarrhea isn't a side effect, it is used to treat diarrhea.

Got to go and get ready for class. Any more tests?

 

I'm trying to take a test now but I'm having absolutely no luck at all getting enough blood. I prick, it bleeds a tiny speck, just not enough. :/

 

Was that the ear or the paw pad, Rose?

 

I've tried two new paws and a new ear. I've used heat (rice in sock and warm wash cloth). I've massaged. I've prayed. I'm at a loss.

She really feels bad. I've forced water on her but I can't get her to touch the food or open up for it. I really feel I'm stressing her out by trying. I do have some ringers here and I can do fluids by IV. I think I will call the vet and see what he says about anti-nausea meds and the fluids. Should I continue to wait until 9:00 tonight to give the second shot of insulin? Is the idea to lower the BG slowly and that's why I didn't want to do it all at one time and we're okay with the drop that we've seen so far, although it's still high?

 

A chat with the vet sounds like a good idea at this point, Rose.
I think you should also tell the vet that Zoey's urine showed a ketone reading at above trace level (and that's something that should be watched very closely, especially given that she's off her food. You don't want that getting any higher).

You've been through a lot today...
Huge hug to you,

Eliz

 

If she were mine I'd ring the vets to let them know what's going on.

Regarding regulation of blood glucose, it's a gradual process. A cat's body needs to gradually get used to lower numbers. Giving too much insulin will either result in a hypo or possibly send numbers higher since the cat's body may react by dumping more glucose into the bloodstream to protect the cat. Even a safe number that's lower than the cat's body is used to can trigger off bounces.

 

The sub q might be a good idea as giving them water orally might fill her up.

If you speak to the vet as well as asking about an anti nausea medication I would also ask for a potassium supplement for her low levels. That will help perk her up. I give my cat kaminox in his food. He loves it as it stinks of beef. It's a little dropper amd I started off with 1/2 ml in the morning and at night. Then upped to from there. He is much stronger now he levels have improved.

If you don't manage to get a test, just give a treat and leave it for 10 minutes.

With regards the dry food, they say that even one of two bits of kibble can bring their blood glucose up by over 100 points.

Don't give any more insulin until it's due tonight. Just test ever couple of hours if you can

 

How is it going now? Did you manage to get any more tests? Speak to your vet?

When you do get back online I would recommend that you either start a new thread (and put a link to this one) with what is happening now ie dose, readings, concerns, etc. or alternatively you could amend the title of this thread by clicking on the edit button at the top by your first post. Whatever method you choose you need to title to reflect your current situation or questions you have.

 

You've gotten a lot of great advice so far! Eliz asked if I could drop in and take a peek, and I can only think of a couple of things to add.

The "potassium low" caught my eye, because my sugarkitty, Bob, suffered from that from day one. It showed as overall muscle weakness, especially his hind legs. "looked like" neuropathy, but in his case, it was due to very low potassium. He also was severely dehydrated, so my vet dealt with both issues with the same treatment. She sent me home with a bag of lactated ringers that had potassium added to them. Bob got up to 200ml of sub-q fluids w/ potassium per day, and did so for weeks. Eventually it was reduced to 100ml every other day, or 3rd day. It took a month or longer before his potassium returned to the normal range. The way it was explained to me was that potassium supplementation needs to happen slowly and be controlled. Because "too high" is just as bad as "too low".
You should never administer sub-q fluids without your vet okaying it. And same goes for potassium. That has to be frequently monitored by blood tests, I think Bob got tested every couple of weeks to see if the level was coming up, and the amount added to his fluids was adjusted accordingly.

And on the issue of getting blood out of the ear. . .
I found that Bob bled better out of one ear rather than the other one. The very first thing I did was take that lancing device and toss it in the trash. My vet asked me "Can you sew on a button?" I said "yes, ma'am". She said, "okay then, you can do this." I "freehanded" the lancet. It really helped me to see where I was sticking it in his ear. And I felt much more in control of the process that I did trying to hold a big old plastic device that made a loud noise when I tested him. The "poking" was much less stressful for Bob and for me, and after just a few days, he gave me no trouble at all at test time. Fresh shrimp as a "test treat" certainly helped. Bob would chew through a battleship if he knew there was shrimp waiting on the other side, so if all it meant was a little poke in the ear? He'd come to me when he saw me getting the meter ready. He'd look at me like he was saying "get it right the first try, Dad, I got shrimp waiting for me!"

I agree with what others have said about dosage. Better two shots a day than just one, because Vetsulin won't work well on a once a day routine. Find out if your vet has experience with Prozinc, Lantus or Levemir perhaps, as all three are much better at treating feline diabetes. Prozinc is a "U40" insulin, like Vetsulin, so you would use the same syringes. Lantus and Levemir are "U100" insulins, so you would use U100 syringes. And with feline diabetes, the recommended routine is "2 shots per day" according to the AAHA guidelines. The biggest issue with Vetsulin for cats is that it isn't likely it will last for even 12 hours, so the other 3 I mentioned would be more appropriate for cats.

 

We have an appointment at 4:00. ....
The above sentence is what I had last written before my internet went down. I will start a new thread now. "2:00 in the morning update"