? 24/12: MITTENS - Novolin N, Small Ketones

Discussion in 'Feline Health - (The Main Forum)' started by Critter Mom, Dec 24, 2016.

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  1. Critter Mom

    Critter Mom Well-Known Member

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  2. Critter Mom

    Critter Mom Well-Known Member

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    STORY SO FAR:

    HUMAN METER - NOVOLIN N INSULIN - Regular Assist Feeding via Syringe

    DIABETES STATUS:
    Dx - 19 Dec 2016; Insulin started PM 23 Dec (extremely poor vet support caused delay)

    KETONE STATUS:
    -
    Urine test: Positive SMALL (at vets c. 12:00 Noon on EST 23 Dec)

    MEDS:

    Anti-nausea:
    - Cerenia administered at vet - c. 12:30 EST 23 Dec - (NB: NO CERENIA DISPENSED FOR HOME TREATMENT!!!)
    - B12 administered at vet (same time as above)

    Appetite Stimulant

    - 1/8 of 7.5mg tablet mirtazapine administered at c. 02:30 EST 24 Dec (next dose due in 48-72 hrs)

    Potassium Deficiency:
    - Next dose potassium supplement due at 06:00 EST 24 Dec (Dose: 1 tablet every 12 hours for 2 weeks.)

    ----------------------------------------------------------------------------------------------------------------

    INSULIN - Novolin N (U100 Insulin) - RELION METER

    PMPS - 389 - Dose: 0.5IU (20:30 EST 23 Dec) - Assist feeding via oral syringe throughout cycle.

    +1.5 - 237
    +2.5 - 266
    +4.0 - 258
    +6.0 - 234
    +8.0- 290 (+7.50 - ate 7.5ml via syringe)

    ETA: Click here to see Mittens' BG Spreadsheet.

    (I'm updating it for now until someone can transfer ownership to Dan & Heather.)
    -----------------------------------------------------------------------------------------------------

    (Note: for those following Mittens in the UK, EST = GMT - 5 hours.)
    .
     
    Last edited: Dec 24, 2016
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  3. Critter Mom

    Critter Mom Well-Known Member

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    Food & Fluids:

    - Assist feeding via oral syringe: meat/broth baby food; home cooked chicken breast and broth; Pedialite.
    - Caregivers have supplies at home for giving sub-q fluids if they are required.

    Hypo Kit:

    - Fancy Feast Gravy Lovers; honey; Temptations treats - all available.

    .
     
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  4. Dan&Heather

    Dan&Heather Member

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    Dec 21, 2016
    Thank you for starting the new thread and compiling all that information into a list.

    The last glucose test we did was pretty stressful for Mittens I think. It took several pokes before we got any blood at all. She was squirming really bad, makes me feel awful for her.

    Dan fell asleep on the couch around 5:00 waiting for the scheduled 6:00 potassium feeding, I wanted to let him get some sleep so I did it myself. I mixed the crushed potassium with 10mL of food. It was very difficult, I feel even worse now that he had to do it all night without me. I was able to get her to eat about 7.5mL of it. I'm concerned because that means she only got 3/4 of the pill in her when she's supposed to have the whole thing. I hope somehow she starts eating on her own soon. The appetite stimulant didn't seem to do anything. She does seem somewhat interested in the food on the plate but never eats any more than a 2 or 3 licks still.

    I have an alarm set to get up and feed her in couple of hours, I really feel like we haven't been feeding her enough. For now though I have to get a little of sleep. Thank you again for starting the new thread. We'll be back on here in just a little while
     
    Last edited: Dec 24, 2016
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  5. Critter Mom

    Critter Mom Well-Known Member

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    Hi Heather,

    Having been there myself I know just how rough it is emotionally to have to intervene like this to help our fur babies. It helps a lot to grit your teeth and 'keep your eye on the prize', not the treatment delivery. Every bit of food Mittens eats, every treatment she gets, every drop of water she drinks is filled to brimming with your love for her - and keep reminding yourself of that. Talk reassuringly to her & tell her why she needs the food and medicine; not at all easy to do when you're tired and worried out of your mind ... BUT ... it will calm all of you a little bit. Even if it feels like you're faking it, it does help!). :bighug:

    Every little bit of food and fluids Mittens gets down is a little victory, helping to keep the ketones down. A step at a time you're getting there: one foot, one paw ...

    Remember that you and Dan are a team: - everything you're both doing is helping Mittens. :)

    :bighug:


    Mogs
    .
     
  6. Sharon14

    Sharon14 Well-Known Member

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    Aug 16, 2015
    Hi Heather and Dan, I've been reading your saga and I must say I'm impressed! One thing I do when I give meds to animals is mix them in a small amount of food and once that is eaten, give the rest of the meal to wash it down. You are both doing an amazing job and Mittens is a lucky cat to have you!
     
  7. Critter Mom

    Critter Mom Well-Known Member

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    * * @Dan&Heather - MOST IMPORTANT THING TO DO TODAY: * *

    Move heaven and earth to get a supply of anti-nausea tablets
    from your %*$/@#^% vet before they close for the day.!!! ( :mad: - Pardon the vernacular but she should have prescribed them yesterday. :banghead: )

    (Sending you a PM - check your INBOX at top of screen in a few minutes' time.)

    Tell vet -

    - has an appetite but still nauseated - licks at food but then can't continue. (This is a CLASSIC CLINICAL SIGN OF NAUSEA!!!)

    If your vet is reluctant, try the "what's to lose by trying?" argument.

    ETA - if your vet says that mirtazapine is a perfectly adequate treatment for nausea in cats, disregard this: you've got solid proof Mittens wants to eat but at the moment she's just too queasy without additional anti-nausea supportive meds (refer to the IDEXX document if needed).


    Mogs


    .
     
    Last edited: Dec 24, 2016
  8. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Mogs, bless you for everything you're doing. I don't have the words.

    Dan and Heather - you are champions in caring for your little girl. What more can I say ...
     
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  9. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Thank you @MrWorfMen's Mom Linda for staying the course. Thank you to everyone else who weighed in. I wasn't much help - just too fatigued and that doesn't mesh well with my health issues. :(
     
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  10. Critter Mom

    Critter Mom Well-Known Member

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    So many members here helped me fight for my baby. (((Saoirse))) (((FDMB)))

    .
     
  11. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    @Kris & Teasel it's a pleasure to help dedicated pet parent like Heather, Dan & of course beautiful Mittens. Everyone else has been on day duty and giving such good advice that I didn't have do much other than standby for BG numbers and any questions. I'm just paying it forward for what I have received from this community. :):)
     
  12. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Well said, Linda. Paying it forward is what makes this forum work so well! It's been a crazy time here recently with hypo antics and new arrivals like Dan and Heather. All the extra seasonal busy-ness only makes it more hectic. :)
     
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  13. Beth 73

    Beth 73 Well-Known Member

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    You ALL are my Heros...:bighug::bighug::bighug::bighug::bighug:. Fantastic job to you both, Dan and Heather..what wonderful fur parents you are.And blessings over Mittens...what a trooper :cat: .Will be keeping you ALL in my heart, thots and prayers on this Christmas Eve.
     
  14. Critter Mom

    Critter Mom Well-Known Member

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    @Chris & China, @Marje and Gracie, other members:

    I've started a spreadsheet for Mittens but I don't know how to give Dan & Heather access (and some help with getting the signature done would be great if that's possible). Can someone help sort this out, please?

    I've recorded last night's BG data in the sheet. Here's the link:

    https://docs.google.com/spreadsheets/d/1N3b-1jXE5FAQ_7oXexRPUE1pWKCu15rjXmlQ6ez3CGE/edit?usp=sharing

    (Other members following: can somebody please let me know if you access Mittens' spreadsheet OK. Ta!)


    Mogs
    .
     
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  15. Olive & Paula

    Olive & Paula Well-Known Member

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    Echo what Mogs said. Get that cerenia 2 boxes if you can. They come 4 pills to a box. You give 1/4 pill daily. The appy stimulant will not work well if Mittens is nauseous. It's perfectly safe to give cerenia daily. It takes about 24 hrs to kick in. So right now you don't want to skip a dose. It comes in injectable form if you think you can give that.

    Here is something else to consider for non eating kitties. The Liver Shake. Never had to use it myself but others had great success with it.

    http://www.felinediabetes.com/FDMB/threads/the-liver-shake-for-sick-cats.30432/

    I will be on and off today checking in. Make sure you both get some rest. Do shifts or tag team. Mittens needs both of you well to get him over this hump. And you will get him though, no doubt in my mind.
     
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  16. Critter Mom

    Critter Mom Well-Known Member

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  17. Olive & Paula

    Olive & Paula Well-Known Member

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    I see it just fine. Great job Mogs. Been following you here. You are such a wealth of info. To attach to their signature. They need to have Google account set up and give you access to their account. After that I don't know.
     
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  18. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Yes, I can access the SS, Mogs.
     
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  19. Critter Mom

    Critter Mom Well-Known Member

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    @Woodsywife - Paula, you're a star! :bighug: ETA: You too, Kris! :bighug:

    Hopefully Chris or Marje will be able to sort out the sharing later on. (I'm going to add the link to the summary at the top of the thread and I'll try to keep updating the spreadsheet in the meantime when Dan and Heather post the BG tests and dose info.)

    .
     
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  20. Olive & Paula

    Olive & Paula Well-Known Member

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    It doesn't look like they got a morning reading yet. You holding up ok @Critter Mom . You been with them from the start. I'll try to get a PJ pic for you to keep you going, as soon as I find the litter bugger.
     
    Last edited: Dec 24, 2016
  21. Critter Mom

    Critter Mom Well-Known Member

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    Jun 16, 2014
    @Dan&Heather -

    As you can see I've set up a tracking spreadsheet for Mittens' BG results. We need to sort out ownership for you so later on you'll be able to update it yourselves. (I'll do my best with updates in the meantime.) Here's the link again:

    Mittens' BG Spreadsheet

    Members replying to your threads will also be able to see the spreadsheet and it will assist their efforts to help you both. The spreadsheet will help you to see how effectively Mittens' insulin is working.


    Mogs
    .
     
  22. Critter Mom

    Critter Mom Well-Known Member

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    My surrogate fur child! Yes please, Paula!! :bighug:

    I'm hangin' in there - just about. :)

    .
     
  23. Olive & Paula

    Olive & Paula Well-Known Member

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    Sent PM
     
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  24. Critter Mom

    Critter Mom Well-Known Member

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    Swoon! :) Thank you, Paula! Please give Her Adorableness some scritches from me. :bighug: (((PJ)))

    .
     
  25. Olive & Paula

    Olive & Paula Well-Known Member

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    Will do, no problem there. Get some rest. Looks like they might be doing the same.
     
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  26. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

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    Dec 28, 2009
    Good morning Dan and Heather! You guys are doing great!!! What a group effort all around!
    FDMB peeps are the best!

    I don't want to clutter up this thread with any unnecessary chit chat since both of you must be exhausted beyond belief and probably feeling like you're looking at the world cross-eyed about now, but I would like to make a couple of suggestions...
    If you're not already, get in the habit of writing everything down and then checking the list prior to administering everything and anything. It'll help prevent over doses when two caregivers are providing care.
    Going forward, mix the crushed pill in a smaller amount of food. You'll have a better chance of getting the entire dose into her.
    According to Larry and Kitties (he's a vet tech): "You can give 1/8 to 1/4 of a 7 1/2 mg tab every other day." Try giving a bit bigger piece than you did last time. These are newer guidelines.


    To those who have experience with N insulin: After Dan and Heather have had some rest and when they're available to dose more often, what about dosing every 8 hours in an effort to get rid of ketones? Higher carb foods can be fed to keep Mittens from bottoming out.

    No matter what insulin is used, when kitty is throwing ketones it's imperative to get more insulin into the cat safely. When Alex threw ketones I would have fed her anything (including HC) to be able to get a reasonable amount of insulin into her while keeping her safe at the same time.

     
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  27. Meya14

    Meya14 Well-Known Member

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    Jan 2, 2015
    Agreed! Every 8 hour dosing is preferable with N insulin and ketones if you can swing it. Now that your cat has insulin on board, it's OK to feed higher carb food if that's easier for her to eat on her own. Any calories you can get in her right now is the key, you can always increase the insulin dose to account for the extra carbs. This will help get rid of ketones.
     
  28. Larry and Kitties

    Larry and Kitties Well-Known Member

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    Dec 28, 2009
    further info on mirtazapine:
    - Clinical signs began between 15minutes and 3 hours and lasted between 1 and 48 hours. Treatments were varied and included IV or SQ fluids, reversal with cyproheptadine (which antagonizes the effects of mirtazapine), decontamination with emesis or charcoal, sedatives, and others.
    - Two basic steps may be taken to avoid mirtazapine toxicity. The first is to utilize an appropriate dose of 1.8-2.0mg/cat administered every 24 hours (less often for cats with kidney disease). The second is to use compounded drug at the intended dose, rather than relying on owners to correctly fraction the commercial 15mg tablets. These steps should dramatically reduce the incidence of adverse effects from this beneficial drug. (MRK)
    above from:
    http://www.winnfelinefoundation.org...29/mirtazapine-toxicity-in-cats-in-retrospect

    - As others have said I would get from vet either Cerenia and/or ondansetron, Cerenia seems to be better for vomiting and ondansetron for nausea. Both can be given together (Cerinia once per day and ondansetron twice daily).
    - N dose it depends upon how much food. Based on the 1/2 unit N does BGs, I would up it to 3/4 unit if Mitten keeps down the same or greater amount of food as when the 1/2 unit was dosed.
     
  29. julie & punkin (ga)

    julie & punkin (ga) Well-Known Member

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    Feb 17, 2011
    You've got lots of good help advising you, but I just wanted to add one thing in case you don't know. Saw the comment about not getting blood in spite of several pokes . . . as you poke it stimulates the growth of new capillaries. So even though it seems like it's not getting you anywhere, it is. It can take a week or two for the capillaries to grow more extensively, but after that point you will get blood every time. In the meantime, know that it's still helping and keep on persisting with the testing.

    my best to you and Mittens!!! You're on the right track!
     
  30. Marje and Gracie

    Marje and Gracie Well-Known Member

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    May 30, 2010
    Because Mogs is the owner of the current SS, even with editing rights (which I have), I cannot change ownership to Dan and Heather or post it to their signature. I’m assuming Mogs is sleeping now (I hope) so I’ve PMd Dan and Heather and if I hear from them, I’ll create a new SS that I can get right to them and get posted immediately.

    @Dan&Heather I sent you a private message requesting a bit of info I need to do the above. Can you please check your inbox ASAP (see “inbox” upper right corner of this page). It will take just a couple minutes max for you to respond with the two bits of info I need to do a SS, make you owner, and post it. Thank you!
     
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  31. Critter Mom

    Critter Mom Well-Known Member

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    Jun 16, 2014
    @Marje and Gracie - Thank you!

    I'm still here at the moment (though not for very much longer - need to eat and sleep). Is there anything you need me to do?

    .
     
  32. Marje and Gracie

    Marje and Gracie Well-Known Member

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    Yes. I’ll send you a PM.
     
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  33. Meya14

    Meya14 Well-Known Member

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    Jan 2, 2015
    Marje, is there any way you can add a tab for 8hr dosing as well as the traditional 12hr spreadsheet?
     
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  34. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Feb 18, 2015
    Heather & Dan, Just wondering how things are going there. We fully realize how totally exhausted you are and understand you need to get some rest too but we'd really really appreciate a quick update as soon as you have the opportunity. Not trying to make more work for you but we are getting a little worried. :bighug::bighug::bighug::bighug:
     
  35. Dan&Heather

    Dan&Heather Member

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    Dec 21, 2016
    Sorry, we both slept alot more than I thought we would. I set 5 alarms last night to make sure I woke up this morning and I don't even remember shutting them off. We are going to get a BG reading and feed her right now. I want to give her some of the fluids that I got from the vet, I know she needs them. They told me I could do them either every 24 or 48 hours depending on how much water she's drank. Yesterday she drank a tiny bit but really it was hardly any, so I really feel she needs them.

    The vet was already closed by the time I actually came to. I don't think we would have been able to get the Cerenia though, we spent out last couple dollars on a few more cans of cat food last night. I know it's not ideal, but can we try to use the pepcid for the weekend? Will it help at all? We need her to start eating and I'm getting frustrated because even if I had been up in time I wouldn't have been able to get the medicine she needs. I feel like I did half of the work, got some stuff she needs but missed a very important part of it. I wish I would've asked about getting some Cerenia for at home yesterday. I need her to eat on her own, the syringe feeding is difficult and frustrating and stressful for all 3 of us.

    I feel like we're losing this battle. I can't stand to think if she doesn't pull through that we made her spend her last time with us being force fed and poked constantly. A few people said we have messages, I'll answer those real quick then we're going to feed and test BG again.
     
  36. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Feb 18, 2015
    So good to hear from you and don't beat yourself up about sleeping through the alarms. You are beyond exhausted and I quite frankly wonder how you are still so co-herent. You are doing everything you can for Mittens and Mittens trusts you and knows you are only trying to help. Remember we've all felt poorly and not been willing patients for those trying to help us despite knowing it was for our own good!

    The Pepcid will keep acid down and that may help with the nausea to some degree but it may not be enough. Just wondering though, is the clinic in Appleton (quite a distance drive if I remember correctly) an ER that would be open over this weekend. (I'm sure this info is somewhere in your first thread so forgive me for not searching just now!) If needed I wonder if they would be able to give the Cerenia if needed. They did see Mittens. Something to think about if you could manage it.

    Agreed that she needs the fluids. I'll let you run through the posts since early this AM and if any questions, holler. You're doing great and Mittens is going to be fine!
     
  37. Critter Mom

    Critter Mom Well-Known Member

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    Jun 16, 2014
    @Meya14 and all other members following -

    Could someone with sub-q experience give Dan and Heather some guidance on when to give the sub-q fluids in relation to the insulin dose. (I've no experience with sub-qs.)

    .
     
  38. Olive & Paula

    Olive & Paula Well-Known Member

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    Sep 6, 2015
    I don't know about the pepcid. It's worth a try though. Give an hour before eating. Look into making this. A lot of people had success with it. http://www.felinediabetes.com/FDMB/threads/the-liver-shake-for-sick-cats.30432/

    Have you tried seeing if he would eat off a spoon or your fingers?

    Also bone broth if you can swing it. http://www.ibdkitties.net/bone-broth/ it has great nutrients in it. Once made freeze in ice cube tray or foam egg carton. Once frozen move them to a zip lock bag. Take one out when you need them. Smokey ate if I put a teaspoon of bone broth on his food once a day. One 'egg' gave us 3 days worth.
     
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  39. Dan&Heather

    Dan&Heather Member

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    Dec 21, 2016
    Yes, I tried, she won't. She won't eat at all, leans down like she wants to but then just wont.I would like to try the liver shake, but I don't know if she will even give it a try.

    I'm getting very depressed about the whole situation. I don't know why the vet didn't ask me if we wanted Cerenia for at home. It was probably metioned to me to ask her for but I didn't realize it was something she was going to need several doses of. There's so much information I feel like I miss/forget stuff far too often.
     
  40. Larry and Kitties

    Larry and Kitties Well-Known Member

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    Dec 28, 2009
    Inject the insulin and subQ fluids in different parts of the body. If too close the insulin will be diluted by the subQ fluid and the insulin action will be slowed
     
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  41. Meya14

    Meya14 Well-Known Member

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    Jan 2, 2015
    The subQ can dramatically and temporarily lower the BS levels due to dilution. Once the water is processed by the kidneys the BS will start to rise again. I think probably best time to give is about 1-1.5 hour prior to insulin to allow time for blood sugars to begin to rise so dose can be given safely. Also, insulin should not be given in the scruff area as it won't absorb well with fluids, you can give it in the flank (side tummy near the back leg) on days you give fluids.
     
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  42. Meya14

    Meya14 Well-Known Member

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    Jan 2, 2015
    For DKA assuming that her problems are due to the ketones and diabetes only, recovery can take about 1-2 weeks once insulin and proper support are given. Most cats recover, and cats who present with DKA as their initial diagnosis have a better recovery than cats who have been diagnosed in the past. Most cats don't seem to have many lasting effects from DKA once the acute period is over.
     
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  43. Marje and Gracie

    Marje and Gracie Well-Known Member

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    Yes. I have a template just for 8 hour dosing pre-made.
     
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  44. Olive & Paula

    Olive & Paula Well-Known Member

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    That's the nausea. Once that's addressed he should start eating better. Your vet is probably closed Monday right? Is the ER an option to get cerenia from as mentioned above?

    Hang in there. You are doing everything you can and hopefully come Tuesday you can get the cerenia.
     
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  45. Nan & Amber

    Nan & Amber Well-Known Member

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    Mar 19, 2016
    You are doing your very best, at a super-human level. Mittens knows that. You are giving her tons of love and cuddles amongst the pokes and the feedings, too-- focus on those times, and on the end goal of the pokes and feedings. All you want is for her to feel better.

    I know you've gotten a blizzard of suggestions, but have you tried raising the food bowl up so she doesn't have to duck her head down? It helps some nauseated cats, and your description of her ducking her head then turning away made me think of it again. She's still interested in food, that's a good sign, you just have to get her over the hump on the nausea.

    Hang in there, I know this is really rough on all of you right now :(.
     
  46. Olive & Paula

    Olive & Paula Well-Known Member

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    Sep 6, 2015
    Here's a pic of injection sites you can use.

    [​IMG]

    [​IMG]
     
  47. Marje and Gracie

    Marje and Gracie Well-Known Member

    Joined:
    May 30, 2010
    @Dan&Heather

    Are you going to dose every 8 hours and starting when? I can mod the SS for that but I need to know if/when you plan to do it. Thank you!
     
  48. Dan&Heather

    Dan&Heather Member

    Joined:
    Dec 21, 2016
    I'm not sure. I feel like I'm just as confused as when we started all of this. Felt for a brief time that I was catching on. We're supposed to give her more potassium in 45 minutes. She's not eating enough, she's fighting us so hard every time we try. I'm not sure when we should give her fluids or when we should give her another dose of insulin. I know we need to check her BG again, should have done it as soon as I woke up, I just feel so bad about poking her. I feel like I'm going to make her not let me pick her up at all anymore cause it seems like every time I go get her it's to do something to her that she hates and she's going to hate us for this because she doesn't understand. I guess I expected a little more cooperation from her, specially with the food cause I know she wants it, I thought she would at least open her mouth for us.
     
  49. Dyana

    Dyana Well-Known Member

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    Dec 28, 2009
    Did she get her potassium and insulin this morning? We always recommend testing at least before every shot of insulin.
     
  50. Marje and Gracie

    Marje and Gracie Well-Known Member

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    May 30, 2010
    OK...I’ll leave the upper part of the SS for 12 hour dosing right now but I can easily change it whenever you are ready.

    Keep in mind that shooting every 8 hours will help you get her numbers down a bit which will help. DKA is caused by not enough insulin and food/water as well as infection so if you can keep the ketones in control by keeping the BG down (which is easier to do shooting every 8 hours with N as you catch the numbers before they get too high), then you can potentially address that issue.

    If the vet has prescribed fluids, you can give them at any time but I’d try to avoid giving them exactly the same time as the insulin and definitely give them in different areas. Giving subqs is more limited in location than shots so if you give the subqs in the scruff, you can shoot the insulin in the opposite side of the chest but just know that shooting the chest, side, or flank with insulin “might” increase absorption rate which is ok as long as you test (it never seemed to be a difference in my Gracie but every cat is different).

    Here is a video on how to give subq fluids if you are nervous about it or haven’t done it.

    It’s going to take time and persistent hands-on care to get her through this.
     
  51. Dyana

    Dyana Well-Known Member

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    Dec 28, 2009
    You can do this Dan and Heather. I know it's hard. I have faith in you. I can tell how much you love your Mittens. J.D. was diabetic for 9 years and I had to learn to give insulin and test his BG. That was frustrating and hard to do, but eventually I learned to do it and J.D. learned that it was okay. Later in life when he was 19 and 20, I had to assist feed him (and I know how disheartening that can be) for a long time, and give fluids, and pills. You can do this. You are a good team.
    Let us help you. Please. Believe me you do not want DKA.
     
  52. Nan & Amber

    Nan & Amber Well-Known Member

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    Mar 19, 2016
    She won't hate you. Really, really, really-- she won't. She's feeling lousy right now, and no one likes having food syringed into their mouth (even without the nausea). She's not fighting you because she's mad at you, she's mad at the world for making her feel yucky.

    Honestly, the fact that she's fighting you is another good sign, in a way-- at least she still has that much energy! Her condition is very very serious, but I'd be even more worried if she were just passive and limp under all the treatments.

    You've been dealt a bad hand by the unhelpfulness of your vet, but you have a lot of tools at your disposal to get her through this, and Mittens is clearly still in the fight. For a cat throwing ketones, her BG numbers really aren't that bad, and she's still drinking (a little bit), interested in food (even if she can't eat on her own), and has the energy to complain about the insults to her feline dignity. It's really rough on the caregivers to keeps subjecting her to all these treatments, but it's critical that you keep it up-- as Dyana says, you truly do not want this to progress into DKA.

    We are here to help in any way we can.
     
  53. Critter Mom

    Critter Mom Well-Known Member

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    Jun 16, 2014
    We understand that feeling. :bighug:

    I know it sounds daft but try singing when you're doing the BG test, or talking to Mittens in a sing-songy voice. It will distract you both and it can be calming.

    Alternatively adopt (fake!) a very business-like approach. (Right! We need to do this to get you better and it will only take a couple of minutes!)

    And praise. Lots of praise. (Can help at feeding times, too.)

    Meya said that the potassium supplement will help with the nausea. When Mittens gets the fluids that should help, too.

    We understand that you're so close to things right now that perhaps you can't quite see how *amazingly* well you're both doing. We can see it, and we believe in you. Don't lose heart!

    :bighug:


    Mogs
    .
     
  54. Critter Mom

    Critter Mom Well-Known Member

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    Bending down for the food/water tends to exacerbate the nausea.

    If you're leaving food out for her (and some of the watery chicken broth if you still have some) remember to raise the bowls up about 4-6 inches. (Try sticking some paperback books under them.) Try leaving out small bowls of different foods - a kitty smorgasbord.

    Try offering well mashed-up food with a little water mixed through it from your hand or your fingers. Again keep your hand up several inches from the ground so that Mittens doesn't have to stoop to eat.

    .
     
  55. Dyana

    Dyana Well-Known Member

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    Dec 28, 2009
    I used a Magic Bullet to puree J.D.'s food into a slurry that wouldn't clog the syringe.
    Please don't listen to what other humans say who don't get the love you feel for your cat that try to alter your perceptions. All of here, know the love of the cat, and a lot of us have been here a long time. We have seen many miracles happen. It is like a big family here. We are here to help you.
    Don't worry about expenses right now, take it one day at a time. There are lots of ways to save lots of money. Right now, it is critical that she get her insulin and food, potassium, and fluids when needed. I know it's hard to do this. Eventually Mittens will understand that you are helping her. Keep on keeping on. Big hugs. We understand. Please let us know her BG test when you get it.
     
  56. Dan&Heather

    Dan&Heather Member

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    Dec 21, 2016
    I gave her the potassium this morning on time, but I wasn't sure exactly when I was supposed to give her more insulin. So the only dose of insulin she's gotten so far is the one from last night. I feel terrible about that because I know we were supposed to do it but I wasn't sure if it was supposed to be at the same time as the potassium so I was planning on asking when I got up to feed her but then I slept thru all my alarms. The potassium that she just got was slightly late, was supposed to be at 6, ended up being about 6:30 so about half an hour ago. We mixed it with 10mL of food.

    I will test her BG right now and then after I hear back from you I will give her more insulin, I know that's very important. I'd like to give her some of the fluids too, I remember a post earlier that said to leave a little time in between those. Will get back to you in a few moments with the BG results.
     
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  57. Dan&Heather

    Dan&Heather Member

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    Dec 21, 2016
    Ok we just tested her again, and got a drop of blood on only the second try thankfully, her BG is 316 right now. So now should we do the fluids before we give her insulin?
     
  58. Dan&Heather

    Dan&Heather Member

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    Dec 21, 2016
    How long in between should we wait? And should the fluids be first then the insulin?
     
  59. Dan&Heather

    Dan&Heather Member

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    Wow, if I would just read everything more carefully I can answer alot of my own questions
     
  60. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Oh Heather, this is a complicated situation so don't worry about asking questions again. We are quite used to it and know why you need to.
    Maybe it would help if you set up a time schedule to know what to do when. For instance: today you gave potassium at 6:00am and 6:30pm. (The half hour difference is not an issue.) but you want to move that up to Noon/midnight dosing gradually (as per Dan last night).

    She got insulin last night at about 8:30 pm, missed the 8:30 am. and we are recommending going to a three times daily dosing. So now you need to decide when the best time for you to do fluids would be and then the insulin schedule would flow from that. Does that make sense?
     
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  61. Critter Mom

    Critter Mom Well-Known Member

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    :D

    You're doing great. Not many who arrive hear need to take the vertical learning curve in a single bound the way you guys are at the moment! :)

    That should be OK but you'll need to be tighter with timing for the insulin. Keeping to a regular insulin dosing schedule is key to safety.

    Each insulin dose exerts an effect on BG for a certain amount of time (duration of dose). You need to make sure that dosing intervals don't overlap, hence the need to be quite diligent with insulin dose timings.

    The Novolin N will have a period in each cycle where it has a stronger BG lowering effect. This is why we use the "+" numbers alongside the BG levels so we can gauge the safety of a test result as the cycle progresses. With an appropriate dose we expect numbers to be lower when the effect of the insulin dose is at its strongest. By tracking the time since the dose was given and the BG level we can determine if the kitty is in a safe range - and going to STAY in a safe range for the rest of the cycle - or whether we need to intervene with carbs to keep numbers in the safe range.

    It's a lot to do for the first few days of insulin treatment because we need to learn how Mittens responds to her insulin but as you get more BG test data to see how the dose is working things will get easier.

    .
     
    Last edited: Dec 24, 2016
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  62. Dan&Heather

    Dan&Heather Member

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    Dec 21, 2016
    Yes that makes sense. Alot of sense, if we need to do this every 8 hours we do need to figure out what times are going to be best for our schedule, but it's already been too long and I dont want to make her wait too much longer.

    I need to go to walmart soon, we have lots of test strips for the glucose meter but only a couple lancets left so I need to go get more. When I get back it will be close to 2 hours since she ate so I will feed her again. Dan just went to take a nap and I'm glad but kinda nervous, it took me forever to get the food into her this morning when I was by myself, I don't know how he managed to while I was at work last night. I'm not worried about giving her insulin and not really about checking her sugar myself, both of those weren't too difficult with her and I think I can do it alone, but I'm a little nervous about giving her the fluids if he's asleep simply because that takes a minute and it might be hard for me to get her to hold still and hold the bag up in the air at the same time.
     
  63. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Feb 18, 2015
    Heather, for now I think it's important to get the insulin in her since she missed the morning dose. When did she last eat and how much? Let's work on the schedule over the next day or so but right now, let's deal with the insulin since you are a bit tentative about doing fluids without Dan to help, then go to Walmart and get your supplies. Question though...it's Christmas eve. is Walmart still open and if so when do they close?
     
  64. Dan&Heather

    Dan&Heather Member

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    Dec 21, 2016
    I'll have to call Walmart and ask about the holiday hours, with all this, going on I actually didn't even realize it was Christmas Eve till you said that, I'll find out. She ate 2 hours ago and it was 10mL of food with the potassium mixed in
     
  65. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Ok so check on Walmart and let me know if you are dashing out door.
     
  66. Critter Mom

    Critter Mom Well-Known Member

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    Well done, Mittens! And well done, Dan and Heather. :bighug:

    .
     
  67. Nan & Amber

    Nan & Amber Well-Known Member

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    Mar 19, 2016
    Any brand lancet should be fine [edit: if you are freehanding, but even with a device there's a lot of compatibility, it's not like the strips]-- so if Walmart isn't open, there might be a pharmacy or even a supermarket that can help you out.
     
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  68. Critter Mom

    Critter Mom Well-Known Member

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    Jun 16, 2014
    Heather, if you need to go out after giving the insulin, Dan will need to be awake to test Mittens' BG while you're away.

    Novolin N starts working very early after the injection is given. Because you've not got much BG data yet you need to monitor Mittens' BG closely.

    .
     
  69. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Mogs, Escanaba isn't that big so hopefully if Walmart is open, she wouldn't be gone too long. Of course that depends on whether they are right in the city or not.
     
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  70. Dyana

    Dyana Well-Known Member

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    Dec 28, 2009
    I think Walmarts are open on Christmas Eve and Christmas. If you have to, you can reuse a lancet, it's just not advised as they get way duller each time you use them. If you have to I would rinse in some rubbing alcohol first and let it dry.

    As far as fluids, I used a plant hook that was in my ceiling and hung a coat hanger from it and the fluids from there.
    I would get everything ready first (rewatch the video, warm the fluids in warm water, then hang them, make sure I had the shot glass ready to flush the line), then go get the cat.

    I think I have many boxes full of lancets that I can send you. They are the 28 gauge that are preferable to getting blood in the beginning.
     
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  71. Red & Rover (GA)

    Red & Rover (GA) Well-Known Member

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    May 18, 2016
    You can always hang the bag on a shower curtain hook. Makes it a little hard to watch levels. If so, hang the bag from a strong piece of string attached to the shower curtain hook. This will bring the bag closer to your eye level.
     
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  72. Critter Mom

    Critter Mom Well-Known Member

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    Valuable background info, Linda.

    .
     
  73. Dan&Heather

    Dan&Heather Member

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    Dec 21, 2016
    Sorry I had to run out, Walmart didn't answer the phone and I knew the 2 grocery stores would be closing soon. Walmart shopko and both grocery stores were closed, but Walgreens was open so I was able to get lancets. I'm going to feed her right now because it's been almost 3 hours now since she ate last. After that I'd like to give her the insulin, I don't have to go anywhere for the rest of the night so I'll be able to keep an eye on her. Dan told me to wake him up in an hour but I'd like to let him sleep as long as I can so he can be alert tonight after I go to bed, so we can get on these shifts of watching her so we can each get a little more sleep.

    Since we're going to start every 8 hour doses should the doses still be .5?
     
  74. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Feb 18, 2015
    The 0.5 didn't take her down too low last night but I am still concerned about being able to get food into her if she does start heading too low so I vote stay with 0.5u for now until we get some data or she starts showing a more active cycle. I also think with 3 doses daily, we need to be conservative because it should result in lower pre-shots.
    Before you give insulin Heather, I would like to hear from some other folks so we have a consensus of opinion here!
    @Critter Mom @Dyana @Marje and Gracie @Meya14 can you weigh in here :)
     
    Last edited: Dec 24, 2016
  75. Nan & Amber

    Nan & Amber Well-Known Member

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    Linda, not 100% certain your tag of @Dyana went through (it's the only one that isn't highlighted blue in your list), and she's the only one I can see online right now so I'm repeating. :)
     
  76. Dan&Heather

    Dan&Heather Member

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    Dec 21, 2016
    Ok I will wait for some more people to give their opinions before I give her the insulin. I just fed her 7.5 mL out of an attemped 10mL. I wish I was better at this but I feel better about it because I figure I'm at least getting her something.

    I'm so sorry to everyone for distracting you from your holidays. I can't believe this is Christmas Eve, I feel really bad for that.
     
  77. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    @Nan & Amber Thank you for noticing. Fixed it. I typed the name instead of picking it in my rushed typing. DAH!
     
  78. Dyana

    Dyana Well-Known Member

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    Dec 28, 2009
    Don't worry about it, Heather. We just want to help Mittens and you and Dan.
    Again, I don't know Novolin N, but I would tend to agree with the 0.5 dose TID for now depending upon her pre-shot test. Do we have a BG test? If you are going to do TID, would 10:00pm, 6:00am, and 2:00pm work for you Dan & Heather? If not, then I would still give the dose (depending upon what her pre-shot test is) and think about what 8 hour three times a day doses would work.
     
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  79. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Actually Heather, I can't think of a better way to spend Xmas eve than to keep a little furry companion safe and his wonderful caregivers supported! No worries.
     
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  80. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    You need to test her right now before the food starts raising her BG.
     
  81. Dyana

    Dyana Well-Known Member

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    Did you get a ketone test, today? You'll want to do that at least once (or more if possible) per day, while she's throwing ketones.
     
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  82. Critter Mom

    Critter Mom Well-Known Member

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    NB - Hang fire on the dosing suggestions for a minute. Meya posted something on the other thread - I'll try to find it.

    A BG test now would be highly advisable. I know it's just after food but it is a fair while since the last test. Also for the Novolin N the guideline is to wait about 30 minutes after food before giving the dose.


    BRB ...

    .
     
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  83. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    I think she suggested 0.25 to 0.5 IIRC.
     
  84. Critter Mom

    Critter Mom Well-Known Member

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    Meya's post from the previous thread:

    .
     
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  85. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Feb 18, 2015
    Found it. Meya said " I feel that starting at a negligible dose (less than 1/2 unit, or about 1/4 unit three times a day) and working up would be safe."

    So should we back up to 0.25u and see how that goes tonight.
     
  86. Critter Mom

    Critter Mom Well-Known Member

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    FYI - Marje has got Mittens' 'official' spreadsheet and signature up and running now. It's ready for TID dosing.

    .
     
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  87. Dyana

    Dyana Well-Known Member

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    I think the 0.25 TID would be acceptable to start with too. I'll find the picture of 0.25 again and post it.
     
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  88. Dyana

    Dyana Well-Known Member

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  89. Dan&Heather

    Dan&Heather Member

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    Yes that would work well for us, I work varied shifts but those times would have me at home for two doses everyday. But I see the post above says I should wait 30 minutes from eating to give the dose, I got done feeding her 15 minutes ago, so if it's quarter after or on the half that would work fine for us too.

    No I haven't caught her in the liter box yet today, I will do one the first chace I get.

    I did one about 5 minutes ago it was 305
     
  90. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    So I vote give her 0.25u in about 15 minutes. To keep it simple make it 10:30pm your time. Easier to track and remember. :)
    @Critter Mom are you in agreement with Dyana and me.

    Heather , are you Ok drawing up 0.25u? Any problem or questions about doing so, just shout!
     
  91. Critter Mom

    Critter Mom Well-Known Member

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    The 0.50 dose last night produced a 150 point drop by +1.5. It ran a little above this for a few hours and then dipped back to 234 at +6.

    If I were in this situation with my own cat the 0.25IU Novolin N is what I would give.

    .

    .
     
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  92. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Ok Heather. We are all agreed the dose should be 0.25u.
     
  93. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Glad you two are helping here. I have a new person on another thread.
     
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  94. Dan&Heather

    Dan&Heather Member

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    Dec 21, 2016
    Yes I feel fine about that.

    Ok, giving her 0.25u at 10:30, getting the stuff together right now. Will post back as soon as I'm done.
     
  95. Critter Mom

    Critter Mom Well-Known Member

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    Jun 16, 2014
    I'm in poor shape here and if I need to do the UK leg again I have got to get rest now.

    - Can someone start up the running log of BG info, feeding etc for the cycle? (Would probably be safer to do this in the thread tonight - esp the feeding info.)

    - I recommend tests at +1.5, +2.5, +4.0 and +6.0 then AMPS at 7.5 hours after this current dose to allow 30 minutes for food to go down before giving next dose of insulin (i.e. a total of 8 hours between injection times).

    - Here is some information recently posted by @Meya14 with recommendations for DKA aftercare (thread for Jo and Ozzy). It includes info on BG ranges, feeding, fluids, etc. It may be a helpful reference for members helping Dan & Heather tonight (and also useful to them when they get a bit of headspace to take in a bit more information).

    CAVEAT to members assisting Dan and Heather:

    NB
    : Ozzy is being treated with VETSULIN so dosing suggestions on linked page are not for Novolin N - general principles for target BG range may be OK to use in Mittens' situation.)

    Some Pointers from Meya on DKA Aftercare




    Mogs
    .
     
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  96. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Feb 18, 2015
    I'm good for a couple of hours or so but I'm not sure about the rest of the night. I'm putting the coffee on now! I'll stay as long as I possibly can. Dan & Heather must be much younger than me!
     
  97. Critter Mom

    Critter Mom Well-Known Member

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    NB: Can members arrange cover for the beginning of the next 8-hour cycle, please? I won't be awake in time.

    .
     
  98. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Feb 18, 2015
    Summary data
    Fed 7.5oz at 10:00pm EST
    PMPS - 305 immediately following feeding
    Insulin given 10:30pm EST 0.25u Novolin N
     
  99. Dan&Heather

    Dan&Heather Member

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    Dec 21, 2016
    I will make sure I get those tests at those times. Thank you so much for your help, really sorry to keep keeping you up like this.

    Thank you everyone, I will post the test results for the +1.5 as soon as I have them.
     
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  100. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Feb 18, 2015
    Next shot will be due at 06:30 EST. If I get some sleep I can deal with that. I'll stay for the early part of this cycle and then see who is around to help if need be depending on what Mitten's numbers look like. If I need to stay up, I'll just load myself in caffeine! LOL!
     
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