? 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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    Works a charm, Nan. Thank you! :)

    ETA - Really glad you're here. :bighug:

    .
     
  2. Critter Mom

    Critter Mom Well-Known Member

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    @Dan&Heather -

    Please can you post brief details of the amount & frequency of fluids recommended by your vet prescribed ASAP.

    Ta!
    .
     
  3. Dyana

    Dyana Well-Known Member

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    Just a few thoughts as I read over the posts this morning with my first cup of coffee..
    The 7.5oz of food reported to be given in the summary, is 7.5ml of food.
    The gravy baby food is okay to give. It just has a bit more carbs in it.
    I think the idea of 300mls of fluids should be confirmed with Meya14.

    You did brilliantly last night. Merry Christmas!!! Keep up the good work.
     
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  4. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Be darned! I didn't know that ...
     
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  5. Nan & Amber

    Nan & Amber Well-Known Member

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    Perfect, thanks!

    It turns out to be hard to get exact numbers here, because they are clearly rounding on those gram amounts, argh. Each food has the carb content listed, and if you trust that and assume 4kcal/g of carb, the first two have zero % carb and the last one is 8%, so they'd all meet the standards of low-carb fare. However, if I go through and calculate expected calories for the given number of grams of fat/protein/carbohydrates, I don't always add up to the number of calories given, so I think we have to assume that there's some wiggle room ±0.5g on all these estimates, and just calculate a range of possible carb values. Here's what I get:

    Beech Nut Classics chicken+chicken broth: [4kcal/g*0g]=0kcal from carb (low estimate) to [4kcal/g*0.5g]=2kcal from carb (high estimate); % calories from carbs is 0/70 to 2/70 = 0-3% carbs.

    Beech Nut Classics turkey+turkey broth: Same as above, but different total calories, 0/60 to 2/60 = 0-3% carbs.

    Gerber chicken and chicken gravy: [4kcal/g*1.5g]=6kcal from carb (low estimate) to [4kcal/g*2.5g]=10kcal from carb (high estimate); % calories from carbs is 6/100 to 10/100 = 6-10% carbs.

    Sum-up: first two are definitely good low-carb options, the third is possibly low-carb but may be a little higher, and will be a good food to have on hand if we need to give Mittens' blood glucose numbers a little more support on the TID insulin schedule.

     
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  6. Nan & Amber

    Nan & Amber Well-Known Member

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    I agree, we should confirm the 300mls amount, or else go by the vet's recommendations. I took that number from post #135:

    24/12: MITTENS - Novolin N, Small Ketones

    Linda referenced looking Meya14's instructions in the previous post, so I'm assuming it is from there but I haven't found it yet-- I think it must be in the previous thread, though.
     
  7. Dyana

    Dyana Well-Known Member

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    Another thought I had as I was getting caught up this morning, was the difficulty in getting the old needle off the line. I remembered watching this giving fluids video again yesterday and noticed what they call the lure lock that seems to hold the needle in place. They talk about it at 12:15 on the video. I remember I had a heck of a time getting the needle off the first time too.
     
  8. Kris & Teasel

    Kris & Teasel Well-Known Member

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  9. Kris & Teasel

    Kris & Teasel Well-Known Member

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    I put in a link to a post Meya made on Ozzy Pawsbourne's thread. Might be helpful.
    http://www.felinediabetes.com/FDMB/threads/newly-diagnosed-after-surviving-dka.169143/#post-1835133"
     
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  10. Nan & Amber

    Nan & Amber Well-Known Member

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    Yes, that must be it!!!!!

    Reading this, I withdraw my 3x day suggestion (in fact I'm going to go back and edit if I can)-- the 300ml/day is the total amount of fluid needed, in both food and supplemented, so 300ml of subQ would be way over the top (and possibly dangerous). Ack!!!!
     
  11. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    One last thing and this is a bit of a hijack for which I apologize.

    There was a new poster last night in Health who has their cat on 8u of Caninsulin after only 1 month of treatment.:eek::nailbiting::eek::nailbiting: I just got under my blanket when I realized I never finished my post to them. So up I got! I am seriously concerned about this cat and their pet parent. I have suggested backing the dose up and starting over and asked that they set up a spreadsheet. Can someone keep an eye out for any response from the poster? Here is a link to the thread
    http://www.felinediabetes.com/FDMB/threads/diabetes-initial-treatment-need-advice.170191/
    Thanks so much and with that I am outta here! :D:D:D:D
     
  12. Kris & Teasel

    Kris & Teasel Well-Known Member

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    I'm on it, Linda. I responded first last night and was very concerned at the 8 u dose when I read that this AM.
     
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  13. Woodsywife

    Woodsywife Well-Known Member

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    I saw this one. Haven't checked this morning yet. I'm watching it.
     
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  14. Critter Mom

    Critter Mom Well-Known Member

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    @Nan & Amber - Sterling job on the food info - will be adding it to the top-of-thread summary.

    Great minds think alike, Kris. I did the same earlier in the thread. I'm going to incorporate this link into the 'top of thread' summary for today (and following days as needed).

    Thanks to everyone for the contributions! :bighug:
     
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  15. Dan&Heather

    Dan&Heather Member

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    She said to give 100mL once every 24-48 hours depending on how much water she is drinking on her own. I felt like she needed it today because she drank barely any at all.

    Dan is awake, I stayed up to see what her BG was going to be, right now it's +1.5 -268. He's got the times written down that he is going to test at, he will post the numbers here as he gets them. I have to sleep for a little while. Thank you so much to everyone and Merry Christmas!
     
  16. Critter Mom

    Critter Mom Well-Known Member

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    @Nan & Amber, @kris -

    Are you OK to keep an eye on Dan & Heather for this?

    (Just want to run over to the high-dose Caninsulin thread for a few minutes.)
     
  17. Nan & Amber

    Nan & Amber Well-Known Member

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    I'm here.
     
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  18. Critter Mom

    Critter Mom Well-Known Member

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    Ta for info, Heather - and for doing such a great job! Wishing you a restorative sleep. A Merry Christmas to you, too!

    :bighug:

    .
     
  19. Nan & Amber

    Nan & Amber Well-Known Member

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    OK, that 268 is a good number-- she's coming down, but not dropping like a rock, so that's a nice response. Looking good so far today!

    Get some rest, Heather, you've earned it!
     
  20. Woodsywife

    Woodsywife Well-Known Member

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    @Dan&Heather

    I have a box of cerenia I can send you. I can overnight on Tuesday if your in the U.S. since PO is closed Monday. If you send PM with your address I will get it out to you.
     
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  21. Kris & Teasel

    Kris & Teasel Well-Known Member

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    I'm here too.
     
  22. Meya14

    Meya14 Well-Known Member

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    This is correct. A cat needs 300ml ****ORAL**** fluids total daily. Since the typical intake of wet food has about 200ml, then there can be about 100ml deficit. Any more than 100-150ml subQ a day could cause electrolyte imbalance or fluid overload and put stress on the heart. Please give fluids per your vet recommendation, it is correct.
     
  23. Dan&Heather

    Dan&Heather Member

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    We just tested her again about 5 minutes ago at 10:15 +2.5 -228 right now.

    We fed her at 9:30. She still squirmed but not as bad it seemed, she actually did good enough that we decided to try a second syringe full. She didn't seem impressed by that and got pretty stubborn and wouldn't open her mouth at first but then got a little better. We spilled kind of alot, but I'd say we got a solid 13mL in her this last time, which is nearly twice as much as we can usually get into her. She also took a few drinks of water, a little while ago.

    Ok, now I really am going to sleep for a while and letting Dan take over. He said he will keep up on posting her numbers and feedings. Good night everyone!
     
  24. Dyana

    Dyana Well-Known Member

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    Good job!
    Get some restful sleep, Heather.
     
  25. Meya14

    Meya14 Well-Known Member

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    If you have some kibble in the house, try putting out a bowl of kibble and see if she'll graze on it. Although most of the time, we worry about carbs in diabetic cats, when ketones are involved, you actually can increase the cabs, as it allows higher insulin doses to be given which will help clear ketones. So if kibble is all that she'll eat on her own, or treats, etc, it's fine to leave them out.

    The goal for blood sugars until she is feeling better is 150mg/dl-220ish mg/dl. This is a little higher than "normal" but it gives some wiggle room for safety in an ill cat.

    Also, if you do stop by walmart again, look for Iams kitten food. This is a very high calorie food that has a consistency that is easy to syringe.
     
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  26. Critter Mom

    Critter Mom Well-Known Member

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    Just for clarification, Meya, can you confirm these reference numbers are for a human glocometer, please?

    (And Merry Christmas to you! :) )


    Mogs
    .
     
  27. Critter Mom

    Critter Mom Well-Known Member

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    @Dan&Heather -

    Hi Dan,

    How is it going?

    * Please post when when you have the +4 BG result.

    * Also, please can you post details of when and how much you have fed to Mittens since AMPS (in '+' notation if possible).


    Mogs
    .
     
  28. Dan&Heather

    Dan&Heather Member

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    Ok, Dan here. Just tested her BG again at 11:45am or +4 and it was 236. +4 -236 About to try some feeding her some more in a few minutes.
     
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  29. Critter Mom

    Critter Mom Well-Known Member

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    FAO Members Helping Dan & Heather:

    To avoid confusion with this cycle, I'm going to wait till after the +6 BG test before kicking off a new thread.

    In the meantime, here's an abridged SITREP:

    ----------------------------------------------------------------------------------------------------------------
    INSULIN - Novolin N (U100 Insulin) - 8/8/8 DOSING - RELION METER
    --------------------------------------------------------------------------------------------------------------
    24 Dec 2016

    AMPS - *** - (no insulin)

    PMPS - 305 - Dose: 0.25IU (22:30 EST) - Assist fed 7.5ml - tested immediately after food.
    +1.50 - 306 - 7.5ml food after test
    +2.50 - 263 -
    +4.00 - 228 - 7.5ml food before +5
    +6.00 - 284
    +8.00 - *** - Sub-q fluids 100ml given some time between +7 and +8 (05:30 - 06:30 EST)

    (Technical hitch with fluid giving set. Next insulin dose will be slightly later than scheduled.)
    --------------------------------------------------------------------------------------------------------------------
    25 Dec 2016

    NB:
    Dosed at +9.25 relative to previous insulin dose (fluids given >1.25 hrs BEFORE insulin)

    AMPS - 298 - Dose: 0.25IU (07:45 EST) - 7.5ml (?) food + Potassium supplement (07:00-07:15 EST)
    +1.50 - 268 -
    +2.50 - 228 -
    +4.00 - 236 - [Dan to feed after this test]
    +6.00 -
    ---------------------------------------------------------------------------------------------------------------------
     
    Last edited: Dec 25, 2016
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  30. Dan&Heather

    Dan&Heather Member

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    S
    We fed her one syringe of fancy feast(7.5ml) a half hour after her insulin, and again 2 1/2 hours later this time we got 2 syringes of food in her(7.5ml and 10ml). About to feed her again right now.
     
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  31. Critter Mom

    Critter Mom Well-Known Member

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    FYI - The reason for keeping track of this info is to judge safety/efficacy of insulin dose and as a guide to how many calories Mittens is getting each day.

    Yiss!!! :woot:

    You guys are da bomb! :cool:

    Go Mittens! :cat:
    .
     
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  32. Critter Mom

    Critter Mom Well-Known Member

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    BTW - Even though I'm not posting much here at the moment, I'm keeping an eye on the thread all the time. I'm beavering away in the background trying to gather together stuff that might be of assistance to you and the members helping out here.

    I am *so impressed* with how well the two of you are doing! Intensive nursing isn't easy at the best of times. You two have had to get to grips with so much stuff in such a short space of time and you're both handling things like absolute pros!!! :cool:

    If I'd had to deal with all the stuff you've been through in the past few days I'd be in a home for the bewildered by now. :confused: You two are just AWE-SOME!!! :woot:

    (((Team Mittens)))

    :bighug:


    Mogs
    .
     
  33. Dan&Heather

    Dan&Heather Member

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    Just fed her 7.5ml of Fancy feast, and was able to get another ketone test(not sure if i needed to or not), it came back small.

    Gonna try another syringe of food in a few minutes since she seems to be getting easier, shes atleast trying to bite the syringe every once in a while so that makes it easier to get food in as appose to when she wouldnt budge and shes not retreating behind the couch after feeding her like she was.

    She also gave out a little grunt(its not really a "grunt" she makes but idk how to describe her meow lol) earlier when i went down to pet her like she use to do before she got sick. It may be nothing but it made me feel like she was feeling maybe a little better. :)

    Thank you all so much again, its alot to deal with but having access to this forum and you great people makes it alot easier! Im sure you all need some rest by now. we really do appreciate all the time and effort from everyone here, and i will continue to post her +6 and +7.5 results as soon as i get them.
     
  34. Kris & Teasel

    Kris & Teasel Well-Known Member

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    These little signs are worth paying attention to, Dan & Heather. They all add up. :)
     
  35. Nan & Amber

    Nan & Amber Well-Known Member

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    Hmm, not liking that as much.... My understanding is that there's a bit of time lag between when ketones are circulating in the blood and when they show up in urine, so maybe this is the effect of yesterday's skipped dose? I will leave the full interpretation to the experts. The fact that she is showing signs that she might be perking up a bit :) isn't consistent with a current resurgence of the ketones, so I'm going to think positive until I hear otherwise from the experts. No matter what, you guys are doing everything right, keep doing it!!!!!
     
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  36. Critter Mom

    Critter Mom Well-Known Member

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    @Dan&Heather -

    I've sent you a PM. Please can you check your inbox ASAP.


    Mogs
    .
     
  37. Woodsywife

    Woodsywife Well-Known Member

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    Yeah Mittens, keep working with mum and dad, they will get you through this.

    Just a suggestion here, next time you give her some food, see if after a squirt she will eat some off a spoon, finger or plate. Hopefully she will perk up enough to at least try.
     
  38. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    This is speculation and nothing more but could it be that the ketones in the urine would show higher from the SubQ fluids flushing the system a bit more. They gotta go somewhere and urine is the body's way of clearing them! I'm hoping the "small" ketones is actually good news!
     
  39. Dan&Heather

    Dan&Heather Member

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    Thats a good idea, i will try it after her next BG test.
     
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  40. Dyana

    Dyana Well-Known Member

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    I second the idea of leaving a bowl of dry food or treats out for her (post #225) in her usual feeding area. Once she starts feeling a bit better, she might just go there and munch a little. Every bit of food is a bonus right now.
     
  41. Dan&Heather

    Dan&Heather Member

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    Just got her +6 and its 189, so +6 -189

    So far today:
    12/25
    6:30am 298 AMPS
    7:45am .25u Insulin
    9:15am +1.5 -268
    10:15am +2.5 -228
    11:45am +4 -236
    1:45pm +6 -189
     
  42. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Wow! Yeah! I'm jumping for joy here with that BG. It's key to get her BG down so this is great news! Those fluids and all that food you got into her seems to be helping! :joyful::joyful::joyful::joyful::joyful::joyful::joyful::joyful::joyful::joyful:
     
  43. Critter Mom

    Critter Mom Well-Known Member

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    The urine voided for that test is for the last 6.5 hours or so; it's looking back in time. Here's tracking info:

    URINE KETONE STATUS:
    23 Dec - c. 12:00 EST - Positive SMALL (at vets)
    25 Dec - c. 06:00 EST - SMALL to TRACE (closer to Trace) - +7.5 post-insulin
    25 Dec - c. 12:30 EST - SMALL / +4.75 post-insulin / +6.5 post-subq


    Since the previous ketone test Mittens has had fluids and insulin, and she has been eating more thus far in this cycle. Hopefully the subqs

    The subtle improvements in Mittens' clinical signs are encouraging (anti-jinx!). One foot, one paw ...

    A-MEN!!!

    :bighug:
    .
     
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  44. Woodsywife

    Woodsywife Well-Known Member

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    Woohoo Mittens, you go girl. Start working the appy now little lady.

    Team Mittens at its best!!! AWWWSOME!!!!!!!
     
  45. Critter Mom

    Critter Mom Well-Known Member

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    Under renal threshold! W-O-O-T!!! :woot:

    Go Mittens! Go Mittens!

    :D

    .
     
  46. Dan&Heather

    Dan&Heather Member

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    +7.5 -223 About to feed her again right now.
     
  47. Critter Mom

    Critter Mom Well-Known Member

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    Do your preshot BG test before feeding.

    ETA -

    Scratch that. BG test is done. (Duh, Mogs!!! :rolleyes: )

    Bit punchy over here. :banghead:

    .
     
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  48. Nan & Amber

    Nan & Amber Well-Known Member

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    Isn't that the 223? It's at +7.5, so we're pretty close to shot time if we keep to an 8 hr interval.
     
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  49. Nan & Amber

    Nan & Amber Well-Known Member

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    I think we are all a bit distracted today, Mogs! There is a lot going on!
     
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  50. Critter Mom

    Critter Mom Well-Known Member

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