4/4 Willow AMP 735bg

good morning

Willow numbers never came down last night, she was dry heaving at 3 am again
This morning with her shot I gave only between 1/4 and 1/2 do her wet food and she did not eat all of it.
I have an autofeeder being delivered today
100% sure no dry food for two days.

 

Here is the link to yesterday's post.
http://www.felinediabetes.com/FDMB/threads/4-3-willow-pmp-417bg.155584/#post-1643675

It helps those it might have missed the condo to know the recent history. Have you called the vet about this? Maybe something in addition to fd is going on right now.

 

Have you been able to test for ketones today? With Willow's previous DKA episode and those high numbers and not eating that is worrisome. A call to the vet should be in order.

 

Have not called the vet yet, the only time she does this is when she has been in the 700+bg range for a few hours. I can tell by the look on her face last night her numbers were high before checking her.

With the vets at this point I know more about her problem than them and the folks on this form are by far Way more knowledgeable .
Unless the vet has done more schooling or had a lot of hands on experience with this disease they are totally clueless. Their first knee jerk reaction is to give the cat a large amount of fast acting insulin to get the cats numbers down fast, this then causes the cat to dump a huge amount of bg into her body causing DKA and keytones. The vets will keep doing the same thing causing the cats kidneys and liver to fail and will keep doing this until the cat is dead or the owner says go ahead and put her down.
Today I'm going to control her food with 1/4 amounts only just enough to satisfy the hunger while not giving her too much that is causing her numbers to shoot up. Her food intake is causing these numbers to go up or could be a bounce.

Have not check for keytones yet, she is in my lap sleeping, catching her today is going to be tough, I'm leaving at 8am should be back around 11am then gone again at 11:45

 

Hi
Not yet, she is eating, she ate a lot yesterday, this morning only a little bit

 

Try to get a test for ketones and if she continues not eating then consider calling the vet. The recipe for DKA is high glucose, not eating, and infection or any combination of those. Testing with the ketodiastix will give an indication, but since the urine is not "real time" (been in the system for a few hours), it does not show what is happening right now. Because of Willow's previous DKA it is important to be viligant about ketone testing.

ETA Does she appear nauseous...wanting to eat but turning away from food, or does she appear uncomfortable....sitting hunched over (meatloaf position)

 

There are meters available that allow you to test ketones in the blood. If you're having a hard time catching Willow in the litterbox to test her urine, getting a blood ketone meter may be a good idea, given her history. The only thing is the strips are pretty pricey - but you won't be using them as frequently as you use BG meter strips.

I wonder if the extra-high BGs are causing the appetite issue. If you are feeding low carb food, it may cause her numbers to go up a little bit, it it should cause a huge increase in her BG. If she is eating anything high carb, then that would be a different story. I'm inclined to think her higher BGs may be a bit of a bounce (although she didn't drop all that low so I'm not sure a bounce would be triggered), or - more likely - she still needs more insulin. At this point you don't want to increase her dose just yet because it can take several cycles for a kitty's body to adjust to dose changes and it's only been 5 cycles, but she may simply need more of it.

Have you read the stickies about SLGS and TR and decided which one you are more comfortable with following? That will give you a structure to follow when making decisions about when and how to adjust Willow's dose.

I know you've had very bad vet experiences, but sometime the vet IS the right answer. Have you searched for a new vet? It can be hard finding one that you ar comfortable with, but they are out there!

 

Okay will do

 

Hi
I have not looked for a new vet yet, she just started this two days ago with the dry heaving and I'm thinking it's due to her high bg count.
It is not just a bad experience with one or two it was four different vets at two different offices. At least my one vet was very honest and told me they are treating her numbers and she kept getting worst. When we took her home she got better. They would have killed her. After reading all the stuff on here I was able to put together what happened and why.
It makes sense that if Willow was at really high numbers for a long period of time and they try to get her numbers down into the 100 range in a few hours her body will react to protect itself. It was this that caused her to get the DKA. The sticky notes here explain to get her numbers down to do so slowly and this makes sense considering what I have learned.

Not sure what one to go with.
I read a sticky on cats having high bg will cause them to be hungry. I'm thinking this is the case with her.
The new feeder will be here today and this will allow me to control her food.

I just talked to a friend who is a ER doctor for human, he said the food intake and the amount of insulin is very important, too much food and not enough insulin and high bg, too little of food and too much insulin will cause a crash.
One of the other members posted I maybe giving too much food, I need to look at the amount of calorie she is getting currently receiving daily and figure out a reduction

Am I thinking correctly?

 

With numbers as high as Willow's, the use of a fast acting insulin is a very reasonable consideration especially in a cat that has recently recovered from DKA. I posted an explanation for how DKA is treated and why in one of your condos a few days ago. I suspect if you talked to your friend who's an ER doc, he'd also note that the use of basal and bolus insulin is a common practice in humans, as well as cats.

 

Considering how high she runs, this could be very well part of a bounce. She was red yesterday and that for her was low.

Something is definitely going on. Any meds or supplements, treats you are giving? Was she tested for acro or IAA? I am no means well versed in this at all, but agree with possibly fast tracking or adding R .

 

Hi
He did explain what your talking about, I have NP insulin that we had her on before, the problem with it dropped her numbers 100+ an hour and we could not control the drop. This is why they changed her insulin.

She was up all night last night and seems tried this morning wanting to sleep, I'll check,her at +2 and +3 today to see if her numbers are doing down.

On the fast acting insulin, prior to the nightmare she never had DKA or keytones.
When she was first diagnosed the vet prescribed us insulin, he told us to go home, give her a shot twice a day, come see us in a month. That was the extent of instructions. No check bg prior and after, I did not even learn about any of this until I started reading up on the Internet. During the next month Willow started acting odd, stopped eating and drinking, I called the vet three times and they said just give her syrup she was probably low. She then started drinking a lot.
When I took her into the vet they said she was dehydrated and put her on an IV. Two days later she was now DKA and had keytones, within two more day and shuttling her from one ER back to our vet, one for the day and one for night. She turned yellow and now her kidneys and liver stopped working. All the vets advised us to put her down. She only got better when I took her home at night and took over the night time feeding , watering and monitoring.

Our main vet could not understand why she was doing better at home. He stopped giving the insulin and waiting to see what happened. I had to force feed and water her for over a week before we seen any signs of improvement, during this time we stopped all insulin to,let her body heal on its own. The vet checked her blood and could not believe the liver and kidney problem was gone.

 

Not sure if they tested her for any of that. Her belly feels hard like she is full of food.
No treats of any kind, no other meds beside the insulin.

 

I just posted her +2 she is now 697bg at +2

I'm thinking she ate too much yesterday,

 

Has she used the litter box? I wonder if she's a bit constipated....

 

Yes, she pooped outside of her litter box last night, we changed the normal litter to a different kind and she does not like it at all, my bad because I never buy this my wife does.
The new feeder just arrived and no batteries, I have to go to work and will stop and get some on my way back home
I'm adding water to her food to make sure she is getting enough water

 

I'm sorry but this just isn't correct. We also use fast acting insulins around here as a bolus for the high dose kitties and I used it even with my non high dose kitty (in fact she was on a tiny dose) just to help her with bouncing. They might be giving Willow too much R, as you said, which might then drop her BG too low too fast but that is not what causes DKA and ketones.

DKA is caused by infection + not enough insulin + not enough food/water. It is not caused by giving a high dose of R. In fact, if a cat is in the hospital with DKA and high numbers, the typical treatment is often to stop the basal insulin and just give the R to get the numbers down fast.

 

I don't think this is a bounce and I also don't think we are talking about adding R at this time...or fast tracking. We need to be sure all the dry is out of her system.

James...remember you do not want to do any drastic cuts in calories. You can divide the calories up more through the day but you need to follow the methodology I posted yesterday to see if the calories you are giving her are causing her to gain, lose, or maintain her weight. Any adjustments need to be tiny. It's also good to be sure she is getting plenty of water.

If she were mien with her history of DKA, I'd be testing ketones twice a day at these numbers and call the vet if you see trace ketones. I'd also be syringe feeding her if she isn't eating.

 

Hi
She is eating and I'm adding water to the food to make sure she gets water, she has been drinking all the juice from the food and eating some food.
I notice this morning her little box did not have a large amount of pee today, this is odd because I have been changing the litter box almost daily due to her peeing a lot. She would pee a lot at one time and by the end of a day we would have to change the litter. I did change the litter to something it seems they do not like and will change it back today. When I go home.

Our scale is not reading correctly today, changed the batteries and it is still way off. Will work on getting new one today as to watch her weight.
On her food I'm just going to spread it out during the day, yesterday she ate a whole can of wet food at one time, she never does this, she normally eats a little and comes back later. Yesterday the more food she ate the more hungry she seemed.
I was corrected by my wife, she did not poop outside of the box she did vomit food, she did poop or at least with think it was her, she had some on her tail this morning at 4 am.

What is R?

On her DKA, I'm not sure the reason, when she went into the vets she did not have it or keytones, within two nights being there we had to now take her to a night ER vet to watch and treat her.
They kept saying her numbers are two high and are trying to get them down fast, it seem to make her worst.
They said her blood work did not show an infection. Look at the vets notes I have on here for what they were doing.

 

Also if she is peeing a lot she can still get dehydrated and may need subq fluids at home. Which could also cause the constipation. Did they show you how to tell if she is dehydrated by the test on the back of the neck? sometimes when they use the litterbox they can vomit right after. which can also mean constipation

 

"R" is Humulin R or Regular insulin. NPH is Humulin N/Novolin or we refer to it as N. N has a longer duration than R but both can yank numbers down.

 

I see Sienne responded regarding R.

It wasn’t clear to me whether you were using NPH (aka N) at home and then lantus or whether the vet was using NPH (aka N). I wouldn’t be surprised at a vet giving you N to give her. Some vets do because it’s less expensive.

 

This is something that is definitely very important to keep in mind. In addition to the DKA, it sounds like Willow may have been on the verge of developing hepatic lipidosis since you mentioned she was yellow at the vet and got better when you brought her home and started hand-feeding her. If a cat - especially one with many health issues like Willow - doesn't get enough food, hepatic lipidosis can come on very quickly.

While the basics of this statement are correct, remember that humans and cats are very different. Humans can eat whatever they want with regards to carb content; you are controlling what Willow's carb intake is. That factor alone makes the "feline diabetes dance" much different from the "human diabetes dance".

 

Hi
The photo is a photo of the first insulin, she does not seem dehydrated, she did pee a little since this morning, she was peeing so much daily we were having to change the little box every day.

On her feeding at the vets, only one ER vet was hand feeing her, th other vet as far as I know did not.
Her liver, kidney, DKA and keytones cleared up once I took her homes and force fed her every two hours, at first she would vomit it all up and I would start over. I stayed up four nights straight checking her blood every two hours and feeding the same, we stopped giving insulin and the vet would give her IV during the day. She was still yellow, the vet felt time to send her home with new insulin and hope she makes it.
He then went on vacation, on March 16th the vets office sent a tech to pick up Willow and check her out because we were going to be out of town that dsy and could not give her insulin in the morning. When I went to pick Willow up that night my vet came out and said he was shocked she was still alive, everything pointed to her dying. He said Willow does not make sense because the more they treated her the worst she would get.

She is eating today smaller amounts

 

Also note
Her gums are dark pink, when I push them and hold then let go they turn white then go back to pink.

When we took Willow home her gums were gray and nothing would make them change color

 

That's a good sign (the pink gums, I mean).

 

James....just want to make one thing very clear for now....you do NOT want to use Novolin, R, NPH or any of the fast acting insulins at home without having a lot more understanding about how it works and when it's useful

We have a few people here who understand how to use it safely and effectively and you don't want to even consider using it at home without their help.

Vets use it often in the office because it does bring BG numbers down fast, but they also have access to stuff like glucose drips in case the BG goes too low. It's not something to play with at home without a real good understanding of the difference between the fast acting insulins (bolus insulin) and the longer acting basal insulins like Lantus

 

James, I wholeheartedly second what Chris just wrote here! Originally, my Shoes was diagnosed in Sept. 2015 and after 4 months on it, he had a major hypo and was probably 1/2 from dying when I got him to the ER Clinic. No one could pay me enough money to get near anything with the words "Novolin" in the title of the insulin!

 

Hi,
That is what they had prescribed to us the first time that almost killed Willow, the only instructions that we were given was to go home give 1 unit twice a day with food ,come back and see us in a month!
This is why after everything I have learned got me so upset with the vets, they did not give clear instructions let alone advise on checking her BG at all.

 

Working on this, I got a autofeeder today, yesterday she ate more wet food then the other days.
The autofeeder will help me with her food at least I hope it does