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6/15 - Updates on Ty

Discussion in 'Lantus / Basaglar (glargine) and Levemir (detemir)' started by CCG, Jun 15, 2019.

  1. CCG

    CCG Member

    Joined:
    Jun 12, 2019
    Original thread here: http://www.felinediabetes.com/FDMB/threads/please-help-kitty-with-ketones.215641/

    Thanks to everyone who has been helping Ty for the last day.

    Ty did OK overnight. Blood glucose levels were much higher than yesterday.
    I fed him before he got his insulin and at +1 PMPs.
    He vomited at around +2 PMPs... just a little bit. Not a ton. And definitely not all of the food I had given him.
    I held off giving him too much more food, but kept giving him water throughout the night and fed again at +7 PMPs. He is keeping it down. Fed again at PMPs (BG was 487).
    Fed this morning after measuring BG and gave 1U Lantus. Also just fed him again and gave some water. Trying not to give too much but am doing consistent feedings.

    We tested for ketones last night at midnight (+2 PMPS) and it was trace or negative. So not too worried about that at this point.
    Have calls into both of our vets (family and internist), inquiring about getting an Rx for nausea. I gave him an appetite stimulant yesterday that our vet gave us but he is still not interested in food. He sniffs it and licks his "lips" but won't go for it. I think everyone is right that he is nauseous.
    The tech at the internist said that his urine test was clear -- no UTI last week.

    Continuing BG monitoring and consistent, small feedings. He is keeping the food from this morning down so far. Welcoming recommendations for what else we can be doing.
     
  2. Dyana

    Dyana Well-Known Member

    Joined:
    Dec 28, 2009
    I know you said you live in a city, so don't know if you have a Costco around. I shopped around for Ondansetron and my local grocery store pharmacy wanted what equated to $3.33 per pill for Ondansetron and Costco (where you do not need a membership to use their pharmacy) wanted $0.33 per pill. This was 5 years ago, but it pays to shop around. I hope you get the prescription as it sounds like he is nauseous. Going to the food and licking his lips is one of the main signs of being nauseous.
    On another note, the ReliOn Ketone test strips are $6.64 for 50 strips, if you have a Walmart nearby. Read the label, as when I used them (again 5 years ago), they are to read at exactly 15 seconds, not the 40 seconds like the ones you are currently using. I also bought the blood ketone meter and found it to be extremely helpful, as you can get a reading (that is more current than a urine ketone reading) anytime you want and not have to wait for pee and stalk the litterbox.
    My kitty J.D. was a DKA survivor. He was in critical condition when he was admitted to the hospital. He very slowly improved day by day. He would not eat while he was in the hospital and they kept saying he could be released as soon as he ate on his own. He wouldn't. He was there for 8 1/2 days, and eventually they released him with a feeding tube.
    He was still weak, when he came home. And, he soon ate on his own, and slowly got better. So there is hope.

    I'm glad you are getting negative looking tests on the test strips. Keep getting those tests whenever possible. Again, I also recommend the blood ketone test meter as it is easier and more current. You will need to test often, for a while.

    Keep getting that food and water in.

    I wish the best for you two.
     
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  3. CCG

    CCG Member

    Joined:
    Jun 12, 2019
    Update...
    Ty just vomited again.
    The vomiting seems to happen when I feed him too closely after giving him insulin. Is that a thing?
    Anxiously waiting to hear from the vet to get him an Rx for nausea.
    He seems pretty alert right now and is sitting on his favorite mat in the bathroom.

    He just urinated and had diarrhea again. Tested for ketones and am confident that it was negative.

    His gums aren't sticky and the skin on his neck bounces back readily, so he may be a little dehydrated but I don't think it is out of control yet. The vomiting and diarrhea worry me.
     
  4. Marje and Gracie

    Marje and Gracie Well-Known Member

    Joined:
    May 30, 2010
    Hi Courtney and Ty! So glad you found us and I hope we can give you some help. We’ve helped more DKA cats recover than I can count so you are in the right place. Ty just needs to get on board with our plans :);)

    First, Tanya is correct that his test for pancreatitis was negative. And he does not have s UTI but he must have infection somewhere. Did they give him an antibiotic either time he’s had DKA? I notice they didn’t check his teeth this last visit but teeth and gums can certainly the source of infection that can cause DKA. It’s really important that the infection is found/treated or you’ll likely face this again.

    As others have said, it doesn’t matter what the carbs are and, in fact, higher carbs, and high calories, are good when treating DKA because it allows us to get more insulin into them safely. More insulin helps bring the numbers down.

    His electrolytes are definitely off. I’m not sure how open the vet will be to you giving him LRS at home if he’s never had an echocardiogram to see what shape his heart is in. Cats can have murmurs and absolutely no heart disease.

    I know Cassandra used NPH but we usually recommend using R to help bring down any high numbers. It’s faster acting and shorter duration. However, you do need an experienced R used to help; my brother in law just passed and I have my sister here for another few weeks caring for her so I don’t have the time I usually would to help with R.

    Other than the electrolytes, nothing jumps out at me. His creatinine is s little low but that’s reflective of everything else. Recovering from DKA takes time, lots of food and water, required insulin dose, making sure the infection is resolving, testing for ketones s couple times a day, appropriate meds and I put cerenia and ondansetron at the top of the list. No cat will eat without nausea being resolved.

    I can make some repairs to your SS so at least people know what’s going on in terms of the extra shot and can flip it over for you so the oldest date is at the top (I can do it faster than you probably can unless you are a SS whiz:)). I do need editing rights, though, so please send me a private message by clicking on “Marje and Gracie” to the left and “start a conversation”.

    Paws crossed and sending lots of healing light.
     
  5. CCG

    CCG Member

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    Jun 12, 2019
    Getting cerenia from vet now!
     
  6. Marje and Gracie

    Marje and Gracie Well-Known Member

    Joined:
    May 30, 2010
    The insulin shouldn’t cause the vomiting. Perhaps if he has an upset tummy and you are handling him more when you give insulin, it causes it?

    If you are in a big city, you might be able to find Renew Life Saccharomyces boulardi; if not, you can order it and it works great for diarrhea as long as he doesn’t have low B12. Because you don’t need to incur that expense for testing his cobalamim levels right now, you could try the S. boulardi. You can give 1/2 cap every 2-3 hours until the diarrhea stops and then go to 1/2 cap twice a day until you see solid poos, and then 1/4 cap twice a day. Jarrows makes it, too, but it has MOS which is great but tastes vile so I wouldn’t give it to a sick cat.
     
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  7. CCG

    CCG Member

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    Jun 12, 2019
    Quick update as I am running around - he is now at 504
    But I gave him cerenia about 45 min ago. Hoping it helps.
     
  8. CCG

    CCG Member

    Joined:
    Jun 12, 2019
    Thank you so much. Will try this
     
  9. CCG

    CCG Member

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    Jun 12, 2019
    Ty came out from his hiding spots and decided to swat our dog when she got too close :). This is good.
    I am feeding him little bits at a time and hoping he will be interested in some food on his own soon.
    His numbers are still high. Is this normal? Should I stick with 1U Lantus tonight?
     
  10. CCG

    CCG Member

    Joined:
    Jun 12, 2019
    Looking into this now. I could run to the pharmacy and get it, or order it online. But I am a little worried about introducing anything new to his system given how sensitive he has been and that he vomited earlier. Am I being too conservative?
     
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  11. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    Yes, you are. The probiotic is neutral and he has the same sort of flora in his gut. You're really not introducing anything new. You're helping his gut to get back to normal. Also, vomiting and diarrhea can have an effect on electrolyte levels so you want to get that under control.

    I mentioned this earlier but I suspect it got lost in the wealth of posts. Baby food may be an option to entice Ty to eat. Beechnut or Gerber Stage 2 -- it's a protein and broth only -- are good options. Be sure to not get anything with onions or garlic in it.

     
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  12. CCG

    CCG Member

    Joined:
    Jun 12, 2019
    I will get some baby food for him to try.

    Somebody mentioned electrolytes earlier and I should be clear that the labs I posted on the previous thread were from 2 before Ty was released from the hospital. So I think his electrolytes were normal when he came home on Tues. I forgot to ask for a copy of his final labs when I called them today. But will do so tomorrow.

    What is a safe way to help him w/his electrolytes at home? Should it be done in office? He has a heart murmur.
     
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  13. Sharon14

    Sharon14 Well-Known Member

    Joined:
    Aug 16, 2015
    Definitely try the baby food, but also pick up some other food than what you’ve been syringing. Some cats develop an aversion to what they were syringe fed.
     
  14. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Well-Known Member

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    Dec 28, 2009
    Don't try to adjust electrolytes at home. There is a very narrow margin between normal and abnormal. A little too much in the abnormal direction and humans, cats, etc. are in trouble. The reason the vet was running so many blood tests when Ty was hospitalized was to make sure the electrolytes were getting back in balance.
     
  15. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Feb 21, 2015
  16. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Well-Known Member

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    Dec 28, 2009
    @Bron and Sheba - I'm hesitant. Ty has been at this dose for 3 cycles and this one looks like a bounce. If the bounce breaks on top of a dose increase, it could mean a very long night of testing. I won't be able to stay awake to lend a hand if this happens and my personal rule is that I won't tell someone to shoot if I can't stick with them until we know the kitty is safe. Given that Ty's appetite hasn't been great, that would complicate getting HC on board for a kitty with dropping numbers.

    It may also be a bit more humane if the dose was increased tomorrow morning.
     
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  17. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Joined:
    Feb 21, 2015
    @Sienne and Gabby (GA) I commented in the previous thread that I thought this might be a bounce but also worried about these high BSLs given the recent DKA. That's why I tagged you and Dyana as I wanted your thoughts. It's good there are no ketones at the moment and with no ketones it should be ok to leave until morning. Hopefully by then his apply will have improved with the cerenia. As you have greater experience I'm happy with what you think. Thanks:)
     
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  18. Marje and Gracie

    Marje and Gracie Well-Known Member

    Joined:
    May 30, 2010
    Courtney

    Are you still shooting 10/10 and do you want to get back to 7/7? If you check at +10 from when you shot this morning and he’s still in red, you can shoot then (which should be 8 pm your time). That will put you a little closer to his regular shot time. Just be sure you watch him tonight because shooting early “may” act as a dose increase but it’s also a method we use to try and get the numbers back down without raising the dose.

    If you still want to get back to 7/7, then tomorrow night, you can shoot 30 mins early and another 30 mins early Monday night; although, if he’s high again tomorrow night at +11, shoot at 7 pm and you’re back on your normal shot time.

    Does all that make sense?
     
  19. CCG

    CCG Member

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    Jun 12, 2019
    Hi all. Thanks so much.
    My laptop decided it no longer wanted to connect to the internet because it needed an updated driver, and I can’t update the driver without the internet. So I am on my phone. Apologies if I miss anything as it’s hard to see all of the posts on my phone.

    Good news is that Ty decided he wanted to eat!!! As suggested, I got him some baby food and cat food that I hadn’t been syringe-feeding him. He was not interested in the baby food but ate a little of the cat food. The cerenia seems to be helping a lot.
    My question for you all: he ate, but not a ton. Should I try to syringe more to get him more calories? Or lay off and give him more time to feel better?
    @Sharon14, you are definitely right about the aversion. He does not want to touch any of the FF flavors right now.

    @Marje and Gracie, thank you so, so much. I am downloading Google sheets so I can get to this on my phone. We do want to get back to 7/7, but I may wait until tomorrow to heed your advice. We went out to pick up a bunch of stuff for Ty and now it is already 8:30 here and he ate a bit just before 8. To be on the safe side I will probably shoot at 10, and then maybe shoot again tomorrow morning a little earlier - 9ish? Or I could do 9:30 tonight and 9 tomorrow morning.

    I am also thinking to play it safe and give him 1U tonight.
     
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  20. Chris & China (GA)

    Chris & China (GA) Well-Known Member

    Joined:
    May 10, 2013
    As high as he's running, I wouldn't worry about how long it's been since he ate. I'd go ahead and shoot at +10 (or whenever you can...not sure what time it is now) and get back to your chosen shot schedule a little sooner.
     
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  21. CCG

    CCG Member

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    Jun 12, 2019
    Gave him 1U at 9:30pm. Still worried about dehydration and ketones but don’t want to force him to eat for now when he is starting to on his own.
     
  22. AliceMeowliss&Cassandra

    AliceMeowliss&Cassandra Well-Known Member

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    Jan 8, 2019
    Hope Ty is doing well tonight. :)
     
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  23. CCG

    CCG Member

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    Jun 12, 2019
    Ty is doing much much better. He is walking around, meowing, and when I got up a bit ago to check on him he came to me looking for food.

    He is eating. But definitely has an aversion to all cat food right now. I have tried three different kinds. And he is not interested in baby food. Going through the appetite stim suggestions from the previous thread and another page that @Tanya and Ducia posted. Thoughts welcome. He is clearly hungry and wants to eat but doesn’t seem to want any kitty food. We had some deli turkey that he would eat, but when I tried to put it near kitty food he said no way.

    BG is still high (400s all night).
    With all that is going on, husband and I realized at our 3am check of ty’s glucose that we only have 2 test strips left (Went through an entire bottle since Thursday night - eek). One I just used now. Ordered more on amazon but they will not arrive until tomorrow. from searching through other threads it looks like I could get a human meter from the pharmacy and use that for today, just make sure to adjust the numbers to calibrate for the fact that Ty is a kitty.

    Thank you all so much for helping me look after Ty. Not in the clear yet but his turnaround so far has been tremendous.
     
  24. CCG

    CCG Member

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    Jun 12, 2019
    @Marje and Gracie, do you recommend only bringing up the PM shot time? Not trying to adjust AM too? Or am I reading this wrong.
     
  25. Sharon14

    Sharon14 Well-Known Member

    Joined:
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  26. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Feb 21, 2015
    I’m so glad Ty has improved so much. That’s wonderful.
    If you get a human meter you don’t need to adjust anything. Just say it is a human meter.
    What about a roast chicken from the shops but not the outside skin which has additives on it.
     
  27. CCG

    CCG Member

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    Jun 12, 2019
    @Sharon14, actually that is one of the options we got him. He usually loves this stuff. He has eaten a little bit of it but reluctantly. I can tell he’s hungry but he won’t go for it as much as he wants to.
     
  28. CCG

    CCG Member

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    Jun 12, 2019
    @Bron and Sheba good idea. I think it is going to have to be something like this for now. I just worry about giving him too much because he has always had a finicky stomach. Dont want this to spiral out of control again.

    Thank you all so much for helping me with Ty. I really can’t thank you enough. I was absolutely devastated and really thought we were going to lose him this weekend. I am so happy about his progress. :)
     
  29. AliceMeowliss&Cassandra

    AliceMeowliss&Cassandra Well-Known Member

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    Jan 8, 2019
    :bighug::bighug::bighug:
    I felt the same way, like Alice would slip away from me..... I think we have all been that scared and worried. I know in the moment it can feel like it is everything and your cat is going to fall apart before your eyes...... and then suddenly, in little spurts, it starts to get better. :) Cat’s can heal so amazingly well!
     
    Last edited: Jun 16, 2019
    Reason for edit: quote fix
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  30. Marje and Gracie

    Marje and Gracie Well-Known Member

    Joined:
    May 30, 2010
    If the BG is in the blue and green ranges or yellow but dropping, you only want to shoot early by 15 mins a cycle or 30 minutes once a day. If he’s mid yellow or above and/or headed up, you can shoot early up to two hours before a shot.

    Here is more info on Getting Back on Schedule.

    Let me know if you have questions.

    If you start using a human meter, let me know and I’ll reformat the SS you are using now. I do it all the time for members and since you’ve given me editing rights, I just need you to tell me when you start with the human meter.
     
  31. CCG

    CCG Member

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    Jun 12, 2019
    Thank you @Marje and Gracie!
    I started using a human meter at +3 AMPS today. So the last two numbers are from the human meter. I only plan to use it until we get more AlphaTrak strips tomorrow which I ordered this morning.

    Ty is still doing OK but there is room for improvement. His numbers have still been high. He still seems hungry but hasn’t been interested in much I’ve given him. He ate a little on his own this morning around 7am. But not since then. Tried cooking him some ground turkey and chicken and he wouldn’t go for it. I ended up feeding him a little more from the syringe because I want to avoid ketones and I want him to get some food & water in him.

    Gave him another 1/2 tablet of cerenia, the vet said that he could have it every 24 hrs if needed (instead of 48).

    Ketones were negative this morning.

    I do notice that the only time his numbers were low was the day after I gave him an extra bump of insulin in the PM.
     
  32. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Feb 21, 2015
    Do you have any ondansetron ( zofran)? It is another anti nausea med and works in different way to cerenia and can be given at the same time as cerenia. Also ondansetron can be given up to 3 times a day. It is a human drug and the vet can write a script and you can get it from the pharmacy. It would definitely be worth while getting some and trying it.
     
  33. CCG

    CCG Member

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    Jun 12, 2019
    No, I don't. I can ask for it tomorrow.

    Ty is definitely doing better but I am still concerned about a couple of things. High glucose levels, continuing diarrhea (I have been mixing pumpkin into his food, and some probiotic), and his continual avoidance of food despite initial interest when he sees it. Should I start a new thread? Or keep this one?
     
  34. CCG

    CCG Member

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    Jun 12, 2019
    Also, I have some gabapentin from a previous vet visit (he used to take it before routine checks because he got so anxious going for an appointment).
    Would it be bad to give him some to help with any pain/anxiety?
     
  35. AliceMeowliss&Cassandra

    AliceMeowliss&Cassandra Well-Known Member

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    Jan 8, 2019
    I can’t personally answer this, but it’s an interesting thought. I don’t have the same syringe feeding experience. Alice mostly managed to eat “on her own” even if it meant holding chunks of meat in my hang in front of her face. She remained motivated enough except for some episodes.

    But the continued difficulty to get him to eat, along with GI issues...

    Could any problems be food related?
    Was he treated for parasites or checked?
     
  36. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Feb 21, 2015
    It does sound like he is still nauseated if he is initially interested when he sees the food.
     
  37. CCG

    CCG Member

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    Jun 12, 2019
    @Bron and Sheba @AliceMeowliss&Cassandra -
    Yes. I think he is still nauseated and mainly just averse to food right now. He will still eat deli turkey on his own and keeps looking at me like he wants me to give him more of it. But I don't want to make him sick. That's also why I'm wondering about gabapentin to calm his nerves in general. He's always been an anxious guy and I have a feeling me feeding him with the syringe hasn't exactly warmed him up to food.
    I've been feeding him w/the syringe still so that he gets some calories.
    Going to ask our vet about the other anti-nausea medicines tomorrow.
     
  38. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Well-Known Member

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    Dec 28, 2009
    You might see if he'll eat without the pumpkin mixed in. Gabby was a very food motivated cat and wouldn't touch her food if I added pumpkin. I honestly think using a probiotic (S. boulardi) will be a better option.
     
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  39. AliceMeowliss&Cassandra

    AliceMeowliss&Cassandra Well-Known Member

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    Jan 8, 2019
    I noticed I have one very pumpkin-averse cat, too. If you already have the probiotic to use instead I think this makes a lot of sense to just use that! :)

    I welcome any correction, but.... As long as nothing weird extra has been added to the deli meat, I would definitely encourage him to eat it, just not in large quantities at once. You need him to feed, feed, feed. More food, more insulin can be safely given, more recovery.....

    You’re doing a great job. :)
     
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  40. CCG

    CCG Member

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    Jun 12, 2019
    @Sienne and Gabby (GA) @AliceMeowliss&Cassandra @Bron and Sheba -
    I have been using the probiotic, too. The trouble is he won't really go for anything but deli turkey on his own (even when I offer other things with NO probiotic or pumpkin... those Fancy Feast tuna delights are usually his favorite and he sniffs but won't eat. He came out while I was feeding the other pets this morning and his eyes were big like he really wanted food. But when I offered him a bunch of options, all he did was lick the a little of the broth.

    I looked up side effects of cerenia and anorexia and diarrhea are listed... maybe I'm not doing him any favors if it's not quelling his nausea and its making him not want to eat? I gave him a second dose yesterday - maybe I should hold off for today?

    I'm going to start a new thread to ask about this & Ty's numbers. His numbers have trended lower after the two times that I either gave an early shot (6/16) and/or gave him an insulin boost halfway through his cycle (6/13 PM).
     
  41. Sharon14

    Sharon14 Well-Known Member

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    Aug 16, 2015
    How’s Ty doing? Have you tried chicken livers? I’ve used them on kitties that weren’t eating well. Some like them, others not so much, but may be worth a try. I usually just nuke them in the microwave for a few seconds. Keep an eye on them cuz if you over do it they will explode, and I promise you don’t want that....
     
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  42. CCG

    CCG Member

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    Jun 12, 2019
  43. CCG

    CCG Member

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    Jun 12, 2019
    Haven't tried this yet... I am cooking chicken breast now in the instant pot so that it's tender... hoping he goes for it. If not, will head back to the store for this. Will definitely keep the microwave advice in mind :nailbiting::)
     
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