can I give pip insulin now? UPDATE Ketones positive

hi, I had to re-register I forgot my logon. Pipkin diagnosed since June 09. He's been on 5 units every 12 hours, but I haven't been able to afford fresh supply since December, over past week I've realised he is having much difficulty in passing stools, which are hard tiny amount and bullets, he now hasn't eaten much for past few days, and I have not been injecting, but he is quite unresponsive, has a really bloated tummy, and seems to want to eat, but since about 2.5 hours ago he has a small amount of cat food, some baby food and some mashed up chicken (he has no teeth), what do you guys think is it ok to inject, his bg reading 10 mins ago is 592, is has been around 430-480. Would appreciate advise, he will be going to vet on Tuesday.
I have tested for keytones and seems clear.
thanks Jayne and Pipkin

 

help pip has keytone reading

please help I've just checked and keytone strip changed colour to pink, can I do anything now or is this it. Please is someone there, I'm going to phone vet and try and get to him

 

Hi Jayne,

I merged your two topics.

By pinks, what do you mean? Trace, small. The wiki article on ketones is here.

Having no background info on PIP, I would recommend a vet ASAP, earlier than Tuesday. I am glad you have a call into the vet.

Possible stale insulin (don't know what kind) + high numbers + GI tract problems + inability to eat although hungry + some measure of ketones = problems that require a vet.

There is a post on Think Tank about NOT withholding insulin because a diabetic is not eating. It's a quick read. http://felinediabetes.com/FDMB/viewtopic.php?f=22&t=9070

Pip needs insulin and fluids (even if just by mouth) until you can get him to the vet today. (My moderator abilities let me see that you are in the UK, so I would say that today is NOW.) Advising a dosage is tricky because we have no history except the 5U of whatever and usually high numbers, which I assume are pre-shot numbers. It's your call how reduced a dosage you give him, but he needs something.

Please keep us informed.

 

oh thanks, Pip has been admitted to vet, I am so lucky to have a great vet, one of them lives above the practice, so I drove pip there and he is a bit dehydrated, so he's on a drip, and the bloated abdomen, vet thinks is fluid, though he has poo causing a block. He thinks it could be heart trouble, or a virus, or a 'mass' . So he'll sort his insulin out and hopefully he'll eat something. Sorry for once again 'over reacting' but to see that ketone strip go pink which is the 3rd colour along from negative and trace, which is around 15mg/dl looking at the bottle. It's such a shock, so thank you all who have read and answered here. I hope i have good news but, well, not sure.

regards
Jayne and Pipkin- from his hospital bed
xx

 

Yes, insulin and fluids. And the vet as soon as you can.

I am sending healing prayers your way for Pipkin.

Og good, glad he is at the vet... still sending prayers. (((Jayne)))

 

you made the right decision to take to vet. prayers your way that whatever it is, it s treatable and you have many more years together

 

thank God for your vet.... Will say prayers that your boy snaps back just fine.

 

vet just called better news

just an update, Drew the on call vet just called, it is 8p.m. british time, so Pipkin has eaten! and is still on fluids, and Drew gave him 6 units - feel a bit unsure- cause he has had old insulin for quite some time. Drew took bg reading and got 26 mmol +2 which I think is around 460, where he was off the scale before he got insulin, so I think 6 hours even if Drew isn't there pip won't drop dangerously. So I thank my vet so much, no one likes to get a call unexpected from vet do we? but I know it may not be 100% good news, but I just may sleep tonight, cause I haven't slept at all for about 2 weeks, I've had pip in my room and I've slept on floor with him, d'you know quite good treatment for sore backs!
I hope I can still pass on good news in the hours to come, again thankyou all so much,

take care and kiss your little friends on the head
Pipkin, though feeling sleepy, just wants to say a big thankyou, as do I
XXX

 

pip doin well

Pip still in hospital, vet phoned 1/2 hour ago as he has done every night to say Pip is doin ok, he will do full curve tomorrow, but now he is much brighter than he was when he was admitted. Feel positive but don't like him in there, but if they can regulate him I can take it from there,
so far paid £354 brit pounds for 24 hours care - yikes, thank god Mum had a card I could use!
thanks
Jayne and Pipkin

 

Jayne, that is good news. I hope he continues to improve and can come home.

Have you gotten new insulin? I don't know if anyone here can help you with that since you are in the UK, right? But please ask if you need help because you will need to be giving good insulin when Pip comes home. This group has an amazing way of figuring out how to help across the continents! Maybe start a new thread on Comunity?

I'll keep Pipkin and you in my thoughts and prayers.

 

we do have members in the UK, as well as other parts of Europe - what insulin are you using?

I will direct these members to you.

 

pip's vet not happy

hi, Pip is still in hospital, now 5 days, till today all seemed positive, but vet just called, the curve they did yesterday, pip showed off the chart (over 598< is that right), he is now on 10 units insuvet lente (seems not one used in US) twice a day, he has been on fluids all this time. Vet is not optimistic, so I need your strength and advice. I said could he come home so I could inject and test here, he is quite high, but hardly ever off the scale, and that was on 5 units.
I raised concerns : inject site always the scruff which is now hard and I was recently trying new site, he agreed though he is still injecting in scruff. Pip cannot be stress free where he is so the reading may not be true, he said he seems ok. Rebound?, yes he was aware, and lastly, he suggested a new type of insulin. We left it that he will call in morning, and do one reading in the pm tomorrow (Friday).. He said he would not allow him home as the only thing keeping him comfortable were the fluids, and he does not want the quality of life compromised, but please, surely he can't refuse to let me take him out, I could be taking him for a second opinion couldn't I? I just want him here where I can observe him. I am off 3 days M,T,W next week. Please I now truely need any comments you may have, I have read messages on this site and I know how much knowledge is around.
Thanks for all help so far
Jayne and Pipkin XX

 

Besides the high bgs, have the other issues been resolved??

 

What is the status of ketones, bowel movements, and eating?

I would have expected your vet to be cautiously using some fast acting, short lived, big dropping insulin (in the states the vets would use Humulin R, R for regular) to watchfully pound those BG levels down, instead of using insuvet lente in increasingly higher dosages.

Are the fluids being given intravenously (IV)? Are supplements, like potassium, being added to the fluids? Is the insulin being given IV?

From the petdiabetes wiki article on ketones (footnote tags omitted):

My thoughts are with you and Pip. I suggest that if it does not appear the vet is following these DKA procedures, you need to try another vet, an ER or specialty hospital.

 

thanks, well he has gone through so many tests, that the only concern is his high bg levels, sorry I have no update on ketones, or pooping, I think he is eating, but I don't know how much water he has access to. You know how different our vets in general seem to be to other countries. I was advised Insulin would last 2-3 months beyond it's date, I never was happy with that, and this time I took it to the limit 7 dec- 14 mar, I won't do it again, if Pip gates the chance. The insulin is being injected into scruff, fluids are intrevenous.
I have decided, he is coming home tomorrow Friday, he will not spend the weekend in a cramped cage, albeit with caring staff.
Tomorrow, I wil be asking:- fast acting insulin, ketone reading,
so thanks
Pipkin most of all and me XXXX

 

IF the other issues have been resolved, if he no longer has ketones present, and if the high bgs are the only issue then yes, get him home. Please tell me if you are hometesting? That dose is very high and the high bgs MAY be a result of overdosing.

 

thanks, you know I forgot to ask re- ketones, I will ask 2moro, and yes he will be home 2moro. I gather if he still has ketones present he shouldn't be home is that right. his reading was not negative, not trace, but next one which is weak reading, that was the first time he has had a reading other than negative, thanks so much.

thanks from Pipkin most of all and me XX

 

Ok so he was moderate for ketones and has very high bgs and is being treated with insuvet lente which is an intermediate insulin.


When you bring him home, you need to ensure he is hydrated, that he eats enough, that you test his urine for ketones and that you are testing blood glucose levels so you can work on a dose that is right for him AT HOME.

Let us know how we can help

Jen

 

Pip is home

Yes, vet called in afternoon, to say that bg levels had dropped, though still high, and he had been taken off fluids and seemed to be ok. He's here, he's comfortable, he has had a small amount of food, cause no one told me when he had been fed or how he was eating , but I'll give him a good with an hour before his injection. I've to give him 11 units twice a day, even I believe that is far too much, so I'll be worried incase his bg drops too much. I'll test him a wee while, he has2.5 hours before his insulin. I am upset cause even though the vet knows I am struggling to pay he sent me away with some branded diabetic wet food and I think charged me £31. I am angry, I paid the bill before I went into see vet, and I didn't get a breakdown or I would have refused, and he charged me for flea treatment when I had said I had given first treatment 3 weeks ago. But that's not important, I just need to be aware next 3-4 days, I did do ketone strip when he piddled and it was negative. That was a big relief.

Thank you all so much,
Pipkin and Jayne XX

 

Pip's numbers are better though still too high. Did a curve 2day:
amps - 326
+2 -362
+5 - 315
+6.75 - 306
+7.75 - 319

So i am happy at the first number but his nadir still is nowhere near good enough. He is eating he is negative ketones, and I did a urine strip test and for first time it was in the range of 250-300. My worry is as he is on 11 units bid is this going to be impossible to regulate him? Surely there is a limit to the dose of insulin. I know his insulin is not known widely, and does anyone think a change of insulin may make a difference to him. I know he may have other conditions impacting on him, just wondered if this is a losing battle for him.

Thanks
Pip and JayneXX

 

The "curve" you obtained is essentially flat with no real "curve". Eleven units of insulin with a flat curve typically is the result of rebound from too much insulin. However, Pip has a history of ketones which may indicate that Pip is high dose kitty. Reading through your history you seem to be getting a lower BG that when on 5 units. I recommend that you start a new post with a brief history. You should also post in the high-dose forum. I recommend that for one of those posts you just refer to the the other post to help keep all the replies in one place.

 

thanks, pip had only one ketone reading week past sunday when this all happened up till then he had shown negative, yes he had been on 5 units till last week when vet upped. I know I possibly had used stale insulin, so thanks I will do as you suggest
J & Px