? Dosing Advice Prozinc 1

Discussion in 'Prozinc / PZI' started by Bear & Lora, Sep 28, 2018.

  1. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Just to clarify.......At Bear's weight he needs roughly somewhere between 250 to 300 calories per day. I don't know the calorie count of the Friskies off hand. My girl is about the same weight (16lb.) and she got 1/2 can FF with each shot and 2 snacks each cycle of between 1/3 and 1/2 can plus a few chicken treats for a bedtime snack and she is maintaining her weight and in remission. If Bear needs to gain some back, he can eat more. Also, diabetics don't get all the nutrition out of their food when they are unregulated you don't need to limit him, If he gets hungry, give him some grub.
     
  2. Bear & Lora

    Bear & Lora Well-Known Member

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    I'm OCD with details but I had to make myself summarize some of our visit otherwise Bear wouldn't get his insulin until after 10. I don't type fast.
     
  3. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    DO you mean he ate the whole can? If so YEAH! Yes to the 1unit with test at +3. I'll try to check back in around then but no guarantee so if he is dropping really fast/too low by any small chance, (I don't think he will) you can give him some higher carb food or if he's real low add a half tsp of honey or karo to his food to bring him up and test again 20- 30 minutes later to be sure he's coming up and make sure he continues to stay up without feeding again (see hypo instructions in the stickies).
    Funny you mentioned not typing fast....I don't either and my fingers aren't working tonight.
    What time is it there? I think you are on Central time...correct?
     
  4. Bear & Lora

    Bear & Lora Well-Known Member

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    Bear has put on 1 lb and 5 ounces since August 28th, about a month ago. He is overweight about 3 lbs. Not that I think Bear should lose weight with his BG all over the place but I will watch him like a hawk, I promise.
     
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  5. Bear & Lora

    Bear & Lora Well-Known Member

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    It's 10:22 PM He's a little over an hour overdue his shot.
     
  6. Djamila

    Djamila Well-Known Member

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    Did you give him his shot yet? Do you think you'll be able to wake up and test him during the night?
     
  7. Djamila

    Djamila Well-Known Member

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    The recipe for ketones is infection + insufficient insulin + not enough calories, so it's important to make sure he gets enough calories right now, even if it means letting him back on the kibble for a few days. We also need to get the insulin back up - not all the way to 3u, but higher than it's been.
     
  8. Bear & Lora

    Bear & Lora Well-Known Member

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    I just checked he has eaten about 2 ounces now, which is a half a can and 6 or 7 chicken treats since we came home.
     
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  9. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Ok well I tend to be a night owl but with this cold, I probably won't make it till 2:30 AM. If you have any major concern and need help and none of us (Kris, Rachel, Djamila or me) are not around, post in health with the 911 pre-fix. There are some great folks from Australia, New Zealand that are usually on at night.

    I doubt you will need any of this, and you are doing a super job with Bear but I know only too well how nice it is to have company when dealing with a low number. We affectionately call them PJ parties!
     
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  10. Bear & Lora

    Bear & Lora Well-Known Member

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    No I haven't shot him yet, and yes I'll get up.
     
  11. Bear & Lora

    Bear & Lora Well-Known Member

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    Remember he had pretty good numbers today and at night he seems to have lower numbers. Last nights wasn't that great.
     
  12. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    @Djamila - I am very glad to see you here. Do you think we should bump Bear up to maybe 1.5 units? I suggested 1u for consistency and in case sleep overtakes Lora given the day she's had. Your thoughts?
     
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  13. Djamila

    Djamila Well-Known Member

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    Grrrr...this isn't how I wanted to do his dosing. I was really hoping we could be methodical instead of continuing to just guess and see what happens. But with the ketones, I'm too afraid to leave his dose low. Ketones are more dangerous than a hypo since if he goes low you can give him some honey or karo. So I'm going to say 1.5u tonight, but please make sure you get up and check him at +3, and if he's below 200 then get up again. I'll give more directions about that in a minute, but I want you to be able to shoot.
     
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  14. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    @Djamila - I was hedging on the 1unit vs 1.5unit too and I echo your GRRRR! :)
     
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  15. Bear & Lora

    Bear & Lora Well-Known Member

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    Ok, be back soon.
     
  16. Djamila

    Djamila Well-Known Member

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    I'd rather give him 1u, but it's too dangerous with ketones. I think we have to increase and send wake-up prayers for Lora in a few hours.

    Lora, if Bear sleeps with you, you might just take your testing kit to bed with you so you can just roll over and check him.

    This is going to get confusing because I'm going to try to give you every scenario in case no one is around later.

    +3 test
    >200 you can sleep the rest of the night
    Between 150-200, wake up again at +4.5 and test again
    Between 80-150 give a snack and test at +4.5
    Between 50-80, give a high carb snack (kibble, or add honey/karo to regular food, or give a high carb wet food if you have one) and test again in an hour to make sure he's rising
    Below 50 Give honey/karo with food and keep testing every 20 minutes until he starts to rise.

    +4.5 test
    Between 100-150, give a snack and sleep the rest of the night
    Between 70-100 give a snack and wake up at +6 to test again
    Below 70 give some kibble and wake up at +6 to test again

    +6 test
    Above 50 - you're done and can sleep the rest of the night
    Between 40-50 give some kibble and keep testing every 30 minutes until he starts to rise. Then you can sleep
    Below 40 give honey/karo and keep testing every 20 minutes until he starts to rise. Then you can sleep.

    Okay, that is a quick rough guide that I hope covered everything. As Linda said, there are usually folks out on Main at all hours day or night, so post if you need help or if I left out a scenario or it doesn't work or something. There is more finesse to all of this than you'll see in these directions because they are intended just to keep you all safe through the night.

    My hope is that he'll stay steady and you won't need to wake up again after the first one, but I want you to have directions for all of it since he's been a little less than predictable the past few days.
     
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  17. Bear & Lora

    Bear & Lora Well-Known Member

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    Done . I know you both are trying to cover everything but before I forget or you are gone,- his morning shot should be 10:30AM since tonight's is 10:45PM? I will be tied up with nurse and mom from 9:30-10:30AM.
     
  18. Djamila

    Djamila Well-Known Member

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    Yes, 10:30 would be about right. You have about an hour of play with Prozinc, but if you're busy with the nurse until 10:30, then we can help you get the shot time back to your preferred schedule another day.
     
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  19. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    I am signing off and will check back later if still awake. I'm sure all will be fine. You've got this. I'm just so glad Bear is home! :)
     
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  20. Djamila

    Djamila Well-Known Member

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    Sleep well and I hope the cold goes away soon!
     
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  21. Bear & Lora

    Bear & Lora Well-Known Member

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    All right I will leave these instructions out and follow them. Thank you both.
     
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  22. Djamila

    Djamila Well-Known Member

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    One thing to keep in mind with the ranges. Fairly often our kitties will do something like giving us a 204 or a 197 when the range directions are for 200. And then we are left trying to decide what to do. It's so close, so do you follow the directions for the top range or the bottom range? In cases like that you need to go with your gut. We call it Mama Sense. Trust yourself, and ask for help if you need it.

    I'm about to sign off for the night too, so take care and hopefully you'll be able to get some good sleep and not have to test all night!
     
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  23. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Woke up just in time for +4.5 and saw that 85 at +3. Glad to see he's come back up now to 241. Was holding my breath as I am sure you were. If you fed him food to get BG up at +3, then give him a little more food and head back to bed. If you used honey or karo by any chance, I'd feed and check again +6 or +7 just to be sure. Bear is a bit unpredictable right now. :)
     
  24. Bear & Lora

    Bear & Lora Well-Known Member

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    @MrWorfMen's Mom
    Bear turned up his nose to all wet food, plus the chicken treats so I resorted to kibble but he would only eat 9 of them I only touched a finger with honey to his lip and when I tried again he turned away. I have never given him anything sweet before and I guess he doesn't have a sweet toothe. Good night and thank you for checking on us. :) I replied to the wrong post again, lol. I need sleep.
     
  25. Rachel

    Rachel Well-Known Member

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    Oh Lora I'm glad Bear is home. I hope you were able to get some sleep and that he's doing well in the morning!

    I'd get ketone tests whenever you can for now. Treating at home is difficult, and you want to stay on top of this.
     
  26. Kris & Teasel

    Kris & Teasel Well-Known Member

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    I'm really glad you had great help from these folks. My kitty has had TWO bouts of diabetic ketoacidosis and it's very serious and expensive to treat in hospital. It takes weeks afterward to get back to normal. Here are some general guidelines (learned the hard way):
    • Feed higher carb (medium carb or even kibble) food to allow larger insulin doses to be given safely. Lack of calories means his body will break down fat, etc. and that results in ketone production. You can slowly switch to lower carb over time and reduce insulin as needed.
    • Hydration is key. Add a lot of extra water to wet food meals (3+ Tbsp) and consider sub Q fluids too. That helps to wash out ketones.
    • Test for ketones at least once a day for a while.
    • Ask your vet for antinausea meds (ketones make them nauseous) and appetite stimulant meds (they MUST eat). Some people give Cerenia for nausea/vomiting but I've used ondansetron (human chemo nausea med) to good effect. Mirtazapine is often used for appetite but makes some kitties "weird". I used cyprohepatadine, a human antihistamine.
    • Have Bear checked for any source of infection or inflammation (UTI, dental, pancreatitis, etc.).
    Sometimes the vet won't prescribe these meds but they're essential to get kitty eating and keep him eating. You might have to be "assertive".
     
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  27. Djamila

    Djamila Well-Known Member

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    Well, he gave you a bit of an adventure last night. I hope you slept well (and are still sleeping) the rest of the night.

    A couple of things going forward: normally you want him to hit those green numbers. However because it was the middle of the night we were trying to steer him away from those just for that cycle. So the next time you get an 85, throw a party instead of giving carbs. That whole list of what to do can pretty much be thrown out now as it was specific to the circumstances last night, and not the rules that you would generally want to follow.

    Kris is our expert on ketones as she has unfortunately had to deal with it a few times now. Good luck at the vet this morning, and let us know how it goes. It sounds like you might have found a good vet which is a very rare thing when it comes to feline diabetes!

    Since you're around today to monitor him, I would recommend staying at the 1.5u dose and using the food to steer him, however I'd really like @Kris & Teasel and @Rachel to take a look and see if they agree with that since I don't have as much ketone experience.
     
  28. Kris & Teasel

    Kris & Teasel Well-Known Member

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    I think staying at 1.5 u and steering with food is a good move right now. All the usual rules go out the window with ketones in the picture. It's essential to be able to give enough insulin and do it safely by balancing it with enough carbs.
     
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  29. Rachel

    Rachel Well-Known Member

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    I agree too. You want him to get insulin and food in...ketones come from not enough insulin and food (plus an infection usually). That means you just have to be more aggressive and use food as a tool for steering when needed.
     
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  30. Bear & Lora

    Bear & Lora Well-Known Member

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  31. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    I can well imagine that's how you feel! :woot: Bear is really putting you through your paces right now. Is he eating any better this AM?
     
  32. Bear & Lora

    Bear & Lora Well-Known Member

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    @KatiBear is barely eating

    No his barely has an appetite.
     
  33. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Is he drinking on his own? Wonder if he might lap up a watered down slurry of wet food? Or maybe get some meat baby food (without garlic or onions) in it. Warming food sometimes entices them too. Of course kibble is just fine too if he will eat any of that. You may need to consider assist feeding if he doesn't start eating on his own. I'm a bit surprised the vet didn't prescribe something for nausea and an appetite stimulant (see Kris' post #126) ......something you could call your vet about. Got to get the little guy eating.
     
  34. Rachel

    Rachel Well-Known Member

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    Ha! It was going so fast I didn’t catch the name. :p

    Yep gotta get him eating. Do you have any forti flora? Some cats like Parmesan cheese sprinkled on food too. Or maybe tuna water?

    Will he eat kibble? Anything is fine at this point if he will eat it.
     
  35. Bear & Lora

    Bear & Lora Well-Known Member

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    @MrWorfMen's Mom @Rachel

    Sorry, this time the nurse had to come late so I was with her. Bear might have eaten two Ckn breast Treats at testing, then I gave him 1 ounce of Friskies Tuna & Egg with about 3 Tbls of water. He licked most of the water up and ate maybe 1/4 of the meat portion. I then put down 10 Science Diet Kibble and he ate one. Later he was drinking at his water bowl. I won't be able to go on the symptom of staggering for hypo, cause he is very unsteady on those back feet.
     
  36. Bear & Lora

    Bear & Lora Well-Known Member

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    I worked with him and gave him extra time to eat as he is eating so slow, so his shot was at 11:05 C.S.T.
     
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  37. Bear & Lora

    Bear & Lora Well-Known Member

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    What do you guys think about me warming up some canned Tuna in water???

    Real Tuna.
     
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  38. Bear & Lora

    Bear & Lora Well-Known Member

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    I will go get him some junk food canned with gravies when I go pick up the fluids at the vet and those Temptations treats.
     
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  39. Rachel

    Rachel Well-Known Member

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    While at the vet ask them for the meds Kris mentioned. Tell them he isn’t eating well and you want to be proactive. The worst they can say is no.

    Yeah give the tuna a try. It’s not ideal as I don’t think it’s a balanced meal but any food is good.
     
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  40. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Right now, anything he will eat is just fine as long as no garlic or onions. Some cats like Kentucky Fried Chicken! Just take the skin off. Seriously, there are times when we all resort to whatever will work. I kept sugar donuts in my freezer for a quick sugar hit when Menace was tossing me low numbers because she won't eat any cat food but her low carb and trying to get honey or karo into her was a nightmare. Found out she loves sugar donuts when I caught her pilfering one day! :woot:

    Talk to the vet about something for nausea and an appetite stimulant too.
     
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  41. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Just watch Bear for any increase in lethargy, confusion or strange eye movements but also be aware that not all cats show signs of hypo. Testing is the only sure fire way to know where BG is at.
     
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  42. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Yes to feeding anything remotely protein-like that he'll eat (minus seasonings like garlic/onions). Those meds are very important to get him feeling better and eating to halt ketone production. I wouldn't wait to chase them down from the vet.
     
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  43. Bear & Lora

    Bear & Lora Well-Known Member

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    The Vet's office doesn't open till 2PM, Vet said she was going to be at that ER Hosp till 3AM. I am supposed to just pick up the fluids but am going to call and see if they require an office visit charge so I can ask for extra meds that you mentioned. The Real Tuna worked, he ate 1.5 oz warmed with 0.3 oz water added. He looks better than earlier. Thank you for your experience and information.

    God blessed me with some common sense, thank you Lord, or I wouldn't dare attempt to be Bear's nurse, more or less. It still is somewhat intimidating.
     
  44. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Yeah to Bear eating. Sending more appetite vibes!

    It's tough and so frustrating when they won't eat. You are doing a great job with Bear! Hang in there! Bear will improve and things will get easier and we are all here to help you along!
     
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  45. Bear & Lora

    Bear & Lora Well-Known Member

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    By the way that real canned tuna's water was drained yesterday, because when I did that ketone test I used the water from the can and diluted it with half bottled water, and Bear drank all of it. I kind of freaked out when I saw the results of the test. Anyway my OCD is kicking in, the point is Bear had 1.2 oz of real tuna drained of water and 0.3 bottled water added. When I get more sleep my OCD will be better, lol.
     
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  46. Bear & Lora

    Bear & Lora Well-Known Member

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    Bear 10-01-18.jpg
    @MrWorfMen's Mom @Kris & Teasel@Djamila@Rachel
    So here is my precious Bear getting his fluids. He is such a Trooper. I got the Cerenia from the Vet. When I asked her about an appetite stimulant she told me the Cerenia would help him with his nausea and he would get his appetite. NOPE! I syringe fed him a 2.5oz jar of Ham&Gravy Baby food-80 Calories so I could shoot. If he didn't feel so crappy I know I wouldn't have gotten away with that, lol.

    The Vet said Cats usually feel better after the second day of fluids. I hope she is right.

    I just reread Djamila's post about throwing a party for a green number. I would feel more secure with a yellow crazy as that sounds. Bear really is feeling bad and I would hate him to suffer Hypo while he is so delicate. This could be ignorant of me but I just am too new to this to know.
     
    Last edited: Oct 2, 2018
    Reason for edit: Should have made an additional note
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  47. Bear & Lora

    Bear & Lora Well-Known Member

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    I probably should of asked much earlier what you would do tonight if you were in my shoes? If I don't get a reply I definitely understand.
    I know everybody has been making a lot of time for Bear and I, especially you Linda. Thank You so much!

    If I'm on my own tonight and Bear's BG are green I will try to give a little food (maybe syringe food) and retest just to make sure he isn't close to hypo.
     
    Last edited: Oct 2, 2018
    Reason for edit: Should have made an additional note
  48. Bear & Lora

    Bear & Lora Well-Known Member

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    Well it's 2:30 in the morning here in Oklahoma. Bear tested at a 229 BG. I should go to bed but I want to be honest with you. I am scared. Bear seems so weak. I am putting him in the litter box every so often because every step is hard for him to make.
    He looks up from my lap at me when I test him like I am so miserable and sick and it touches my very soul.

    He made all yellow today and I tell myself that has got to be good because his blood sugar isn't bouncing and no pink, red, or black but is it really? I read that article in the main forum, the one that her cat had ketadosis and was at the ICU. I read that before any of us knew Bear had that too. That sad story was burned into my memory when I read it.

    The vet made it pretty clear I could do at home what they would do at the hospital without Bear's BG raised up due to anxiety and stress. I think he has a chance but he isn't doing well right now and even his complaints when I stick his ear are weak and sad. Not the irritated, complaints he gave before.

    I'm not giving up on hope but I can feel it diminishing a little bit. I want tomorrow to be better, better for my Bear.














    b
     
  49. Rachel

    Rachel Well-Known Member

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    Oh Lora! I know how tough it is to see our babies sick and miserable. You're doing everything exactly right for Bear and taking such great care of him. I wish I had something I could say or do to make this easier for you but know that we're here for you :bighug:

    As for the yellows, it's not really bad that he's been in flat yellows all day. Sure, getting some greens would be great, but we've actually seen it happen a lot before where a run of flat yellows precedes a suddenly low number. Not sure WHY, but it seems to happen. Could be that is going to happen here.

    Have you gotten another ketone test in? I wonder if they have gone down or are staying the same.

    I'd call the vet today and let them know Cerenia didn't work and ask for an appetite stimulant.

    Lora, I think DKA can be done at home, but I'm not 100% convinced that you should do it at home. I'm not saying you CAN'T, only that maybe the best place for Bear is a hospital for a few days to get him stabilized. Most kitties I've seen in DKA spend at least a couple of days with the vet so they can be monitored and get IVs or whatever else they need. Often, I believe it includes a fast acting insulin to help bring their levels down to get those ketones out. NOT something I would recommend doing at home. I don't really know enough about DKA to give you advice, but maybe it's something to think about. If you choose to keep treating at home, that's fine, but I just wanted you to know that if you decided you wanted to give a hospital stay a try, that's okay too.
     
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  50. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Oh Lora. So sorry you got left to your own devices last night but I would have made the same decision regarding insulin. Those are lowish yellow readings which is encouraging. I can only imagine how you are feeling. Nursing a cat with DKA is pretty intense and I agree with Rachel. It can be done but I'm not sure it should. You have other responsibilities and you don't want to make yourself sick with all this. I'm wondering if it would be better to have Bear hospitalized for a couple of days to get him stabilized. I am also wondering if the vet checked his teeth or for a Urinary tract infection as inflammation/infection are often part of the reasons for the DKA developing.
    If you decide to continue to nurse him at home, I would definitely have the vet check for a UTI and give you an appetite stimulant. The key here is to keep Bear well hydrated, and getting enough calories and insulin into him. It would be much easier if he would start eating some on his own.
    Sending healing thoughts and prayers for Bear and you. :bighug::bighug::bighug::bighug:
     
  51. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Was bear diagnosed with full blown DKA? If so and you can manage it financially AND your vet clinic can handle treatment having him in hospital is probably best. DKA has to be treated aggressively with fast acting insulin to pull down BG, fluids to keep electrolytes balanced (potassium supplementation is often neeed) and constant monitoring of a variety of signs. He HAS TO eat. He needs whatever meds keep nausea at bay and increase his appetite. This can mean 3+ days in hospital and he’d still need a lot of attention at home afterward.
     
    Last edited: Oct 2, 2018
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  52. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Lora, I apologize if my post above seemed too curt or clinical. I wanted to get the info out before doing the morning routine with my three. :) My experience with Teasel's two bouts of DKA tells me that it's best done in a veterinary intensive care setting with 24 hour care. My clinic has a 24/7 ER ICU in it with vets on duty around the clock. Teasel was very ill and it was actually a relief for me to know he was getting the kind of care I couldn't manage at home. I visited him every day though. You already have your hands full so I'd recommend leaving Bear in hospital IF your clinic/vet/staff has experience treating DKA. Bear will likely need more than just Cerenia and fluids to get him over the hump. Yes, the stress of a hospital stay will affect BG but they should be using R insulin (fast acting) at the start to get BG down ASAP. The switch to his regular insulin would be done over time if he proves to be able to eat on his own, his electrolyte profile stabilizes, ketones disappear and he can stay well hydrated. They should do a trial off IV before he comes home to see if he keeps up his hydration level on his own.

    Re Cerenia: it's a great med for nausea and vomiting but might not be the best for nausea alone or in all circumstances. I learned about using ondansetron (brand name Zofran) here on FDMB. When I asked about it for Teasel the vet said they used to use it but Cerenia was now the drug of choice. I asked for a prescription of ondansetron to try and they gave it to me. FDMB members have even used Cerenia WITH ondansetron for a kitty's bad nausea because they target different brain receptors. I gave Teasel ondansetron for several days after he came home. I filled the prescription at my human pharmacy (even the generic is $$$ here in Canada).

    Re appetite stimulant: mirtazapine is often used but can make many kitties act strange - agitation, yowling, etc. Cyproheptadine is a human antihistamine that can work well but needs more frequent dosing. I asked for that too when Teasel was ill because mirtazapine didn't seem to help when I gave it just before his hospitalization. I used cypro too after he came home.

    When Teasel came home I gave antinausea meds and appetite meds for several days, gradually weaning of the appy med as he ate better on his own. I kept up the antinausea med a bit longer. I gave sub Q fluids here at home three times but stopped because he was eating all of his soupy wet food meals. It took weeks for him to feel back to his version of normal.
     
  53. Rachel

    Rachel Well-Known Member

    Joined:
    Aug 25, 2013
    I’ve hears mirtazapine called meowzapine before due to all the meowing it can cause!
     
  54. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    Here's a compilation of DKA advice I pulled from various FDMB posts that helped me once Teasel was home. I think much or most of it came from @Meya14 who rarely posts anymore but is very knowledgeable about DKA. This might be helpful to you:
     

    Attached Files:

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  55. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    How is Bear today?
     
  56. Bear & Lora

    Bear & Lora Well-Known Member

    Joined:
    Sep 24, 2018
    @MrWorfMen's Mom @Kris & Teasel @Djamila @Rachel

    So first let me tell everyone Bear has improved some. He is taking more steps before he lays down. His tail is more swishy, and irritated is way better than I don't care about anything. He is also lapping the gravy from FF and he ate some baby food on his own. Bear has always loved ham. :)

    Last night just got to me too much. There are so many questions I might have to go back and address them in different posts. Here's to the questions I remember. The Vet didn't say Bear has Ketoacisdosis, his papers from the Hospital say Differential Diagnosis: Ketoacidosis. Does that men he has it or not? Differential is a form of the word different?

    No I haven't checked his ketone levels again, I will make it a priority do do that asap.

    Funds are limited for us. I had to quit my job once my mother starting leaving the stove on, the front door wide open, forgetting to eat, sticking a steel knife in the toaster to fish out the bread etc.

    I am a bit recharged this morning but after last night I know I will have to make it a priority to catch some more sleep when I can, 4hrs max and less the last 4 days is making me wonky.
     
  57. Bear & Lora

    Bear & Lora Well-Known Member

    Joined:
    Sep 24, 2018
    So Bear's BG of 330 this morning is food influenced. He lapped that baby food and gravy from a plate I left down between 9AM &10AM I tested him at 10:50. I gave him 2 syringes of Baby food and shot at 11:05.
     
  58. Bear & Lora

    Bear & Lora Well-Known Member

    Joined:
    Sep 24, 2018
    I have all Bear's lab work but I have to say it is mostly Greek to Me. Most all of it is initials, spelling some of the words out sure would make things easier. My son asked me to take a pic of them and send, he looks at labs all day. He later said Bear's Kidneys are great and his liver too. The only issues Bear had when the Vet went over them with me were; ketones, stress induced BG, and slight elevation in white blood cells.
     
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  59. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Glad to hear Bear is a little more active and eating some on his own. That is definitely encouraging. An elevated WBC could indicate an infection. If you could plot in the lab values on the LAB worksheet in Bear's spreadsheet, then we can compare his Aug tests to his current. I'm still wondering if he could have a urinary track infection...they are really common in unregulated diabetics.

    Differential diagnosis is medical lingo for suspected diagnosis and sometimes there is one possibility and sometimes more.
    Keep offering Bear any food he will eat and make sure he stays well hydrated. Grabbing his scruff and then letting go to see if it settles immediately or takes a moment is one indicator. You can also check his gums to see if they are sticky. If he needs more fluids, you can syringe some being careful to do so slowly so he doesn't aspirate the fluid and of course you can also do the SubQ fluids as per vets instructions.

    If Bear continues to take more food in today, then I wonder if his insulin should be increased back up to 2u tonight. Lets see what this cycle looks like and I am setting an alarm to come check on you at shot time tonight. Can you check Bear at +4 today? It will just help to fill in some data on the Spreadsheet.
     
  60. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Hey Lora, Just saw that 60. Bear is still safe but need to keep his BG up. Try feeding him some baby food with a bit of honey or karo to up the carbs in it if he won't eat on his own. Kibble is also fine. Just need to keep him surfing and not dropping more.
     
  61. Bear & Lora

    Bear & Lora Well-Known Member

    Joined:
    Sep 24, 2018
    I need an estimate on his calories. I know he isn't getting enough at this point. I decided to syringe feed him more balanced food (Pate's) versus empty calories (Gravys). His +2 was 60. I knew that baby food wasn't high enough in calories but hadn't realized the Pate food would work in the syringe. If I could get his calories up with some nutrition meant for a cat I think we could up his insulin. Really, really good news is his Ketones have went down to moderate #40 (Relion Ketone Test). My hopes have risen!

    I will need some advise on calories, plus balancing the insulin with his needed food load.

    You know I have felt so helpless watching his appetite come and go since I started monitoring his BG. I would much rather have Bear eat on his own but until he does and (he allows me to syringe feed him), I feel much better knowing he can get what he needs and not make this situation worse (more ketones).

    As far as the Lab work put on his SS. I was trying to do that yesterday but am too unfamiliar with the medical terminology (Initials). I put some on there of Aug 14th. I can take a pic or scan them to my computer and post it on this thread or send it to someone who knows what's what and can enter his labs. I have no problem with giving my User & Pass.
     
  62. Bear & Lora

    Bear & Lora Well-Known Member

    Joined:
    Sep 24, 2018
    Oh and by the way I did syringe fed Bear 0.5oz after his 60BG and I will test at +4.
     
  63. Bear & Lora

    Bear & Lora Well-Known Member

    Joined:
    Sep 24, 2018
    Thank you Linda, I appreciate you with all my heart! I don't know how to send hugs on here but I would send you some. :)
     
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  64. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    With that 60 @ +2 I'd test again 20 minutes after the feeding just to make sure he's staying up or rising a bit. Don't wait till +4.

    Yeah for the ketones being down but we want them down to trace or none. Progress but still a little ways to go.

    As for calories, I'd aim to get a minimum of 200 calories into him everyday and hopefully 250 or even a bit more. There is some special cat food you can get from the vet that is high cal, and easily watered down for syringing. Might be something to consider. Or get some kitten foods which are usually higher calorie.

    If you post the labs we can have a peak.
     
  65. Bear & Lora

    Bear & Lora Well-Known Member

    Joined:
    Sep 24, 2018
    Ok, going to test now.
     
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  66. Bear & Lora

    Bear & Lora Well-Known Member

    Joined:
    Sep 24, 2018

    Bear 244 BG
     
  67. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Ok then! Now you can wait a bit. Just want to confirm...did you add any honey or karo into the food cause that will boost BG but it also won't last that long.
    This is the food I was mentioning for syringe feeding and higher calories.

    cn_can_dog_cat.png
     
  68. Bear & Lora

    Bear & Lora Well-Known Member

    Joined:
    Sep 24, 2018
    Nothing added. Friskies Liver & Chicken Dinner Pate
     
  69. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Oh good. But, the next time you get a considerably lower number like that, it would be a good idea to retest immediately to ensure it wasn't just a bad strip. Could have been right but also could have been a fluke. It happens. And with Bear being a little unpredictable right now, better to double check so we are sure the data is solid. :bighug:
     
  70. Bear & Lora

    Bear & Lora Well-Known Member

    Joined:
    Sep 24, 2018

    Ok, I will absolutely retest to make sure it isn't a screw up. :)

    I'm going to try to load Bear's lab records.
     
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  71. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    On quick glance, nothing sticks out except for the tests that can suggest infection of some sort. Noticed vet made mention of possible pancreatitis but I don't see any testing for it. There is a snap test they can quickly do in the vet's office but all vets don't necessarily have it although I'd expect the ER would. On the other hand, with no signs of abdominal tenderness etc. she probably took that off the list of possibilities.

    I think the "ua" under "Treatment/Diagnostics" stands for urinalysis but I don't see those results. Is there another page? If you want me to plug in the lab numbers on your spreadsheet I can do it for you. Let me know and I'll send you my email via PM. You don't have to give me your password. You just give me permission to edit. Once the numbers are plugged in, then you take my permission back off.
     
  72. Bear & Lora

    Bear & Lora Well-Known Member

    Joined:
    Sep 24, 2018
    Pearl 9-30-18 (3).jpg Pearl 9-30-18 (3).jpg

    The Vet pointed out a figure on the lab results and said it ruled out Pancreatitis.

    Yes, I would appreciate & love your help putting the labs on.
     
  73. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Usually with active pancreatitis, the amylase and lipase would be elevated so she must have used that make that judgement call. His values look fine. I'll send you a PM.
     
  74. Bear & Lora

    Bear & Lora Well-Known Member

    Joined:
    Sep 24, 2018
    @MrWorfMen's Mom

    So on the days Bear was eating well, he was up to 5oz of canned food, pate & flaked, mostly fish because when at the store I was looking for a variety to feed him. They only had in the lower carb (no sauceor gravy) Turkey & giblets the rest were fish. I will try to get some of that Purina Critical Nutrition tomorrow so Bear's calories can be upped (I won't have to syringe 5oz daily) that will be easier on Bear for sure. He was also eating with that 5 oz of wet around 12 Freeze Dried Chicken.

    Today we are only up to 1.5 ounces syringe fed.
     
  75. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    He really needs more calories in whether you have to syringe feed or he's eating on his own. The Critical nutrition is easily made into a slurry for use with a syringe if need be. This is why nursing a cat with DKA is so intense. It requires a lot of time and effort to make sure they are taking in enough calories and staying hydrated. If he's still not eating or interested at all, he likely needs more than just the Cerenia.
     
  76. Bear & Lora

    Bear & Lora Well-Known Member

    Joined:
    Sep 24, 2018
    Yep, you are right on all accounts. I will call and leave a message in the morning to the Vet. Bear needs something else....
     
  77. Bear & Lora

    Bear & Lora Well-Known Member

    Joined:
    Sep 24, 2018
    Just tested Bear's ketones. He is in the small range #15. YES! He seems to be on the rebound. I'm so glad those da** things are leaving his body.
     
  78. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    animated-feeling-smiley-image-0091.gif Looks like progress but have to keep it that way. Go Bear....eat for your Beans! (FDMB for humans!)
     
  79. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Labs are all posted and I marked anything elevated in red for easy viewing. It appears your lab is using some different scales to what was put on the template so I changed those for the values that were tested.
     
  80. Bear & Lora

    Bear & Lora Well-Known Member

    Joined:
    Sep 24, 2018
    Thank you, thank you.
     
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  81. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Saw the 269 and dosing of 1.5u. Good decision! Wondering if you want to try to back Bear's shot time up a bit again or is the later time working better with your Mom's other caregivers? Just thinking that you could, pre-shot allowing of course, shoot a half or even an hour earlier tomorrow morning if you want to get back to your previous shot time. Unless you have any questions/concerns, I'm gonna sign off soon and head for LALALA land soon!
     
  82. Bear & Lora

    Bear & Lora Well-Known Member

    Joined:
    Sep 24, 2018
    Yes, I need to work it back eventually to 9AM, so an hour earlier tomorrow at 10AM would be good. I would like to be able to test Bear at night without losing most of my sleep time. :)
     
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  83. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    I always preferred doing dose increases or shooting earlier to get back on schedule in the mornings so if there was any extra monitoring needed, it happened on a day cycle. Looks like you managed to get considerably more food into Bear today. That is great and is probably helping keep those ketones down. I hope you get some sleep tonight.
     
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  84. Djamila

    Djamila Well-Known Member

    Joined:
    Aug 1, 2015
    Hi Lora! I'm so glad to hear that Bear's ketones are reducing! You're doing a great job of nursing him, and Linda has made some great suggestions about food and labs and all. @MrWorfMen's Mom, I was skimming a bit since I wasn't on at all yesterday and am trying to get caught up. Are you thinking the 60 was maybe an error? I saw your suggestion to increase the dose and I'm inclined to agree, but that 60 worries me a bit since we aren't sure if it was an error or lack of food, or a "real" 60. Maybe wait through this morning's cycle and see what shows up?
     
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  85. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    @Djamila I was nothing short of shocked with that 60 and agree it could have been lack of food, a wonky strip or "real". I had initially thought if any of you were around we might consider upping the dose last night although I was never keen on dose increases for night cycles and in this case, a little less so, but at that point we didn't yet know ketones had gone down and I didn't think it prudent to keep holding at 1.5u.
    Bear was pretty flat last night up to +3 but I'm not sure I want to assume he stayed that way. I tend to agree that perhaps we should wait, keep him at 1.5u and see what's up. The other thing is that Lora was going to shoot an hour earlier this AM to start working back to her preferred shot time, so while there is no depot to worry about, it's still a shortened cycle so holding for now seems prudent. Lora got a lot more food into Bear yesterday so fingers crossed he starts feeling better and eating at least some on his own.
     
  86. Bear & Lora

    Bear & Lora Well-Known Member

    Joined:
    Sep 24, 2018
    @MrWorfMen's Mom @Djamila

    Hello ladies,
    Well I slept through two alarms this morning. Argg! First I need to let you know I retested Bear's Ketones and I was wrong yesterday, he was still in the moderate range. Apparently I have a harder time differentiating between Peach colors. I will retest him soon.

    Second thing I need you to consider is Bear's appetite hasn't even come close to recovering and it takes me 25 minutes to syringe feed him, (I have to get more syringes and some bigger ones), so if his BG goes low I would have to resort to honey (which he despises) and then try to quickly fill a small syringe which is only 3CC's.

    Bear hardly ever hits blue range, yellow and then green seems to be his drops. I know hypo isn't like a code blue, get the electric paddles, but I have only been testing Bear for eight days and this trial by fire has me feeling like a whipped puppy. I want Bear in the blue and green, (blue is a nice color) but Bear's BG likes to play hop scotch with blue.

    I also have to get syringes with more lines, so we can do some gradual increases when needed. I can hardly find the .5 on these needles.

    Leaving my house during the day is like scheduling a visit with the president.

    Please take these things under consideration when contemplating dosing amounts.

    Tomorrow I will be gone all afternoon, ultra sound & wound care center.

    Bear's BG was 370 and since I overslept and am behind on my day I shot him 1.5U and then fed him.

    Please don't think I under value either of you. Your kindness, thoughts, knowledge and experience are invaluable to Bear and I. XOXO
     
  87. Bear & Lora

    Bear & Lora Well-Known Member

    Joined:
    Sep 24, 2018
    @MrWorfMen's Mom @Djamila

    Do people ever do different dosage amounts in the AM & PM?

    What was the name of that pill/herb that helps with neuropathy? Things have been moving so fast I forgot.

    Linda Bear is walking on his pads (backfeet) like he is tip toeing. It looks as if he is walking on something disgusting and doesn't want to put his feet fully down in the nastiness. His gait is choppy(not smooth & inline) with him raising his back hips higher. Does that fit neuropathy?
     
  88. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    ABSOLUTELY! While Bear is the "star" of this show, you are the producer and therefore just as important if not more so. We have to take your schedule, responsibilities and ability to keep up to all this into consideration. You have the final word and anything we suggest is just that....suggestions not orders.

    While not what we hoped to hear, it's good to know the ketones are still up. You need a really good light to read those strips because it is hard to differentiate the colours.

    Yes he does have a habit of jumping ranges. When he has hit blue, it's been from red and then of course the green has been following yellow. And the fact that there is intense monitoring and an inability to easily get some carbs into Bear right now, has to be a major consideration when deciding if dose increases are safe. It's a balancing act and as you say it is still early days without a lot of data on which to base decisions about what he might do. He has been somewhat erratic.

    I'm glad you got some extra sleep although I'm sure and sorry that has now caused you more stress about your day's schedule.:(

    If you do decide to head out today for any errands and can stop at Walmart, they should have the U100 Relion syringes. You want the 3/10cc (ml), 30 or 31gauge, 5/16th" needle with half unit markings. These however will have to be used with a conversion chart but will allow you to make tiny changes in dose. They should have a feeding syringe for babies that is larger too to make feeding a bit easier.

    Not to add to your stress, but I would definitely call the vet and ask about an appetite stimulant and that hi calorie food. If you can get that it could make things a bit easier on you.

    Looking for a video of cat with neuropathy for you to look at. Be back soon.
     
    Last edited: Oct 3, 2018
    Reason for edit: corrected typo and added info to syringe info parag 5
  89. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Have a look at this video. It shows neuropathy quite well. It's walking on their hocks rather than on their toes.



    The name of the supplement is Zobaline and you can order it online at Amazon or there specific site. Just search Zobaline and you'll get some options.
     
  90. Bear & Lora

    Bear & Lora Well-Known Member

    Joined:
    Sep 24, 2018
    Yep, Bear has that and even at the video cat's worst, Bear is worse at this point. :(

    Thanks Linda.

    Bear's BG +2 is confusing to say the least. It is almost like he didn't get insulin today, 376BG?
     
  91. Bear & Lora

    Bear & Lora Well-Known Member

    Joined:
    Sep 24, 2018

    Bear could possibly reacting to the temptations treats. The second ingredient is Corn..
     
  92. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Yes those temptations are high carb are very likely influencing that +2 BG but better to get some food of any kind in him than not. Let's see if he drops a bit later. Can you get a +4 or +5, whichever works better for you today? That's when the bigger drop should be starting or peaking. If you need to wait till +6 that's OK too.

    Poor Bear with the neuropathy. The good news is that once BG is regulated better and with some extra B12 support, the symptoms will subside and Bear will get back to normal. Keep in mind, that while humans experience pain with neuropathy, and it's hard to see them walking like that, it's not painful in cats.
     
  93. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Oh crap! I see when I described the syringes earlier I didn't include "with half unit markings". My bad! Sorry! Hoping you didn't go to Walmart yet. :banghead:
     
  94. Bear & Lora

    Bear & Lora Well-Known Member

    Joined:
    Sep 24, 2018

    Ok, quick update the Vet prescribed an appetite stimulant and recommended Cn, En, & Om. I got some of each. She recommended a feeding tube if we can't get Bear to eat, she said syringe feeding is high stress on a cat. I syringe fed Bear 1 oz of CN when I got home, it was much harder because he is feeling better. His ketones are at small range today but I am going to have to try again latter to verify. He is using the litter box on his own and has been sneaky. Later I will move it to the middle of the room where I can see it. I am going to the pharmacy now so I can get the appetite stimulant in Bear. I would rather Bear didn't have to have a feeding tube. Talk to you soon
     
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  95. Bear & Lora

    Bear & Lora Well-Known Member

    Joined:
    Sep 24, 2018

    I haven't had a chance. :)
     
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  96. Djamila

    Djamila Well-Known Member

    Joined:
    Aug 1, 2015
    If I'm remembering right, @Kris & Teasel has some experience with a feeding tube, and as I recall she said it really wasn't bad. Hopefully she can chime in when she has a minute. I've read on the board that they are far less stressful than syringe feeding, but I haven't had experience with it myself.

    Lora, I wish so much that we could be there with you and help carry some of this burden. It is exhausting, especially when everything is so new. I'm so thankful that Linda is around so much to walk with you through all of this.

    Looking at today's cycle, I do think a little increase in insulin could be safe now. What would you think about a "fat 1.5u". You would draw to the 1.5u line like you've been doing, and then just a smidge more. So kind of eyeball where you think is a little more than 1.5u, but not quite 1.75u. One trick is to draw some colored water into an old syringe and use that for comparison. Then when you draw the insulin you can be sure you're being consistent even if it isn't an exact fraction.

    If you've got Temptations, and if he'll eat them, then you can steer him up if you need to. Those things are crazy high in carbs and are often used to treat hypos. Please don't even worry about the carbs right now. Your biggest concern is just getting food into him, and keeping the insulin going since the insulin helps with clearing the ketones. After he's been clear of them for a little bit, then we'll start working on getting better numbers. Right now your goal is food, insulin, and any number that is safe, even if it's a little high.

    It is really important that you're taking care of yourself right now too. Kind of like in an airplane when they tell you to put your oxygen mask on first. You can't take care of Bear (and your mom!) if you've exhausted yourself. So if you want to wait until tomorrow to try a little more insulin, do what you need to do. Your sleep is important.
     
  97. JL and Chip

    JL and Chip Well-Known Member

    Joined:
    Dec 28, 2009
    Minor typo ... You want 3/10 cc insulin syringes (not 3cc).

    (I don't think they even make 3cc insulin syringes but who knows what they'd try to sell you).
     
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  98. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    @JL and Chip Good catch. Thank you. I must have been high on cold meds this afternoon. :arghh:

    ETA: I am going to correct my faux pas in the original post for clarity!
     
  99. Djamila

    Djamila Well-Known Member

    Joined:
    Aug 1, 2015
    How is the cold today? Are you starting to feel any better? I hope you're able to get lots of rest and some warm tea!
     
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  100. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Into day 4 and starting to feel a bit better finally. Dang cold medicine is supposed to be non-drowsy but I think it's actually been keeping me awake at night and the nighttime stuff says it can cause agitation so I avoided that and still wasn't sleeping well. Not taking any more of that crap! And yes, hot tea and snuggling up and napping with my furballs at every opportunity has been the name of the game. BONUS!
     

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