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Gave insulin even though Ming won’t eat

Discussion in 'Prozinc / PZI' started by Crista & Ming, Oct 12, 2018.

  1. Crista & Ming

    Crista & Ming Well-Known Member

    Joined:
    Jun 10, 2018
    I came home to find Ming had puked about 9 times from what I found. Twice it was food and the rest just white foam. I suspect the first time was in front of the litter box as usual.

    You know, I always have this SENSE that something’s wrong with him. I felt it when I walked through the door. Or maybe it’s just because he didn’t come running down to greet me like usual. But he was at the top of the stairs, on his side, and didn’t come down even when I called his name. He did eventually walk slowly down and I called him to eat.

    But he didn’t want to eat. Not even his beloved Fancy Feast. And that’s when I noticed the puke/spots of reflux.

    I gave him bupe and cerenia. Although the cerenia was unfortunately crushed up in the package so I mushed what was left in a small piece of food and shoved it down his throat. I don’t think all of it went in but some, I guess.

    He had a BG of 22.1. I decided to give him a 4.6 u dose instead of 4.8 u. Even though he didn’t eat. And now I’m sorta of regretting it because what if he gets hypo?!!! And he won’t eat?!

    Did I make a mistake? Should I have shot less? Or not at all? I thought maybe the bupe + cerenia + lowered BG might make him feel better and = to him eating and getting back to normal.

    I wonder if it’s a pancreatitis flare up or if it’s the low-ish cycle he had last night plus the bouncing before and after.

    I texted my coworker/vet and she said I can bring him in tomorrow.

    His BG at +1 was 21.6.

    Right now, he’s loafed with his head in his water - something he does when he feels super bad.

    What do you guys think? What should I do if he still doesn’t eat tomorrow? Should I still dose?

    Arrghhhh!!!! My biggest anxiety is seeing or hearing Ming puke and not eat and get another flare up. I’m always on edge when it comes to that.

    The following is upsetting and involves a cat death but I’m really thankful for this forum and feel safe talking about it here with fellow cat lovers. But please don’t read if cat deaths upset you:

    I also had a really unfortunate day yesterday. I witnessed my first emergency at work. A client came in for an exam to see if her cat should get her heart murmur checked out. The cat went into cardiac arrest and we all tried to revive her. Did the whole shebang: CPR, all those meds to revive the heart, and intubation. I was holding the kitty’s head and helping with intubation and holding for the tech to put in a catheter so they can administer meds right into the vein. Her tongue was completely blue.

    I wasn’t thinking too much. Just going through the motions. But one of the vets (there were 3 vets, 2 techs, and 2 assistants all working on this cat) said “She just came in for a routine exam!!??” And the receptionist who called the emergency asked if she was alive and the vet said, “Barely.” And I just suddenly start bawling. One of the vets told me it’s okay and said they would take over. And I just left to go cry in the back.

    I think they did resusitate her in some way but it wouldn’t have saved her and would have only prolonged her dying. The owner came in and I saw her face and it was heart breaking. They euthanized her in the end.

    One of the techs later told me maybe the cat was too stressed at the vet and drew a clot or had a heart attack since she already had a murmur. And that this was inevitable since she was 15 and had this murmur for so long and it was not treated beforehand.

    Everyone said it’s okay and it’s understandable since it was my very first emergency. They said this type of thing doesn’t happen at the clinic very often and it’s usually animals who clearly will die (like pets hit by a car) or who are high risk patients in surgery that this happens to.

    Anyway, thank you for reading my post and taking the time to process and also answer my questions from earlier. Again, I am so happy to have found you all.
     
  2. Crista & Ming

    Crista & Ming Well-Known Member

    Joined:
    Jun 10, 2018
    I know most of you are probably sleeping and that’s okay!

    I’m thinking if his BG is high enough tomorrow morning, I’ll just give him maybe at least 1 unit of insulin just so there’s something in his system.

    This is what Ming usually does when he feels bad. Except more loafy. Maybe the bupe is kicking in.

    image.jpg
     
  3. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    I'm sorry you were alone to figure this out last night. And also understand completely how traumatic your experience was at work yesterday .. :bighug:

    This does seem to be a pancreatitis attack from your description. The usual treatment is for symptoms only - Cerenia, bupe for pain, maybe subQ fluids to keep him well hydrated. You probably know all this.

    I see on your SS that he didn't drop too low after the 4.6 u dose. It's very hard to know what to dose in these circumstances but SOME insulin should be given to avoid the perfect storm of conditions that can increase the likelihood of DKA: not enough food, dehydration, not enough insulin, infection or inflammation somewhere.

    You could ask your vet to do the quick in house pancreatitis test. It gives a yes/no answer. The very expensive test ($200+) that has to be sent away is better but not perfect. If there's a previous history of pancreatitis, vets will often treat symptoms. A Cerenia shot can often give them a boost better than a pill, especially if the pills were open and older. If his nausea and lack of appetite continue there's another good antinausea med to try called ondansetron. An appetite stimulant can help too but only after the nausea is addressed.

    @Djamila is a pancreatitis expert. She'll probably have more advice for you.
     
    Last edited: Oct 13, 2018
    Djamila likes this.
  4. Djamila

    Djamila Well-Known Member

    Joined:
    Aug 1, 2015
    Oh Crista, I'm so sorry. You had a really rough day! So much love to you this morning. :bighug:

    Kris has said pretty much anything I would have said. There just isn't a lot to be done for pancreatitis, although the few things that can be done are each very important!

    For Sam I've found pain management to be one of the most important things I can do, so keep up with the bupe consistently until his appetite returns. It's harder to catch up with pain, so it's better to stay ahead of it as much as you can. But I would say to avoid the bupe injection unless Ming has had it before and you know she doesn't react to it. More and more I'm reading about cats having poor responses to injectable. It works wonders for the cats who can take it in that form, but for others it makes them stay awake and/or get really agitated.

    And don't worry about the cerenia being crushed. I've given it to Sam crushed up in crushed freeze dried treats when he wouldn't let me pill him. It works just fine that way (if you can get Ming to eat it - even treats dont' completely cover up the taste).

    I think you did the right thing to give the insulin anyway. Every Cat is Different, but pancreatitis often elevates the BG numbers and keeps it high anyway, so a hypo is less of a concern (although always possible, of course). And you're right that when it's really high, a cat can be less inclined to eat, so bringing it down can help. Of course doing that puts the burden on the human to test and monitor and be able to force feed/rub karo if necessary, but the odds are you in favor that you'll do far more good than risk.

    I hope the meds overnight will help Ming turn it around quickly. Sending you lots of healing vines!
     
    Kris & Teasel likes this.
  5. Rachel

    Rachel Well-Known Member

    Joined:
    Aug 25, 2013
    Aw Crista I'm so sorry! What a tough day. I would have reacted the same as you if I worked in your job...I think it's really hard to see kitties in pain and when they die unexpectedly like that...well yeah. It makes sense it would be upsetting.

    I hope that Ming is feeling better today! Djamila and Kris gave great info already. I'll only add that if he ever goes hypo and you can't get him to eat, you can always rub honey or karo on his gums. I'm not sure that's as effective as food, but if you needed to get something in him..
     
    Djamila likes this.
  6. Crista & Ming

    Crista & Ming Well-Known Member

    Joined:
    Jun 10, 2018
    Thanks everyone :) I’ll keep up the bupe. I can tell he’s a little stoned. I took the liberty to give him a slightly higher dose. Instead of 0.2ml, I gave 0.25ml. My previous vet prescribed 0.3ml before and he was the same weight as he is now.

    Not much luck all night. At one point, Ming jumped into the bathroom sink which he never does. I turned on the water and let it pool in the sink and he drank a lot. He has water all over the house but I guess he wants the running water.

    He ate maybe two bites of fancy feast but that was it. And now he’s just laying on the floor and loafing sometimes.

    You’d think I would be good at pilling cats since it’s kind of one of my jobs but that’s something I struggle with lol. I think I will see if I can have some cerenia to inject instead of to pill.

    I’m really hoping to get to the vet and get him on fluids. I wonder if she will prescribe steroids for the pancreatitis (if it is but I and you all are sure it is). What would you everyone feel about having him on steroids? This isn’t the same vet before that Ming had an appointment with. It’s her day off which is frustrating but I don’t feel comfortable texting her on her day off haha

    The vet I’m seeing today is more about natural remedies. She does animal acupuncture! So I wonder if she will take a more conservative approach as opposed to the other vet who is more aggressive/willing to take big steps with treatment. I’ll probably mention that the other vet talked about steroids and see what happens. Although I personally am a little afraid of that with his diabetes and all.

    I hate to make the drive to my work with Ming and stress him out but better than worrying about him at home with no one to watch him.

    I’ll probably give him a 4.6 dose again once I arrive at work and I’m sure his BG will be super high because of the stress. Right now it’s at 18.6
     
  7. Djamila

    Djamila Well-Known Member

    Joined:
    Aug 1, 2015
    I have mixed feelings about steroids with pancreatitis. There are some who believe they work, and others who don't. Same with the antibiotic use with panc. We know that panc comes and goes on it's own, whenever it wants to, so my hunch is that when steroids are used and the cat gets better, it's more of a coincidence than a causation. That being said, if Sam got sick enough with it, I know that I'd try anything to help him. Even steroids with diabetes. Especially since Sam is a life-er with diabetes anyway. I'd probably be even more hesitant if I still thought remission would be an option for him.
     
  8. Crista & Ming

    Crista & Ming Well-Known Member

    Joined:
    Jun 10, 2018
    My doctor blocked off half an hour to go through everything with me and her plan and that’s later on in the day. I’m on lunch but just quick updates. She said WAY more but I just can’t rmemeber or understand any of it. I’ll also figure out some way to download all the labs and post them here.

    But main things:
    - a little asthma. Which I suspected and asked every vet about. They all weren’t too concerned since he wasn’t coughing all the time.
    - fatty blood. He’s also had it before and I thought maybe it’s the fancy feast. Will talk more about that in terms of diet.
    - blood suggests an acute infection somewhere
    - will do an ultrasound most likely which I’ve also done in the past

    He’s still not eating but he’s on IV fluids and other things that we didn’t write down yet. Usually we write everything down but since he’s a staff pet so it was all very play by ear. I’m assuming I’ll be able to see a chart soon by the end of the day! I know he got gabapentin and bupe though.
     
  9. Candy&Company

    Candy&Company Member

    Joined:
    Sep 12, 2018
    Wow, this sounds so much like my Lucky..


    1.) The litter - is it the litter? Detergent? Etc. Something is in his nose - anything introduced recently, by you, anyone else..?

    2.) Fatty blood - meaning.... what? What are his blood results? All of them - high, low cholesterol, triglycerides, etc?

    3.) Infection - scope him over, hardcore - main areas = his teeth, look at his teeth as best you can, his ears next -smell them. If the mouth smells like dying fish/flesh, tell your vet. If the ears smell like months old yeast, tell your vet. Sinus us another area, along with the lungs and upper digestive tract. Or bladder.

    4.) Ultrasound -STOOOOOOOP. talk to your vet about where you're scanning, agree on it, before doing it. Ultrasounds work best on soft tissue parts like the abdomen for bowls, bladder, kidneys, etc..

    5.) He needs to eat - period, you need to syringe feed him if necessary.

    6.) This in a way, does sound like pancreatitis - have you thought about CBD oil..?

    Main things - feed him, as hard as that might be, plus water.. and vet. :bighug:
     
  10. Rachel

    Rachel Well-Known Member

    Joined:
    Aug 25, 2013
    I'm also not sure what the fatty blood means. As for the infection...that's concerning. Not eating + not enough insulin + infection = DKA a lot of times. Are you checking for ketones at home? Does your vet have any sort of idea of where the infection is coming from or how to treat it?

    Did the vet do the pancreatitis test?
     
  11. Candy&Company

    Candy&Company Member

    Joined:
    Sep 12, 2018
    I'm with Rachel on this one which is why I mentioned the common infections - can you tell us if they did, which pancreatitis test was it? If they haven't yet, ask for the full monty if you can afford it - spec FPL feline, senior prof - if your baby is over 7 yrs old. That's one of the best pancreatitis tests out there - but there's others. Let us help you?

    How often does your baby vomit - do you known when it's worst..?

    The picture you put up - that's my Fena, when I'm getting it "wrong" - so something's not quite right. Tell us EVERYTHING - all foods, all meds, everything, even if it seems small and stupid its not, tell us, please....?

    food - how much, what kind, how often
    water - how much added, bowl out for extra?
    pee/BMs - what're they like?
    weight loss/gain, what's going on..?
    skin/itching/grooming - what's going on?
    cuddle/snuggle/love time - anything different/unusual...?

    Please let us know the more info, the better. Ketones, like Rachel said is a BIG THING - plse let us know if you test this.
     
  12. Crista & Ming

    Crista & Ming Well-Known Member

    Joined:
    Jun 10, 2018
    Hi everyone. I just got off work and need to eat and sit down.

    I downloaded all the labs and I think there’s one more test I’m waiting for that will arrive tomorrow. I’m not really sure.

    But to put our minds to ease: no ketones. Vet was happy not to see ketones.

    Everything else I’m not 100% sure about or understand. I plan to sit down and google things and ask you all what it all means.

    I was working at the same time that my vet was talking to me and going through everything. But she’s very open to me texting her or calling her to ask any questions I have.

    When I left, Ming was eating. Got cerenia and ampicillin. There is someone at work 24 hours to take care of Ming and his plan ensures that he is being fed every 2 hours. The nurse at night is a diabetic kitty expert so I’m also feeling quite happy she’s taking care of my kitty.

    I will post again in a few hours.
     
  13. Crista & Ming

    Crista & Ming Well-Known Member

    Joined:
    Jun 10, 2018
    Oh yes. The test we’re waiting for tests pancreatitis. And vet said the in house test might suggest that but can’t tell her 100% that it is pancreatitis. And only that there’s an infection.
     
  14. Crista & Ming

    Crista & Ming Well-Known Member

    Joined:
    Jun 10, 2018
    I've uploaded the labs. I don't know how to read them to fill them in the spreadsheet. If someone could let me know and also interpret everything.

    Vet also talked about Ming losing proteins in his urine and that it is concerning. Also something about the ALB and GLOB numbers.

    I'm really tired lol. I realized I didn't eat anything last night when I found vomit all over the house. I think I will take tonight and just relax. Ming isn't home and is being cared for and I'll take this chance to actually sleep :smuggrin:

    But please! I would love any advice and interpretations from the lab results.

    My vet will call me tomorrow for an update.

    @Candy&Company I will get to your questions as soon as I feel up to it! Maybe later tonight or tomorrow. I'm very sorry but I hope the results and updates at least answer the most pressing concerns. And I REALLY appreciate it!
     

    Attached Files:

  15. Djamila

    Djamila Well-Known Member

    Joined:
    Aug 1, 2015
    Crista, I hope you were able to get some good rest last night knowing that Ming is in good hands. Sending you much love and healing vines for Ming. Please don't worry about the barrage of questions. Often people just throw out questions for you to consider. Answers are only needed if you're up for it. You have enough on your plate right now.

    The spreadsheet doesn't follow the IDEXX testing exactly. You have to do a lot of bouncing around to enter things in its current form. I found it helpful to enter the ones I could easily figure out first, and cross those off, and then slowly figure out the other ones by process of elimination and google.

    I don't know enough to interpret labs, but @Critter Mom and @Marje and Gracie are both great with it. They are not on the board all the time though, so hopefully the tag will bring them over to take a peek.
     
    Rachel likes this.
  16. Rachel

    Rachel Well-Known Member

    Joined:
    Aug 25, 2013
    Crista, I hope you got a good night's sleep! It's hard sometimes when our babies aren't home, but since you know Ming was getting great care, hopefully you were able to relax! My big concern was ketones, and since the vet said there weren't any, that eases my mind and I'm sure yours.

    Please do let us know how Ming is doing when you're up for it. Sending you tons of :bighug::bighug::bighug::bighug:
     
  17. Crista & Ming

    Crista & Ming Well-Known Member

    Joined:
    Jun 10, 2018
    Thanks, everyone for the kind words and encouragement :)

    My coworker said he didn't really eat last night but was willing to eat some dry food. His BG levels stayed below 15. I'm assuming my vet will be prescribing appetite stimulants today and I'll definitely push for it and even syringe feeding. I'm going to go in in the afternoon and see if he'll eat for me again.

    I wonder if once we treat his asthma, things will be better? And also treat his possible constipation. Although I haven't observed enough if he's been straining to poop but he always pukes right in front of the litter box. That's something that my vet mentioned again and I'll ask if treatment is possible. I always knew pumpkin helps with that but who knows if he'll eat it =__=

    Doctor will call some time after 9 or 10 am. It's 8 am right now.

    It's clay and really dusty. It's the 40lbs litter from Costco. I'm definitely going out today and changing it out to something else. Maybe see how much Dr Elsey's litter is or see if he'll use paper or corn litter.

    I heard: high cholesterol and lipase. His blood was bright pink and creamy and it's happened before. He was on fancy feast and other canned foods. Then we switched to DM. Now I'm on raw. So it's kind of discouraging. I really don't want to go back to DM. But my vet said sometimes cats are predisposed to it. She also talked about homemade meals or changing to a different protein. This seems like a topic we'll get to once we get Ming eating again. She is focusing right now on making him feel better and eating.

    I'm very into smelling my cat's ears and mouth lol!! So no, he seems good unless I've gotten used to his mouth smell and can't tell. But I've smelt bad cat breaths before. My vet sent his urine to be tested out of house as well for bacteria.

    My old vet and now vet saw that one of his kidneys is bigger than the other which indicates there may have been an at infection some point. His x-rays have been sent to our ultrasound specialist to see if she sees anything else.

    I don't think we're at that point yet but I'm not that opposed to it? And yes, there are usually two areas the ultrasound specialist looks at: the abdomen and chest cavity. I JUST did my first ultrasound day on Friday! So it was very fun and interesting to see the ultrasounds and the specialist showed me some interesting things.

    YES! Most definitely! I'm going to push for some type of food encouragement today.

    It probably is and coupled with all these other issues he has like asthma and uncontrolled diabetes. I have a coworker that gives her dog CBD. The dog had bone cancer and had a leg amputated. I'll be asking her about it soon once this is all over.

    Not often but when it happens, it's an episode of 20 vomits or more all over the house within a couple of hours. Every time he DOES vomit, I rush him to the vet because I KNOW and am in fear it is pancreatitis. So I don't ignore even a little vomit.

    Most of the info is littered around different threads and my spreadsheet but definitely for those coming in now, I'll write out a quick history:

    BEFORE DIABETES:
    • He was on a variety of canned foods: fancy feast classics, nature's variety instincts, and weruva. I would have loved to keep him on Weruva but he is picky and spoiled so that's why he got FF.
    • I tried raw with him in the beginning but he wouldn't have it at all. But we eventually worked him up to the Freeze Dried variety but he would get bored of it and not eat it. And I'd go back to his beloved FF.
    • He never really drank water unless he was sick.
    • He was a honking 18 lbs before his diabetes!
    • Normal daily poops
    • Pees were always very large. Bigger than my palm and I'll say I'm an averaged sized woman.
    • No skin or grooming issues. His fur soft.
    • He's not into cuddling but follows me around and likes to look out the window and chase bugs outside when I let him out in the yard supervised for half an hour or so.
    • He's always had a cough. He might cough once every day or every few days. Or maybe he's coughing everyday but no one notices it. When I first adopted him, I took him to a smaller clinic and we did x-rays and he was on steroids and l-lysine. I asked about asthma but they didn't think it was but saw that his heart was larger than usual. We did another x-ray a year later and vet didn't say his heart is getting bigger. Then we changed vets and I mentioned that history to them but they were not concerned since his coughing was not constant.

    AFTER DIABETES:
    • I kept his diet but my old vet pushed for DM. My mom pushed for DM. He kept getting pancreatitis flare ups and would be hospitalized every month for it. He was diagnosed in March 2018.
    • He went from 1 unit to 6 units since March.
    • In September, I decreased him to 4 units since I started home testing finally. The new vet agreed with our change in dosage.
    • He ate DM exclusively from August to middle of September. Before that, he would get DM with Freeze Dried Raw
    • By October, he was completely on raw - both frozen and freeze dried. He is eating Primal brand and Pork flavor only. I have some other flavors that I haven't had the chance to try out. I give him freeze dried when I can't take away his food on time.
    • Poops have decreased to once every 2-3 days since raw and they are very small. On DM, his poops were extremely large, dark, and long.
    • Before 6 units, he peed EXCESSIVELY. We would go through 40 lbs of litter within a month. Since 6 units and since decreasing his dose and home testing, his pees are smaller (still large though) but he would pee 2-4 times a day as opposed to 5-6 times a day with large pees.
    • I would say he's been more lethargic and now as curious since his diabetes and I always attributed that to never getting him under control
    So that's a quick history of Ming.
     
  18. Crista & Ming

    Crista & Ming Well-Known Member

    Joined:
    Jun 10, 2018
    Yes he indeed has pancreatitis. Doctor said she will reduce his insulin today because his BG is low. I’m going in later and showing her the spreadsheet!

    She said she doesn’t want to use mirtazipine just yet because he’s eating dry foods and it makes cats loopy. I’m about to go into PetSmart and get some cheesy fancy feast and maybe he’ll eat with more fervor.
     
  19. Rachel

    Rachel Well-Known Member

    Joined:
    Aug 25, 2013
    Ack! Pancreatitis...sigh. It does seem to be something a lot of kitties have been dealing with of late. Yes, try to get him something he'd be willing to eat on his own. I don't really have experience with that, so I don't have much to offer but tons of hugs and healing vines!
     
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  20. Crista & Ming

    Crista & Ming Well-Known Member

    Joined:
    Jun 10, 2018
    Looks like he ate about 6 tbsps of DM dry according to his chart. And he ate some treats while I was there. He wouldn’t eat the cheese and chicken flavoured fancy feast but oh well. It’s not something he usually eats. But he looked MUCH brighter!

    They gave him 3 units of insulin this morning because he went low to 4.0 mmols. Doc wants me to stick with 4 units for 2 weeks and not change it so often like we do here. Which mmmmmmmm......... I mean, what do you guys think? This is another vet though from the first one that spoke to me a month ago. But also a different vet from yesterday lol!! I know, it’s confusing.

    But let me recap:
    - Vet A: I spoke to a month ago just for an exam and her opinion. She was a fan of small doses of steroids to deal with his pancreatitis. But after seeing him, did not plan to pursue that and agreed with us lowering his dose to 4 units after his first curve.
    - Vet B is who treated Ming yesterday
    - Vet C took over today because today is Vet B’s day off but I saw Vet B today checking in with Ming and her other patients. But I spoke to Vet C today mostly. We decided to keep him one more night and she’s the one that doesn’t want to give appetite stimulants at the moment since he’s eating.
     
  21. Djamila

    Djamila Well-Known Member

    Joined:
    Aug 1, 2015
    Right now, he eats whatever he wants to eat until he's feeling better. As far as the high cholesterol, that can sometimes happen on raw food, but I'm not familiar with the fatty blood, so I don't know if those are connected. I do know that fancy feast is pretty high in fat and low in protein, so it might not be your best option. In the food list in my signature, you can sort by fat level or protein level or whatever you want to check for. Or as your vet suggested, there is always homemade. I make mine using foodfurlife supplement powder so it's just whatever meat I buy and some powder and water. Super easy if you decide to give it a try.

    As long as he's eating, not much need for an appetite stimulant. Sounds like the other meds are helping if he's willing to eat again. Lots of healing vines to Ming, and peac to you.
     
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  22. Crista & Ming

    Crista & Ming Well-Known Member

    Joined:
    Jun 10, 2018
    Yes! I went and got lots of kitty junk like that paste from the tubes that all cats seem to love and everyone loves to film haha. He ate all of that :)

    I see. And why is that? Are there specific proteins that are lower in cholesterol?

    And again, thank you all for the healing vibes and well wishes :) I love that my coworker checked his BG levels over night and knew exactly what to do. It's SO nice to have such knowledgable and dedicated people caring for my kitty - both IRL and on this forum. Trust me, the last few times Ming has been sick, I would be stressed the whole entire time. Even when he was at the hospital, I would not be able to sleep and just have a sinking, damning feeling. But I only had that the first night he vomited everywhere and I've been all right. Of course, worried but no where near as worried as I was in the past.
     
  23. Crista & Ming

    Crista & Ming Well-Known Member

    Joined:
    Jun 10, 2018
    Posting again just because I want to get this out of my head.

    I am not too opposed to keeping him at a dose longer than a few cycles. I feel like a 4.6 dose is good for Ming and a 4.8 dose cuts it too close for him. But as you can see, his 4.6 dose sometimes doesn’t produce low green numbers or even blue numbers sometimes.

    What’s the “harm” with keeping him at a dose for 2 weeks??? He’s so bouncy too. I wonder if keeping him at a dose I know works and isn’t dangerous will help deter him from getting pancreatitis and all that jazz.

    Anyway, I miss him but also feel sort of relieved I don’t have to poke anything lol

    Here’s a photo of him after we gave him gabapentin. He clearly hated the taste and would write a really bad yelp review of my clinic if he could.

    AD1B98F8-4CE0-4261-A785-0D757FC35D23.jpeg
    51CFC79F-B3B0-4F60-856B-2251C83285CC.jpeg
     
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  24. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    I often let Teasel stay at a dose for quite a long time. He's an unpredictable bouncer and will go along merrily in yellow and blue, drop into dark green then revert to yellow and blue. My goal is always to find a "good enough" dose for him that keeps him in decent numbers but doesn't require much intervention like a lot of testing, steering with food, etc. I've lived with this a long time now and need to stay sane for my sake and his sake. ;) Mind you he's been on insulin since January 2016 and I've worked hard at getting him to this point.

    I don't think you can really do anything dose wise that will prevent pancreatitis, especially in a kitty who's prone to it. Dose as well as you can, watch for panc signs and start treating symptoms (especially pain) when you see the first hint of them. Like many relapsing/remitting chronic conditions you can sometimes reel back a flare by jumping on it before it gets out of control.

    If you feel confident about the 4.6 u dose give that for a period of time. You have the option of eyeballing 4.7 u too.
     
  25. Djamila

    Djamila Well-Known Member

    Joined:
    Aug 1, 2015
    Dosing with panc can be tricky. As Kris said, if you're seeing bouncing, then holding the dose longer is a good idea. With Sam, I have to raise his dose as quickly as I can when he's in a real flare to try to stay on top of the numbers. He feels bad enough, the last thing he needs is high BG making him feel even worse. THen I have to be ready to bring it back down when he starts to feel better. So it just depends on what you're seeing in the numbers, which approach is best.

    I honestly dont' remember the reasoning for why raw diets often correlate with high cholesterol. I wonder if it has to do with which proteins are being fed? Just a guess.
     
  26. Djamila

    Djamila Well-Known Member

    Joined:
    Aug 1, 2015
    Your comment about the yelp review cracked me up! And that gaba stuff is nasty. My boys hate it too. :oops:
     
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  27. Crista & Ming

    Crista & Ming Well-Known Member

    Joined:
    Jun 10, 2018
    There seemed to be some type of confusion with the different needles. Saturday night, Ming went down to 4 mmols (72) with a supposedly 4.6 u dose given with a u-100 syringe. And so Vet C was concerned and decided to dial it back to a 3 u dose on a u-40 syringe for Sunday AM. But he stayed in the 20s (360) throughout the day. And then I guess they gave 3 or 4 u for Sunday PM?? Typing this now, I realized I didn’t ask what his numbers were last night.

    But anyway, Vet C is giving 2 units on a u-40 today and testing BG and wants to keep him on that for a week. She’s afraid he is bouncing too much and flirting with hypo.

    He’s also only eating dry which hmmmm... I don’t like but at least he’s eating?

    She said he can come home today after they take his +4 and +6 readings. But the fact he’s only willing to eat dry still concerns me but they say he’s bright. So maybe it’s just me being super worried mama bear and he’ll eat his regular wet or raw when he gets home. But I’ll be sure to bring some dry home just in case he has decided he hates wet for the time being.

    What do you all think? 2 units is so little for him but maybe we really missed that nice dose or maybe Saturday night, he was slightly overdosed? The vets aren’t familiar with using u40 units in u-100 needles and I tried my best to write out on a note what a 4.6 dose would be on a u100 needle but I guess if they wished to reduce the dose, it would be confusing.

    I don’t know. There were too many hands giving that insulin dose and I suspect everyone confused one another. From me telling Vet B what the dose is to Vet B handing it off to Vet C and then the different assistants administering the insulin during the night and during the day... I’m sure it got way too confusing.
     
    Last edited: Oct 15, 2018
  28. Crista & Ming

    Crista & Ming Well-Known Member

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    Jun 10, 2018
    This thing is... it’s so hard to see those signs in Ming! He’ll be fine and dandy, eating his food and the next second, he’s vomiting up a storm.

    Perhaps it’s the bouncing that eventually nicks him in the pancreas. Because the day before his vomiting, he went low and came right back up.

    What signs do you look for in your kitty, Kris?

    Also, did I mention in this thread that I had noticed before that his blood was bright pink when I would do his readings? I’d say his blood was that colour for a month. I noticed it but decided since he wasn’t showing any symptoms of anything that it’s fine. Obviously not =_= I WANT to say I noticed it when I switched his diet but I can’t say for sure.
     
  29. Rachel

    Rachel Well-Known Member

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    Aug 25, 2013
    Hmmm...I really can't say about the pancreatitis Crista. It's just something I don't have experience with. As far as I know, a lot of cats end up eating dry during a panc flare because you just want them to eat anything...and that's what they want to eat sometimes. Wet is better of course but you do what you have to.

    As for the dose...well it seems a bit crazy to me to drop it so much. Reducing him when he has been so high all this time and is staying high doesn't make sense. You've been hitting some good numbers on around 4.6, so going to 2 is strange..and with the pancreatitis, his numbers are likely to be higher, and I worry that with the eating problems, and then giving much less insulin along with the panc flare...that just sounds like a recipe for ketones. I could be nuts (like I said, I have no experience with panc) but I don't think I've seen this method tried either...what are your thoughts on it all?

    I'd be sure to test daily for ketones if you do drop it that much...at least while he's not eating well.
     
  30. Crista & Ming

    Crista & Ming Well-Known Member

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    Jun 10, 2018
    So lucky, Rachel! Panc suuuuuuuucks.

    I’m inclined to go ahead and keep him at at least 4 u tonight. I’ll speak to my vet again just to clarify with her why she thinks 2 units is okay when 3 units yesterday didn’t even touch him (her words).

    Plus, I just read somewhere on the forum that fluids tend to lower BG. So that might be why when my coworker gave him 4.6, he went low to 72.

    But yes I’ll attempt to test for ketones and that’ll be something I’ll be researching tonight. Good thing I bought the ketone tests already!
     
  31. Rachel

    Rachel Well-Known Member

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    Aug 25, 2013
    Oh I know! I've been very lucky that we haven't had to deal with that so far. I'm keeping my fingers crossed that my babies never get it!

    Yes, I've heard that fluids tend to lower BG. I have no idea why, but there's plenty of evidence that it does. Maybe ask your vet about ketones too? Just let her know you're concerned about that with all the factors at play here and that's why you're unsure about lowering the dose SO much. That might help spark some good conversation about it all and help get to the heart of the matter.

    Let us know if you need help with the ketone testing! It's really not that hard and we have some good tips and tricks to help out.
     
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  32. Crista & Ming

    Crista & Ming Well-Known Member

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    Jun 10, 2018
    Okaaaay so Ming is home now. He's still not 100%. He'll eat some treats but doesn't care for wet food. He peed right away in the new litter. I got World's Best Cat Litter. I'm not feeling great about him being at home but we'll see.

    I talked to Vet C. And she explained she wants to start over with Ming. She's afraid he might still be riding that rebound train/bouncing car/somogyi rebound effect. She read that it can last up to 72 hours. So after 3 days, we'll go from there. And I'll test for ketones.

    I understand where she's coming a lot more after talking to her. I do think 4.6 wasn't perfect. It was the BEST but not perfect. Maybe starting from the beginning will help... I just don't like that he's not eating normally. He's eating but not normally. And that he has pancreatitis. Would loved to have experimented with this when he was normal.

    He's also on Clavamox to help with infection and I plan to give him sub q fluids tomorrow as well.

    I'm about to do his BG and I plan to shoot about 45 minutes early. They've been giving him his doses at 9pm/am which doesn't work the best for me. It was pushed forward because on Sunday morning, they were waiting for the doctor to come in and assess his dosage.
     
  33. Crista & Ming

    Crista & Ming Well-Known Member

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    Jun 10, 2018
    Oh and yes! Would love some tips on how to test for ketones! But I'll go explore the forum and google ways to collect it in the mean time. I think everyone might be sleeping again XD Sometimes, I wish I wasn't livin' on the west coast haaha
     
  34. Djamila

    Djamila Well-Known Member

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    Aug 1, 2015
    Crista, I am very concerned about lowering the dose right now. The bouncing is because first of all, Ming has been sick the past few days, and second, the dose has changed dramatically from one cycle to the next. Both of those things would set off bouncing in even the most stable cat.

    Ketones develop when a cat is sick + doesn't get enough calories + doesn't get enough insulin. Ming is being set up for all of those things at once between the pancreatitis and choosing now to lower the dose. Please be very very vigilant. I would say to test for ketones every single time he pees. And if he stops eating and seems lethargic, get him into the clinic immediately. I realize that those sound like the same symptoms as pancreatitis, but they are also signs of ketones, and ketones turn deadly with devastating speed.

    Please forgive me if I'm scaring you, but I am far more afraid of ketones than I am of hypo because of the number of kitties we have lost or nearly lost around here from a sudden emergence of DKA.

    I do not believe that Ming was being overdosed at 4.6u, so lowering the dose seems to me to be an unnecessary risk. If they really want to try a reset, I would encourage waiting until he has fully recovered from the pancreatitis first. I'm thankful that you have close relationships and access to your vets. Please don't hesitate to get him back to the clinic with all haste if something seems off.
     
  35. Djamila

    Djamila Well-Known Member

    Joined:
    Aug 1, 2015
    Oh, and as for testing for ketones. Sam is nice enough to lift his butt for me when I reach in with the test strip, so I just stick it in there and get the test. Kitties who like a little more privacy will sometimes allow the bean to reach in with a long handled spoon so you don't have to get quite as close. And really private kitties you can wrinkle up some plastic wrap in the most frequent pee places in the litter box and then test from some pee caught in the wrinkles. You just have to make sure to interrupt Ming before he kicks too much litter over it.

    And if he's really determined to avoid the test, you can use fish tank gravel or special litter that's designed for things like that and doesn't absorb.

    Hope that helps!
     
  36. Crista & Ming

    Crista & Ming Well-Known Member

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    Jun 10, 2018
    Djamila, I agree. I've been sitting here, inputting his numbers from the past few days at the vet and teetering between 2 and 4 units. I wish I had tested for ketones when he peed when he came home but I wasn't ready and didn't expect him to go pee right away. I was literally in the middle of pouring his litter when he came by and entered his litter box.

    When he pees in the litter and there's a little pool in the middle, is that okay to test? Even if there's no plastic wrap or anything?

    I am... wanting to give him at least 4 units... he's at 21.3 or 383 right now. I'll be dosing in half an hour. I'm also not afraid of him becoming hypo, honestly.
     
    Last edited: Oct 15, 2018
  37. Djamila

    Djamila Well-Known Member

    Joined:
    Aug 1, 2015
    If the choice is getting the ketone test from the little puddle, or not getting it at all, I'd say go for it. But of course it's best to test it from uncontaminated pee. In the end, you just have to go with what you've got though. :cat: They tend to be pretty dang sneaky when it comes to litter box habits.
     
  38. Crista & Ming

    Crista & Ming Well-Known Member

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    Jun 10, 2018
    I'm more concerned about him bouncing again. But seems like 3.5 units did nothing the other night. And 2 units today really did nothing. I'm really surprised he's even at 21.3 right now. I'd expect him to be even higher.

    Those are my dilemmas. 4 units sounds nice though.
     
  39. Djamila

    Djamila Well-Known Member

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    Aug 1, 2015
    Okay, looking at the data now, I don't even really see him bouncing that much. He's shown some pretty typical responses with a good cycle followed by some flat cycles. That can be called bouncing, but it can also just be called "normal" before a kitty hits a really good dose range.

    I can understand leaning towards 4 units since he's been moved around so much, and then maybe adjusting from there. That sounds better to me than 2 or 3u for sure!
     
  40. Crista & Ming

    Crista & Ming Well-Known Member

    Joined:
    Jun 10, 2018
    Yeah ok. I'm going to do 4 units tonight. He's not eating right now. Ate a few treats right when he got home but doesn't care at all about wet food or anything else. He's sleeping but not sleeping in front of his water.

    4 units might avoid a dramatic bounce hopefully.

    Sigh, I hate being that client that doesn't listen but... I don't want ketones.
     
  41. Djamila

    Djamila Well-Known Member

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    Aug 1, 2015
    Ketones are bad. Bouncing is just part of the process.

    And really, it doesn't look to me like Ming bounces that much. Although to be fair, we don't even have a month of data yet so it's hard to be sure. After a low number, his next PS isn't usually remarkably high (ignore the hypo cycle - that's a different story). His next PS is usually right around his "normal" PS range. I tend to worry about bouncing when the next PS skyrockets out of normal range , and then the kitty dives and skyrockets again. Ming just gets a good number, and then runs flat for awhile. He doesn't really jump on the trampoline after a good number and get super unstable.

    Remember that Ming isn't regulated yet, so his numbers are going to be a little all over the place. He hasn't had enough time time in healing numbers at this point to really start showing a lot of improvement. This whole dance takes awhile. Much longer than we all wish it would. But keep reminding yourself that you've only been collecting data for just under one month. That is such a short amount of time still.

    Plus pancreatitis. Which sucks. And also makes this harder. and it sucks.
     
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  42. Djamila

    Djamila Well-Known Member

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    Aug 1, 2015
    Hey, what is that paste stuff you mentioned earlier? I haven't heard about that...?
     
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  43. Crista & Ming

    Crista & Ming Well-Known Member

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    Jun 10, 2018
    Ok he got 4 units. Not eating. I'm supposed to give clavamox with food but... he's not eating lol

    Since you mentioned the paste, I'm going to try it again. Here's a video! There's several different brands nowadays but they're all that kind of thing that most cats seem to love and it's fun to feed!
     
  44. Crista & Ming

    Crista & Ming Well-Known Member

    Joined:
    Jun 10, 2018
    Well, he ate the paste but won't have nuttin' to do with anything else. Even if I put the paste on top of something, he just licks it. I guess I need to get more paste lol

    I'll skip the clavamox tonight. I don't want to traumatize him and I'll give him bupe now though.
     
  45. Crista & Ming

    Crista & Ming Well-Known Member

    Joined:
    Jun 10, 2018
    He’s sleeping really ... deeply. I don’t know. Maybe he’s super tired?? Or he’s high?

    Sighhhhh. It’s out of character for him but I’ll try not to think too much about it. At least he’s not sitting in front of the water bowl. image.jpg
     
  46. Rachel

    Rachel Well-Known Member

    Joined:
    Aug 25, 2013
    Could be a combo of exhausted and high. ;) My guess is that he's just exhausted from his vet time. My cats always get that way when they've been at the vet...even for a short amount of time.

    I'm very relieved you didn't give 2 units last night...even seeing that 4 units shows that he stayed in higher numbers. I would definitely get those ketone tests in. I know it sucks to be that patient that doesn't listen, but vets simply can't be specialists in everything...every disease in every species? Even human doctors don't have to be that! Ketones just frighten us all because we've seen them enough here to know that they can be very bad.

    Do you have any forti-flora? My cats will eat anything with that on it! Or maybe some parmesan cheese? Will he eat tuna or anything? Did he refuse dry food as well?

    Sending lots of eating vines for Ming today!
     
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  47. Djamila

    Djamila Well-Known Member

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    Aug 1, 2015
    My kitties do that coma-like sleep after vet trips too. I think the stress just really takes it out of them. Plus, if they've gone to the vet it's usually because they're sick. so they need extra deep sleep to heal anyway. Plus bupe ;)

    Do get calories in him, in whatever form necessary. Keep feeding him the kibble if he'll eat it, as right now eating is more important than the quality of the food. Once he's out of the woods on the panc and his dose is safer, you can work on transitioning him back to wet food.

    So the paste is "junk food" I assume? Is it just at the grocery store? I haven't seen those before, but it's always good to know what options are out there when a kitty is anorexic.
     
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  48. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Aug 17, 2016
    Here are my experiences, having been through not one, but two, DKA crises with Teasel:
    • his first occurred two months after diagnosis when we couldn't get a good Lantus dose. He was high and flat at 1.5 u and I knew nothing about the nuances of dosing - nor did my vet. The vet suggested we stop insulin for 48 hours and try a restart. He was in DKA 24 hours later but there might well have been something like pancreatitis brewing at the time. He'd had earlier spells of vague unwellness prior to his FD diagnosis and these might have been pancreatitis.
    • his most recent illness episode (mid May to end of July this year) put him into DKA again. He had the expensive pancreatitis test done twice in that period and it was negative both times. Both times I was told that a false negative is possible. There was evidence of slightly thickened bowel wall on his ultrasound so likely some IBD in the mix. My kitty is inflammation prone.
    • in retrospect I think this last episode could have been averted or at least reduced if I'd had a pharmacy here at home to use - Cerenia, separate antinausea med, appetite stimulant, pain meds, subQ fluids to give, etc. All I had was some old Cerenia and a bit of mirtazapine. He was too ill for those to do anything then.
    • the main things that were different at the vet clinic compared to what I did at home later were IV fluids, electrolyte testing/supplementation, some administration of faster acting insulin to get BG down.
    • his appetite there was hit or miss but he needed that intensive monitoring I couldn't provide
    • when he came home my focus was on: 1. getting him eating using antinausea (ondansetron) and appetite stimulant (cyproheptadine) meds; keeping him hydrated (lots of water added to his wet food plus two administrations of subQ fluids); 3. urine ketone testing.
    • I subbed ondansetron (Zofran) in place of Cerenia based on reading here and would have added Cerenia if he'd needed it. They can work well together. I replaced mirtazapine with its awful taste and possible weird side effects for cyproheptadine based on reading here. All I had to do was say I wanted to try those and the vet was on board even though Cerenia and mirtz are their go to choices.
    • I made sure to go home with a supply of meds and a script for ondansetron that I filled at a human pharmacy.
    What I've learned and what I'd do next time (please, no!):
    • address any loss of appetite IMMEDIATELY (ie., after the first missed or partially eaten meal because Teasel is a good eater) with antinausea meds first. That can often get them eating. Add in the stimulant only after nausea is addressed and they still aren't eating optimally.
    • feed anything they'll eat - high carb wet, kibble, baby food, etc.
    • add water to food so you're giving at least an extra 150 -200 mL a day over and above anything in the wet food (1 Tbsp = 15 mL)
    • if that method won't work, give subQ fluids (ask vet how much but 100 mL a day is a start) if no cardiac issues.
    • start testing urine ketones at the first sign of being "off"
    • keep a pharmacy of meds at home!
    What I've read here about post-DKA at home management:
    • food and insulin are key! More calories per day are needed to prevent ketone formation
    • feed food high enough in carbs to allow a high enough insulin dose to be given
    • this is not the time to try to get BG down into ideal ranges - settle for "OK".
    • appetite can/will be variable so be prepared to address nausea first and add in the appy med second only if needed
    • hydrate, hydrate, hydrate!
    I hope this helps a little. Even if Ming doesn't have ketones, these steps will help in a panc attack, IBD flare, etc. and might well prevent ketones from rearing their head.
     
  49. Djamila

    Djamila Well-Known Member

    Joined:
    Aug 1, 2015
    Kris, I hope you've saved that response somewhere, that is a really good set of lists! While I know the focus is on DKA treatment, I might add to it the importance of pain management when pancreatitis is in the mix. I find that antinausea plus pain management is almost always enough to get Sam eating again. I think I've only needed cypro once despite his many many rounds of pancreatitis. In part because his is mild compared to some kitties, and in part because I hit the pain meds early and often as soon as I see that weird posture that tells me he's uncomfortable. Also, I think the CBD/THC combo helps with appetite as well as pain. I realize not everyone lives in a place that allows THC, but for those who do, a small proportion really does seem to add a little oomph to the treatment. Disclaimer: The jury is still out on safe amounts of THC, so use with caution.
     
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  50. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Aug 17, 2016
    Thanks, Djamila! We all have pieces of information to add to the mix. That's why FDMB is SO valuable a resource. :)
     
  51. Crista & Ming

    Crista & Ming Well-Known Member

    Joined:
    Jun 10, 2018
    I’ve briefly read everything you all have wrote. Thank you so much, truly.

    Right now I’m bringing Ming back to the vet. He ate nothing for me after the treats. And I did a ketone test and I honestly can’t say if it was trace or moderate ketones. I might have waited too long but there’s ketones I’m assuming. I was talking to the night assistant all night whose had 4 or 5 sugar cats and she talked about all the things you guys did. Was even stumped why he was recommended for 2 units and talked about insisting on Cypro.

    He stuck it out in the 20s the whole night or the 390-400s
     
  52. Crista & Ming

    Crista & Ming Well-Known Member

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    Jun 10, 2018
    And I’m thinking of giving him 4.4 or 4.6 units. Assistant said it would probably be okay to give 4.6 units. I’m only hesitant to go to 4.6 because I’m chicken and I don’t want him to go too low and bounce right back up
     
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  53. Djamila

    Djamila Well-Known Member

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    Aug 1, 2015
    Try to think of it as a steep curve instead of a bounce. The insulin is supposed to bring him down, and then it wears off and the BG rises. Every hour in the lower numbers is another hour when he can heal a little. The fact that he rises again after that cannot be avoided at this point. And staying high and flat all the time denies him time in the healing numbers. High and flat is no good. A smile shaped curve is what you're aiming for at this point.
     
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  54. Crista & Ming

    Crista & Ming Well-Known Member

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    Jun 10, 2018
    Alright. I’ll think long and hard while I drive and make a decision if I do 4.4 or 4.6. 4.6 is winning though
     
  55. Crista & Ming

    Crista & Ming Well-Known Member

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    Jun 10, 2018
    So I ended up not giving a dose but they're giving him insulin via IM. I'm not sure what that means but they know he needs to go down. I walked in and immediately Ming was swept away and they all went to work lol I probably looked like a zombie because a few coworkers asked if I got any sleep and if I was exhausted. I am teetering between spacing out and tearing up. I'm just thinking the WORST right now: what if I pour all this time and money into him and it turns out, all his illnesses are just too much and QOL is bad? But I keep reminding myself that when he's good, Ming is super bright and funny and fat and loves food lol So even if we can't get all of his illnesses in control, at least when he's good, he's good.

    He has ketones around 3.5 mmols. And they're calling the ultrasound specialist today. They'll check BG hourly and ketones whenever he goes. He also had bacteria in his urine from Friday but for some reason, no one did the culture for it so they're doing it now. I don't blame them for forgetting - sh*t happens and the head tech was NOT pleased that that was missed. The head vet said it would be beneficial to see the internal medicine specialist vet.

    I'm on board with whatever. I've got no money but I'm thinking I'll pay off this debt slowly somehow. Money can be made but there's only one Ming.

    I've gone home to sleep. I have to work the night shift tonight so I'll see Ming tonight.
     
  56. Crista & Ming

    Crista & Ming Well-Known Member

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    Jun 10, 2018
    Yes it's junk food. I think it's basically like baby food. Something the night assistant does all the time is get baby food that's meat only and feed it to anorexic animals. Almost always does the trick.

    I found it at PetSmart. They just recently started carrying it but before PetSmart had it, Walmart had it too.
     
  57. Crista & Ming

    Crista & Ming Well-Known Member

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    Jun 10, 2018
    I'm also wondering if my vet's glucometer reads lower and mine reads higher. I did BG at 630am and he was at 22.2. At the vet, they used their meter and got 20.1.

    I've read there's differences and the night assistant said the difference is usually by a fraction and now whole numbers. But she made a point that it's impossible to test and there will always be variables between even a single drop of blood.
     
  58. Crista & Ming

    Crista & Ming Well-Known Member

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    Jun 10, 2018
    Been told his BG is down to 8 or 144. And that he’s eating treats. Still not on appetite stimulants. I stressed again that he’s not really eating even if it’s just treats.

    I just don’t see the point in waiting? I understand mirtazapine might make him loopy but I quickly read up on cypro and it seems like it’s relatively safe if not overdosed. Vet B said she would consult with Vet A about that.

    He’s on dextrose so his ketones should be gone soon.

    And the ultrasound specialist isn’t available until Thursday and see if we can hold off until then. But I f he still doesn’t do well overnight, then he’ll go to that big expensive trauma centre/referral centre in our city (Canada West for all us Canadians) for an ultrasound.

    Coworker who is an assistant said he’s feistier than this morning. But he’s still in pain in the abdomen, vet said.

    Night nurse who is the experienced sugar cat owner told me to DEMAND Cypro hahaha. I tried. Vet said she would’ve given it to him if he wasn’t eating on his own by noon. I almost wish he hadn’t eaten just so he’d get it. That’s kinda backwards, right?
     
  59. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Aug 17, 2016
    What's hammered into us here is treat nausea first because that will often get them eating again. Give appy meds only if nausea has been addressed adequately. Pain is a deterrent to eating to so if he has a sore abdomen he needs pain meds. Is he getting any?
     
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  60. Djamila

    Djamila Well-Known Member

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    Aug 1, 2015
    Oh Crista. I'm so sad to read that he has ketones. As Kris said, nausea (and pain) first. Then appetite meds. And no more lowering the insulin dose. Even if it means throwing a full on temper tantrum in the waiting room.

    Okay, you've been given more than enough advice with all of these vets and techs and us and you are probably beyond overwhelmed and exhausted. Please know that we are all sending prayers and good thoughts and healing vines and positive energy and whatever else everyone believes in. Thank you so much for keeping us updated. I really hope you can get some rest tonight despite all of the worry.
     
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  61. Crista & Ming

    Crista & Ming Well-Known Member

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    Jun 10, 2018
    Ah I see I see. Yes, the night nurse mentioned he’s already getting cerenia and bupe so why don’t they just give him the appy meds. Haha she’s got a very strong opinion and I’m thankful for that. When she heard they recommended 2 u, she called me to tell me that she thinks that’s stupid but that it’s ultimately my choice.

    And yes I believe he’s getting pain meds.
     
  62. Crista & Ming

    Crista & Ming Well-Known Member

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    Jun 10, 2018
    Definitely. I will ahah I think Vet C just didn’t really understand that he’s not a wait and see kinda kitty.

    He’s on that IM insulin tonight with specific instructions to make sure he stays in a good range. Short acting insulin for better control.

    The internal medicine specialist said she is happy to see him on Monday. I’d be happy too. I only hope the $$$$ is reasonable lol

    They say he’s being more feisty compared to this morning. Which is good and bad imo. Good because it means he’s got energy but bad because it still means he’s not 100% better. I know him. I think we all know our kitties. And although to the vets and others, certain behaviours sound promising... knowing how our kitties usually are, it’s not as promising to me as it is to them. I’ll see what he’s like when I get there in a couple of hours. Last night, when I went to pick him up, I knew he wasn’t good. He didn’t perk up when he saw me and went right back to sleep. That’s not him.
     
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  63. Crista & Ming

    Crista & Ming Well-Known Member

    Joined:
    Jun 10, 2018
    No more ketones this morning!

    He had some trace last night but it was probably the last of it leaving his body. He was much perkier last night and ate dry foods and treats mostly. Licked at wet food. I really wonder why dry food is more appetizing when he’s sick?

    We were giving him diluted humilin almost every hour or two because his BG was in the 20s the whole night. But at least he wasn’t super lethargic. I believe during the day today, the doc is ensuring that Ming’s BG will get lower and they’ll transition him back onto ProZinc. She said something about making up the humilin each time rather than diluting a whole bunch. She wondered if pre-making diluted insulin/humilin lessened the effects of it. I’ll be watching him tonight again for my night shift.

    Then an ultrasound tomorrooooow. I feel better about him now. He was more himself. I’d say he’s about 60% himself.
     
  64. Djamila

    Djamila Well-Known Member

    Joined:
    Aug 1, 2015
    Pancreatitis can last a couple of weeks sometimes, so he probably isn't going to seem fully like himself for awhile still. Same with DKA. The recovery can be slow, even after the ketones are clear. Just keep lovin' on him and give him time.

    I'm so so so happy to read that he is clear of the ketones! Any word on the possible UTI?

    What are you hoping for from the ultrasound? Is it just to get a baseline and confirm the pancreatitis? Or is there suspicion of something else? The cause of the ketones is already known: he has inflammation (the pancreatitis and the possible UTI) + he wasn't eating (and wasn't given appy meds) + they lowered the dose.

    As for the food, sometimes when a cat gets sick on a food, they develop an aversion to it, so that could be a factor in why he doesn't really want to eat it right now. Also, most kibble is filled with flavor enhancers that aren't found in wet foods. That's part of why we often recommend Fortiflora. It's technically a probiotic, although from everything I've read it's not all that effective in that regard. But what it's really really good at is getting kibble lovers to eat. Sam will practically bite my fingers off when I start sprinkling some on his food. He only gets it now when he's sick, but it works every time. I've often joked that he would eat a shoe if I sprinkled it with fortiflora first. My other cat doesn't really care for it, but my other cat also doesn't like kibble, so there may be a connection there.

    It's so good to hear that Ming is feeling better, and to hear your "voice" sounding more hopeful again. Hugs to you and chin scratches for Ming!
     
  65. Crista & Ming

    Crista & Ming Well-Known Member

    Joined:
    Jun 10, 2018
    And then tomorrow, Vet A who is the boss lady vet will take over his case tomorrow. So that’ll be interesting.

    When I came in yesterday morning, Vet A was there too and Vet C was ... I want to say frazzled but mostly upset to know Ming didn’t do well overnight at home and was briefing Vet A on what was going on. At one point, Vet C was sighing and Vet A just went, “Do you want me to tell you what to do?” And Vet C said “YES, please!”

    It was both funny and really nice to see them working together. They went to the back OR to discuss and work out a plan.

    When I came in later that night for my shift, the day time assistant told me Vet C was beside herself, and watching Ming like a hawk and worried and not wanting to let me down. I could tell she was very worried about Ming and I guess me coming in that morning was quite shocking. She wasn’t the doctor on call that night but told us to call her instead if anything happens to Ming.

    Anyway, I’m really grateful and so extremely, incredibly lucky to be in this position where I can fall back on so many people for so many different opinions and backgrounds. Everyone’s input was so invaluable. I think if I didn’t have this forum, I would’ve kept Ming on 2 units at night and for the day, brewing in ketones. If I didn’t have these doctors, I would’ve continued going to my last vet and not really moving forward and looking for advice from specialists.

    So I really really really hope this is the beginning of a new path into getting Ming’s health issues in control.
     
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  66. Crista & Ming

    Crista & Ming Well-Known Member

    Joined:
    Jun 10, 2018
    Thanks Djamila! Yeah, I was so down yesterday. It didn’t help that I was also watching the show, This Is Us. If you haven’t watched it... it’s a really good show but also a tear jerker every darn episode!

    I think the ultrasound is just to make sure his pancreas isn’t completely messed up. And I’m also curious to know what it looks like in there now. The last time he had one, i heard it looked like there was a lot of scar tissue.

    The internal specialist said steroids should be saved for those who aren’t responding to treatment but he did so we’re definifely holding off of steroids for now.

    I actually don’t know anything about a possible UTI. I’ll ask about that later when I go in.

    And ya, I was eyeing the flortflora last night that was in the lab. I’ll be asking if I can have some tonight.
     
  67. Djamila

    Djamila Well-Known Member

    Joined:
    Aug 1, 2015
    Lol...I had to stop watching it because it makes me ugly cry every. single. episode. So good though!

    Maybe I'm imagining the UTI thing? I thought you said something about bacteria and a culture, but I have a terrible memory! If there's some fortiflora in the lab, definitely give it a little sprinkle on Ming's food and see if he likes it. That way you know before you buy a whole box. It does last a really long time, but still a little pricey up front.
     
  68. Crista & Ming

    Crista & Ming Well-Known Member

    Joined:
    Jun 10, 2018
    Oh right yesss. He had some bacteria in his urine. I’ll need to ask about that as well. I vaguely remember reading his his notes that there’s no growth. Not sure if it was related to the urine. Anyway that’s me guessing.

    Vet B and C both raised concern/speculated that perhaps the raw food has too high of a bacteria load for him to handle. What do you think about that?
     
  69. Rachel

    Rachel Well-Known Member

    Joined:
    Aug 25, 2013
    Yay for no ketones!!! One of the best things we could hear!

    As for the bacteria...I don't know enough about it to be sure, but it seems unlikely that raw food bacteria is causing urinary tract bacteria. While there is some bacteria possible in the food, cats have such a high tolerance in the gut to handle bacteria, I don't think that would cause problems. And it seems like if it did, it would cause GI upset, not urinary.

    Yes give the forti-flora a try. My cats love it! I sprinkle a tiny bit on food when I need them to take meds mixed in or something and I have to fight to make sure the right kitty gets it!
     
  70. Djamila

    Djamila Well-Known Member

    Joined:
    Aug 1, 2015
    What was causing Vet B and C to have those concerns? The vomiting? Are they thinking it wasn't pancreatitis, but rather some sort of food poisoning type thing?

    Pancreatitis isn't caused by food, so I would say no in that regard. The ketones have a known cause already. I don't remember you saying Ming was having diarrhea, was he? I'm not sure what from the food could be in play here. And Rachel is right, cats have a very high tolerance and aren't any more inclined to get sick from raw food than they are from kibble (which has it's own bacterial issues if you dig into some research on it - warning: it can get pretty nasty if you start reading about the bacteria in commercial kibble).

    So I guess I'm not clear what they are concerned about with the raw food?
     
  71. Crista & Ming

    Crista & Ming Well-Known Member

    Joined:
    Jun 10, 2018
    Ming was a lot more of himself tonight. He needed to be fasted for his ultrasound after midnight. He ate some FF just before that and then after, was asking for food. He chose the wrong time to be hungry :rolleyes:

    Vet B and I guess by extension, Vet A decided on 2 units of prozinc last night. I was like okay....... why...... and the chart said to discontinue humilin. Then I asked Vet A what numbers should Ming be within and she decided we should give humilin if his BG isn’t below 18 mmols.

    For most of the night he was in the 20s and then at one point, was at 17. High, high, high.

    No ketones of course.

    But funnily his mood was very good. He was purring and meowing and climbing on the bars. He stuck his hands out a lot.

    E4C07D4F-2B7E-44E6-82D6-83276898574E.jpeg
    4DF84E30-82C7-49AA-9563-52353FE5C8D0.jpeg

    I only hope they see that 2 units did nothing and decide to up it during the day.

    Also Vet A talked to me about steroids again. It would be a very low dose once every 3 days. She said she wouldn’t recommend it if she didn’t think it was time/a good option.

    I am willing to try but also scared. I asked the night assistant with the sugar cats what she thought and she said: “ Steroids are great for reducing inflammation so I guess thats why she wants to use them. tho to ME he has pancreatitis due to poor control so when THATS better resolved his pancreatitis will too but I only understand the basics“

    I might have to let Vet A know again my fears and ask if we are starting steroids, to perhaps at least start them later so Ming has time to recooperate? Not sure. And also maybe see what the internal medicine specialist says.
     
  72. Crista & Ming

    Crista & Ming Well-Known Member

    Joined:
    Jun 10, 2018
    And as for the bacteria, I asked Vet A. She said they haven’t gotten the report back from the lab. I think Vet B and C were just speculating as to why he had bacteria in the first place. I’ve heard the same reasoning before from one of the vets at the clinic Ming used to go to.
     
  73. Crista & Ming

    Crista & Ming Well-Known Member

    Joined:
    Jun 10, 2018
    Also one more photo of him after I changed his bed:

    00C802B2-8176-4DB7-AE70-4481F9188A81.jpeg

    Good bye beautiful belly fur! I’ll miss you until you grow back :arghh:
     
  74. Crista & Ming

    Crista & Ming Well-Known Member

    Joined:
    Jun 10, 2018
    Ooooookay. I’m sleepy and really will need to talk to Vet A again tonight. She said she will talk to me more then.

    He finished his ultrasound and they found he has micro abscesses on his pancreas. She mentioned something about them possibly or being necrotizing. So we’re treating him on a stronger antibiotic for a month plus the steroids. And then monitor and change his insulin doses accordingly.

    She did say she will most likely increase his insulin and I hope she does lol 2 units doesn’t do anything. And that I should continue to test his BG and let her know and work out the dose as he continues his treatment.

    I asked if she’s seen his last two ultrasounds which were done earlier this year. She said she did not but will be calling my old vet to get copies of them.

    She said with treatment, he will still have pancreatitis flare ups but ideally, it should be down to once a year instead of every month.

    My night assistant with the sugar cats was extremely (and oddly) optimistic. She texted: “Ok I wonder if thats the reason hes diabetic? The abcesses are impeding the cells from producing insulin how interesting! Perhaps once the infection is resolved so will his diabetes!”

    I have a list of questions already. If any of you also have questions, I will definitely ask them for you to the vet.

    For now, I must sleep lol another night shift is up ahead.
     
  75. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    I'm glad Ming is feeling better and you have more information going forward. He's a very handsome boy! :)
     
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  76. Crista & Ming

    Crista & Ming Well-Known Member

    Joined:
    Jun 10, 2018
    Okay dokey.

    Ming started his pred today. He is getting 6 units this morning. He was on 4 units last night and nothing happened lol BG high high high. And he got ketones. Ketones were high for one of his pees and then trace amounts for the next two pees.

    His fluids were at a high rate so that probably is flushing everything out. My vet told me not to get too worried about the ketones and that she suspected it would happen because of how high he was. I think since she’s taking over now, she’s definitely more aggressive with her treatments and kind of only did the 2 units as a sort of ... courtesy. She even told me that she’s doing 2 units because that’s what her books or whatever said. Of course, it would’ve been nice NOT to do that but what’s done is done. And he’s finally getting a higher dose.

    He’s acting GREAT though. Purring and eating relatively well. He’s even eating wet food now.

    He’s getting bupe 3 times a day now instead of 2.

    My vet is going to talk to a specialist today that advocates for steroid use in cats with diabetes. She’ll forward whatever response she gets to me as well. I think that will be very interesting.

    Vet also suspects he’ll probably be getting 8 units at one point just because of everything that’s happening.

    And Vet A said the fatty blood is not from diet and is a good indication that pancreatitis is impending.
     

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