Help Needed - not 911 - Wenchie

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Deb & Wink said:
Perfect!
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Great! So just to touch base, even though Wenchie has had the Pepcid AC, she threw up about 5am this morning. It's not everyday but at her weight she needs every ounce of food to stay in her. I desperately want her to gain back her weight. She's a skeleton with a lot of fur - she just feels so fragile and small.

The good news is tonight's PMPS was 261. We were happily surprised! We're continuing with our 1 drop dosing and will move to 2 drops on Monday morning and test her throughout the day.

I'll keep you posted!
 
I’ve been stalking your spreadsheet. :-). Nice to see that 261 preshot.

I’d try to get a +2 or +3 tonight if you can just to see where the cycle is heading, although I know you knock off early. It also wouldn’t hurt to get mid cycle test tomorrow now that you’ve seen a better number.

As for the vomiting ... though it isn’t “standard” procedure, I personally would experiment with leaving food down, even in the two hours before the shot, to see if it makes a difference. It might or might not. But then you’d know. Sometimes we just have to do what we have to do and tinker a bit, even if it’s not the norm. Just be prepared to do a few spot checks during the cycle since you could theoretically be shooting a slightly food influenced number. I had to do that with Charlie as my beloved “Skeletor” (not his nickname, just his heartbreaking body shape when he was ill) was prone to vomiting and nibbling small amounts all day just like Wenchie.
 
JL and Chip said:
I’ve been stalking your spreadsheet. :). Nice to see that 261 preshot.

I’d try to get a +2 or +3 tonight if you can just to see where the cycle is heading, although I know you knock off early. It also wouldn’t hurt to get mid cycle test tomorrow now that you’ve seen a better number.

As for the vomiting ... though it isn’t “standard” procedure, I personally would experiment with leaving food down, even in the two hours before the shot, to see if it makes a difference. It might or might not. But then you’d know. Sometimes we just have to do what we have to do and tinker a bit, even if it’s not the norm. Just be prepared to do a few spot checks during the cycle since you could theoretically be shooting a slightly food influenced number. I had to do that with Charlie as my beloved “Skeletor” (not his nickname, just his heartbreaking body shape when he was ill) was prone to vomiting and nibbling small amounts all day just like Wenchie.
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Stalk away!!!

Yes, my husband and I both were so happy to see that number! I will retest at +2 to see where she’s headed.

I have thought about just giving her a tablespoon at 4am because she is so hungry and so painfully thin. She is such a slow eater and just likes to graze. It’s definitely worth a shot. And I will retest just to make sure her number is stabile.

Thank you so much for all your suggestions! I hope I can help others some day the way all of you so generously have helped me and my girl.
 
I would try leaving some food down overnight so that Wenchies tummy does not get empty. If that happens, acid can buildup and some cats have a liquidy/frothy vomit in the early morning.
I solved this problem with Sheba by leaving her some small snacks overnight in the autofeeder.
 
Bron and Sheba (GA) said:
I would try leaving some food down overnight so that Wenchies tummy does not get empty. If that happens, acid can buildup and some cats have a liquidy/frothy vomit in the early morning.
I solved this problem with Sheba by leaving her some small snacks overnight in the autofeeder.
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Wenchie actually came in around 4:30 this morning and my husband gave her a small teaspoon of food (she had already thrown up a tiny bit earlier). Since she's a s-l-o-w eater, that kept her satisfied.

Thank you so much for your suggestion! This is such a battle but I'm determined to get her into remission and feeling good!
 
@Deb & Wink

Just an FYI - I received an email this morning (actually last night) from my vet telling me she really wants Wenchie on 1/2 unit! I had sent her an update on her, with our dosing protocol, as well as the spreadsheet and she still thinks she should be on 1/2 unit!

Time for a new vet methinks! My husband's childhood friend is a vet, as is his wife and they are about 40 minutes north of us. He retired but she is still practicing. Time to take Wenchie there. Had I given her 1/2 unit, she would have spiraled into a hypo event, possibly have to be hospitalized (which lines this vet's pockets) or even death. I'm sorry, but as I do my due diligence with our own health, I owe it to my animals to do it for them. That's why I'm here. You guys have given me the best and most caring advice through this whole thing. I honestly don't care what this vet thinks - the numbers don't lie!
 
Have you ever considered having a feeding tube inserted? To get more food into Wenchie.

Have you ever thought about feeding kitten foods? They can have more calories than the adult cat foods. Not always, but sometimes. So you would need to check the food chart.

Have you ever thought about feeding plain meat baby foods? Like Gerber or Beechnut. To supplement the cat food you are giving her.

Do you have a timed feeder? So someone does not have to get up in the middle of the night and remember to give Wenchie a bit of food to eat.

p.s. 0.5U of insulin? With Wenchie's low numbers? Did the email give any reasoning behind the 0.5U dose suggestion of your vet?

Just trying to think of ideas to get more calories into Wenchie.
 
A timed feeder is the way to go if she will eat out of it. You need to get ahead of the vomits and start feeding her before she starts vomiting if you can.
Sheba loved her timed feeder and would race down the stairs to it as soon as she heard it click over.
 
Deb & Wink said:
Have you ever considered having a feeding tube inserted? To get more food into Wenchie.

Have you ever thought about feeding kitten foods? They can have more calories than the adult cat foods. Not always, but sometimes. So you would need to check the food chart.

Have you ever thought about feeding plain meat baby foods? Like Gerber or Beechnut. To supplement the cat food you are giving her.

Do you have a timed feeder? So someone does not have to get up in the middle of the night and remember to give Wenchie a bit of food to eat.

p.s. 0.5U of insulin? With Wenchie's low numbers? Did the email give any reasoning behind the 0.5U dose suggestion of your vet?

Just trying to think of ideas to get more calories into Wenchie.
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I have the food chart up and am looking at different foods. Yes, thinking about kitten food as it has more calories. Just have to find the right one. You wouldn't believe how much Wenchie eats - at LEAST 6-7 cans per day. I'm also buying some raw foods to try as well.

Never thought about baby food. I will look into that as well. It's not a problem getting up in the middle of the night as my husband has always been a choppy sleeper. He's up and down all night long. Wenchie came in at 4:25 so we knew she wanted food. I will also look into a timed feeder.

And, no, regarding 0.5 U of insulin - her email gave no indication of WHY! I asked her in my very polite but firm email if she looked at the spreadsheet. We are definitely changing vets. I really wanted to say, "yes, we'll keep her on 1/2 unit until it kills her or your practice makes more money!" but I didn't. It's highly irresponsible. This is a HUGE practice, open 7 days a week with all the equipment available. I thought it was a good choice. Don't think so any longer.

Her AMPS was 270 this morning. I want to raise her but want to wait until she's on this for a full week, which would be Sunday. I'm honestly frightened to raise her when she "seems" to be stabilizing. Am I wrong?
 
As long as you are checking her for ketones daily, it's ok to wait for the full week until you raise Wenchie's dose.

Since your husband is a "choppy sleeper" he could get another test in sometime during the night time cycle.:) Just sayin'.
 
Deb & Wink said:
As long as you are checking her for ketones daily, it's ok to wait for the full week until you raise Wenchie's dose.

Since your husband is a "choppy sleeper" he could get another test in sometime during the night time cycle.:) Just sayin'.
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Yup, I'm checking her ketones daily. All negative.

My husband wouldn't feel comfortable doing it without me LOL! If we had to, I would definitely get up.
 
Maybe a return email to the vet, asking her to look at the BG numbers on specific days (2/17, 2/21) and specific times from your SS.
Ask her what hypoglycemia symptoms you should be looking for at low BG numbers. Don't give her a list, have HER give you one.

Ask her if she knows the dangers of hypoglycemia and could explain them to you.

Ask her how low the readings should be before she would be concerned. And why.
Ask her what the normal BG readings are for a non-diabetic cat. (40-120 usually)
Ask her what the BG numbers should be for a regulated cat. (<300, nadirs <100)
Ask her what the "renal threshold" is for a cat. (The BG level at which the glucose spills over into the urine.)
Ask her if she has definitions for regulated, well regulated, tightly regulated.
Ask her how many cats she has treated for feline diabetes.
Ask her how many of those cats are using Lantus insulin.
Ask her to explain to you how Lantus insulin works in a cat.
Ask her what other insulins she prescribes for cats.
Ask her how many of those cats she has treated she has gotten into remission (diet controlled).
Ask her how many of those diabetic cats have had DKA (diabetic ketoacidosis).
Ask her how many of those cats she has treated for diabetes have had hypoglycemia symptoms severe enough to be rushed to the 24 hour emergency vet hospital and put on a glucose drip.
Ask her if she has ever treated a diabetic cat having seizures, then coma, then died.

Here is our definition of the various levels of regulation: What is Regulation?

What is Regulation?
There are different definitions of regulation. As hometesting becomes more common, we've been getting a better understanding of what cats and their humans might be capable of. Janet & Fitzgerald propose the following "regulation continuum":
  • Not treated - blood glucose typically above 300 mg/dl (16.7 mmol/L), poor clinical signs
  • Treated, but not regulated - often above 300 (16.7) and rarely near 100 (5.6), poor clinical signs
  • Regulated - generally below 300 (16.7) with glucose nadir near 100 (5.6), good clinical signs, no hypoglycemia
  • Well regulated - generally below 200-250 (11.1-13.9) and often near 100 (5.6), no hypoglycemia
  • Tightly regulated - generally below 150 (8.3) and usually in the 60-120 (3.3-6.7) range, no hypoglycemia, still receiving insulin
  • Normalized - 60-120 (3.3-6.7) except perhaps directly after meals -- usually not receiving insulin
There may also be an extra category of "mostly above 300 (16.7) but with good clinical signs" which occurs with some cats who are getting insulin. We don't know why it happens, but such a cat probably should not be considered to be regulated. On the other end of the spectrum, it is possible for a cat who is not getting insulin to have blood glucose as low as 40 mg/dl (2.2 mmol/L) on a glucometer calibrated for humans. If you have a non-diabetic cat, try testing her with the same meter to get a safe comparison figure.
 
@Deb & Wink "ask her to look at the BG numbers on specific days (2/17, 2/21) and specific times from your SS."

Yup - I sure did in my first email to her. I attached the SS and referred to it in my email as well as my follow-up email. I'm wondering if she even looked it. I wouldn't be surprised if she didn't. I'm pissed.

Sadly, another one of my cats is sick today and we're taking her in, but seeing another vet. She's been vomiting a lot since last night, won't eat, and now hiding under my dresser. When it rains, it pours.

We will be taking Wenchie to see my husband's friend who is a vet, despite being quite a distance from us. We trust her to be honest and straight.

I won't be sending her the questions you listed above but believe me, I would if I thought it would be received well - I'm sure it wouldn't! Nothing worse than an educated client. When my friend was diagnosed with breast cancer in Dec. 2018, I immediately became her advocate. I went to every single doctor's visit, was there for her surgery, radiation, etc., took copious notes, read research on treatments, medications, surgery - everything. She's on the other side of it now, pretty much "cured" although doctors don't like using that word. And because we were so informed she got better treatment and looks to have beaten it. Never got a bad word from any doctor - not one took it personally when I would ask "Why?" or "Why not?" It should be that way in veterinary medicine. My old vet was that way but she's in Connecticut. I miss that practice.

You have been such an advocate for my Wenchie and I cannot thank you enough. This saga is far from over but I'm going to do whatever I have to do to get her into remission.

to be continued.....
 
Thank you - I will read through all of this. I’m considering a vet practice that is relatively close and will definitely read through these questions.

We’re seeing a different vet today but one that is familiar with all my cats. Riley is almost 13 and is our problem child. She was a bait and switch from the rescue but my husband felt sorry for her. She is an extremely picky eater, whiny, rambunctious, badly behaved, despite all our efforts over the last 11 years. Simply put - she’s a tough cat to love. But we are committed to our rescues and do our best to work with what we have.

It’s raining here and we’re under a wind advisory.

Calgon take me away!
 
Honestly Diane, vets are terrible at dosing advice. We love our vet, he's been lovely to our babies for other things, but he is not good at diabetes, especially dosing. He had Billy on 2 units twice a day to start, which ended up being way too strong. Then, after Billy had been off insulin for 20 days, he wanted us to put Billy back on 2 units twice a day because his fructosamine test was a single point too high! At the time, Billy's pre shot numbers were ranging from 70-115. Can you imagine putting a cat running that low on 2 units of insulin?!

We still use that vet, we just ignore his dosing advice, and his office scolds us, and we don't care. Thank goodness for this site though. Billy never would have made it into remission without the help we got here.
 
Even my vet -- who encourages home testing & gave me paperwork on it with guidance on increasing/decreasing doses & who didn't rush to insulin but tried just food change first tried to put my cat on 3u twice a day at first....and I talked her down to 2.5....which, on dose 3 when I finally tried home testing, could've killed him.
She's handed over the reigns to me - just looks at my spreadsheet now.
 
Juls and Billy said:
Honestly Diane, vets are terrible at dosing advice. We love our vet, he's been lovely to our babies for other things, but he is not good at diabetes, especially dosing. He had Billy on 2 units twice a day to start, which ended up being way too strong. Then, after Billy had been off insulin for 20 days, he wanted us to put Billy back on 2 units twice a day because his fructosamine test was a single point too high! At the time, Billy's pre shot numbers were ranging from 70-115. Can you imagine putting a cat running that low on 2 units of insulin?!

We still use that vet, we just ignore his dosing advice, and his office scolds us, and we don't care. Thank goodness for this site though. Billy never would have made it into remission without the help we got here.
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That is so true. We were at the vet with another of our cats, Riley, who ended having very full anal glands (yuck!) and pancreatitis. Some cerenia and she's off to the races.

Our regular vet wasn't there so we saw a different one but she was well-informed on Wenchie. She was asking ME questions - how to you drop dose? How did you know the original dosage was too much? Ummmmm - really? Geez. I never thought I could educate a vet about this so early in the game but there you have it.

I told her, in a very nice way, that although the dosage guidelines might be OK for some cats, it wasn't for Wenchie. I wanted to say YOU JERKS COULD HAVE KILLED HER! But I refrained LOL!

You guys are never getting rid of me - this group is just too good!!! Now, off to take a nap. I've been up since 3am after Riley's vomiting got us up. I'll be back to post Wenchie's PMPS. And she's looking and seeming a bit better each day thanks to all you guys!
 
toomanycats said:
Even my vet -- who encourages home testing & gave me paperwork on it with guidance on increasing/decreasing doses & who didn't rush to insulin but tried just food change first tried to put my cat on 3u twice a day at first....and I talked her down to 2.5....which, on dose 3 when I finally tried home testing, could've killed him.
She's handed over the reigns to me - just looks at my spreadsheet now.
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Wow - just as we have to take control and know our own bodies, what works, what doesn't, do our own research for our own health issues, we MUST do that for our animals. Same here - 1/2 unit would have eventually killed my girl and I promised Wenchie I wouldn't let diabetes or the treatment kill her. I've opened my spreadsheet to my vet so I do hope she is looking at it. (I had to take out the nasty vet comments! Had my husband double check me too! LOL)
 
Send your vet to this forum. We do have a couple of vets and vet techs that post here.

At the least, she can read some of our documentation.;)
As you know there is a ton of documentation on feline diabetes here.
Plus we link from other sites, including vet journal published info and vet websites like the AAHA.
And have information on some of the comorbidities that happen with feline diabetes as well.
 
Deb & Wink said:
Send your vet to this forum. We do have a couple of vets and vet techs that post here.

At the least, she can read some of our documentation.;)
As you know there is a ton of documentation on feline diabetes here.
Plus we link from other sites, including vet journal published info and vet websites like the AAHA.
And have information on some of the comorbidities that happen with feline diabetes as well.
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That is a great idea. It would be good for her to see that this isn’t some random website that spouts bad info.

The vet we saw this morning is very informed about Wenchie and she asked me lots of questions, which I felt comfortable answering. She also said she thought I was doing a good job. Yeah - me and a village of angels!

On another note, Riley has pancreatitis. She got a shot of Cerenia and sent me home with some as well. Her other bloodwork came back perfect - kidneys, liver, thyroid all perfect.

One funny thing happened when we were waiting on test results. A Brinks truck pulled up. I took a picture and posted it on my Facebook page. Yeah, apparently the veterinary business is lucrative.

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Pancreatitis is no fun. That was one of the issues my Charlie battled for quite a while. The primer @Deb & Wink linked contains very valuable info. Here’s hoping Riley feels better soon.

Now that you’re seeing better pre-shots in Wenchie, it would be a good idea to catch a mid-cycle test, such as a +5, +6, or +7, to see how low the one-drop Lantus dose is taking him. Lantus dosing is based on nadir values (low points in the cycle), not on pre-shot values. I realize you’re planning to do a curve on Sunday but sometimes there are fluctuations from day to day so it would be good to have a few interim numbers. As is often said ... every cat is different (and sometimes every cat is different every day).
 
JL and Chip said:
Pancreatitis is no fun. That was one of the issues my Charlie battled for quite a while. The primer @Deb & Wink linked contains very valuable info. Here’s hoping Riley feels better soon.

Now that you’re seeing better pre-shots in Wenchie, it would be a good idea to catch a mid-cycle test, such as a +5, +6, or +7, to see how low the one-drop Lantus dose is taking him. Lantus dosing is based on nadir values (low points in the cycle), not on pre-shot values. I realize you’re planning to do a curve on Sunday but sometimes there are fluctuations from day to day so it would be good to have a few interim numbers. As is often said ... every cat is different (and sometimes every cat is different every day).
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It isn't but at least, with the Cerenia, there's has been no vomiting. I will absolutely do some mid-cycle testing, especially if her numbers are low again this morning. We can see that she's definitely feeling a little better.

Thank you for helping me help our girl - we love her so much. She's always been such a great cat and we owe this to her to get her feeling as good as we can now that she's an old lady.
 
Did you get a mid cycle test in today?

I see that you’re planning to bump up dose tomorrow and that’s likely warranted, but Wenchie likes to throw curve balls so was just curious whether she’s staying high and flat through the cycle or dipping lower.

How is Riley today?
 
JL and Chip said:
Did you get a mid cycle test in today?

I see that you’re planning to bump up dose tomorrow and that’s likely warranted, but Wenchie likes to throw curve balls so was just curious whether she’s staying high and flat through the cycle or dipping lower.

How is Riley today?
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I fully planned on doing it today but I didn't get a chance. I had to run to my niece's house (and hour and a half away) because it's AWAYS something with her. Sheesh.... But, tomorrow I am planning on doing 2 drops and monitoring her very closely. Her number was high tonight and she seems very stabile. Do you think I should hold off until Sunday and just test her mid cycle tomorrow? I'd rather be safe than sorry.

At first it seems like a good idea - and she's been having good days lately - which may be skewing it for me, i.e. "she'll be ok on 2 drops".

Yeah, think I'll wait until Sunday and do the mid-cycle testing tomorrow before raising her to 2 drops. I want her to continue doing well.

OOPS! Forgot about Riley - she's doing much, much better. Cerenia is a great drug. She started bouncing back mid-morning and she's back to her picky, pain-in-the-butt self. She's always been a picky eater and she's back at it!
 
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