? HELP! :(

Having reduced Ches' dose as vet was ever increasing it, as were the numbers...

AMPS is now 39.6! Hold dose or reduce further?

Seriously scary numbers.

He is eating and drinking well

 

Hi AJay, I don't usually like to give dosing advice but, if it was me, I don't think I'd reduce the dose further at this point. Please make sure you're keeping an eye on ketones, as well.

Hopefully others will weigh in here shortly!

 

With a history of DKA and those high numbers a dose reduction does not fit into the picture. You are not seeing any big drops that might account for bouncing, although there have been a few days you have not been able to get mid cycle tests to be sure. You really need to be very vigilant about testing for ketones with those glucose levels.

How old is the insulin? Have you been refrigerating it? Unrefrigerated Caninsulin is only good for 30-42 days..the time established varies between countries according to what guidelines they use. Are you rolling the insulin before each shot? Have you tried different areas for the injection? Sometimes a kitty will respond better to for instance a flank shot rather than a scruff shot.



Is Chester eating and drinking well on a regular basis? That is very important with a kitty with a history of DKA.


It may also be that a longer acting insulin such as Lantus or Levemir may work better. Just throwing out some thoughts here.

 

@Tuxedo Mom
Thank you Ches is eating and drinking well and regularly (despite vet starving him for 14hrs whilst he was with them - don't ask..)

I am checking daily for keytones as well as signs of UTI and GI inflammation.

His numbers show (I think) that as a result of his unstable GI system (various issues at various times) his numbers were being pushed up. The vet was reacting by increasing the dose. Yet if you look at the SS he started to come good at 2.75..

Initially he was in the hospital for 24hrs (preferred vet). They did a curve on 2.75 which worked out perfectly. Twot vet (not my vet- don't ask) then laid into me n insisted I drop the dose... Cue ensuing issues after..

He gets a regular meal twice a day with small (20/30g) in between.

Changing insulin is not an option right now. Vets won't entertain it. Insulin is not old. This vial I've had about 2 weeks. I've only been his devotee for a month and a week...
Insulin is refrigerated- in the middle of the fridge and rolled every time it's used.

Changing vets is not a option either. There aren't that many round here. I still need a close by vet in emergency etc... These guys will work with me, albeit there are limitations...

Thanks re the different sites. One to try for sure

 

Thank you for the explanation. Obviously the other issues are at work here since the numbers have remained consistently high since the vet visits started. At this point you can't really use what dose Chester responded to before, since requirements can change even on a daily basis. Since Vetsulin is an in and out type of insulin you need to be responding to both the prehot numbers and the nadir and working at keeping the numbers in lower ranges.


My concern is that the numbers are staying consistently high. Today you had a preshot of 39.6 and a +2 of 37.9. For Vetsulin that is unusual since there is usually a noticeable drop by +2 or +3. You might want to try and get a number more tests in today to see if there is actually a point where the numbers do drop. And of course continue with the ketone testing as many times as you are able to. At least Chester is eating and drinking well, but those high numbers are concerning with a kitty that has a history of DKA.

 

Agreed @Tuxedo Mom . You have NO idea the levels of panic going on round here. This has been going on so long...

You can be sure I am under NO illusion of how serious high numbers are and the risk of Dka...

I have just subq'd 35ml to be sure he is keeping up hydration

 

I do understand your panic. My GA kitty ran in high numbers a lot and I was always on high alert for ketones/DKA.

My concern with the high numbers is that I can't see this being a bounce....there are no low numbers or big drops showing. However, that being said, there is no data from the time Chester was at the vets. I wonder if you could try to get the readings that they took during that time. If there are some big drops or lows that could mean this is part of a bounce since bounces can affect numbers up to 3 days with some kitties.

 

They never reached below 20 @Tuxedo Mom . He was fighting inflammation at the time tho.

He always hovered between 20 and 30 Big bounces in between those

 

The "usual" with Vetsulin is that it gives drop of about 50%. If you look at August 18 you see that the drop from preshot to +7 was just over 50% which is what you most often see with Vetsulin.

Was Chester actually identified with an infection? If they suspected a UTI was it cultured? Without an actual culture it is hit and miss as to whether the bacteria is susceptible to a specific antibiotic.

 

The vet didn't culture this time round. He tested and the strips showed there was a mild infection. He decided not to treat with anti-b's this time round, but flush through, which is what they did.

He did however present with inflammation not long after that - he is very sensitive, although all his bloods, Panc, FIP, HyperT, kidney, liver, acro, haematology for parasites etc.... you name it, he has had it, has come back as normal.

Essentially, we have a very malnourished (poss chronic) cat, who is not tolerating a great deal. He is doing better than he was a month ago, but obviously this is a very difficult tightrope to walk with him. Now that we have managed to get his GI to accept Bison, we are somewhere to getting control of one area of him.

@Kris & Teasel and @MrWorfMen's Mom , what do you think? You've seen this bumpy journey too - any ideas?

 

How is his weight doing? Is he maintaining his weight or losing weight. Sometimes with IBD pancreatic enzymes need to be used if there is not proper absorption of nutrients. Hopefully the other members can come up some more ideas on what line of action will help more.

 

He's just about maintaining weight. Not greatly gaining.
I've put him on plant based enzymes for his pancreas on the basis it's going to be going thru a hard time whichever way we look at it.
His probiotics include s boulardii at high doses. Felini Complete is being intro'd carefully to make sure he doesn't reject it. B12 is 1 capsule a day.

This is way out of my comfort zone

 

Overall you are doing all the right things and giving the right foods/supplements.

As I mentioned before it might be useful to see what glucose readings/doses he got when at the vets the last time. It will fill in some missing pieces as to whether there were any big ups and downs or big drops or low numbers that could be pinpointed as causing a bounce.

 

I agree with what Mary Ann (Tuxedo Mom) has said. The dose needed can change frequently and more so in a physiologically unstable kitty. Vigilance wrt ketones is essential. Something is driving this but we don't know what. I think that filling in the gaps in BGs is important along with regular, careful increases in dose. Inflammatory issues might be keeping him high but you still need to get on top of that.

I know you have strict rules about insulin prescribing in the UK. It was my understanding that a switch could happen if there was evidence that one or more that were tried weren't working. Would ProZinc be any better now that you know more about him? Has you vet given you specific reasons why a depot insulin is off the table?

 

I just can't win.

I'm living on a knife edge, every. single. day.

This is way out of my comfort zone. I am turning to you guys for constructive help.

I am not far from throwing up from the stress of all of this. Pretty much every single day.

Do I increase or decrease? What do I do?

You HAVE to believe me I AM doing everything I can for Chester. Sleep deprivation for a month doesn't get any easier. Yes I'm freaking out!

I feel so ridiculously alone and that I'm fighting a losing battle without a prayer of getting anything right here.

Vet WILL NOT change insulin. Feels it's easier to stabilise on Caninsulin because it doesn't depot.

 

I am terrified the next time he goes back to the vet will be the last time :'(

Nadir today of 32.5. On 2.75. I'm screwed :'( and so is he :'(

I'm in peices here :'(

 

I think you're in one of those uncomfortable spots where you have to do something but there's no clear path ahead. I feel your frustration and we're trying to help. At the same time we're aware of the precarious situation and want to be careful in the comments we make.

I'll just throw this out: it's possible that on top of all his issues he has some glucose toxicity built up from spending a long time in high numbers. The 2.75 u dose that helped at the end of August isn't cutting it anymore. The way through glucose toxicity is by carefully increasing the dose, 0.25 u at a time, and not letting him stay long at an ineffective dose - 3 or 4 cycles max. You're at your wits' end so why not try 3.0 u tonight and tomorrow AM/PM then up it to 3.25 u for 3 cycles, then 3.5 u for 3 cycles and so on. Testing at +2 can give an idea of where he's headed. Ketone tests daily.

Does this help?

 

He's only dropped to 2.75 this morn. Is that going to fire things again?

 

OK. Give 3.0 u tonight and go to 3.25 u tomorrow. Caninsulin is in and out so every dose is a new situation.

 

He's stopped eating Kris Just today, from late morning

 

AJay, I agree with all the above, too. Also, if Ches seems to be prone to UTIs, you might want to look into d-mannose. It's an extract from cranberries and other fruits that works by binding to e. coli bacteria in the bladder, which are then flushed out with the d-mannose. Yes, it is a sugar, but one that does not seem to affect glucose levels. Squallie was having idiopathic UTIs almost constantly and was on and off antibiotics all the time. I started giving him d-mannose and he hasn't had a single problem with UTIs since then. I don't believe it would be harmful in any way to Ches, but always check with your vet before giving any new med or treatment.

Seems to me that this thinking is exactly backwards! Cats have extremely high metabolisms, three times faster than that of humans, so the depot insulins work really well for them. I'm sorry your vet won't consider switching him to anything besides the Caninsulin. I feel your frustration and your fear, but please don't think you aren't getting anything right; your poor little man has some overwhelming issues going on at the moment, and you are doing everything right to try and help him.

How long ago was that? His appy might pick up again later in the day. If not, can you syringe feed?

 

Stopped being interested AND eating about 4 hrs ago. I noticed it when I did +4 reading.

Interested but not eating it. I've given him a famitadine

 

Ajay, I mean this in the kindest way possible: please take some deep breaths and get to as calm a place as you can. Kitties feed on our stress and anxiety - I have no doubt about this. It's another way you can help Chester and it'll help you to think more clearly about what the next steps are. We're always here to help ...

 

Is he on any type of appetite stimulant? If not, that's another thing to consider. Squallie and one of my civvies with IBD are both on cyproheptadine, seems to work pretty well for them. Mirtazapine is another option, although it can have some side effects.

 

Hi there--

New person here-- I've been following Chester's story, but not commenting, sorry to jump in here "out of nowhere"! I just have one more question about the insulin-- has it been the same pen/bottle since you started Caninsulin (I see a note on the spreadsheet about a new pen being "ordered", not clear if it's in use)? And do you know how the insulin was treated before you got it?

I do think Kris is probably right about the possibility of glucose toxicity and the need to be a bit more aggressive with dosing, just wanted to keep in mind the possibility of a decline in insulin effectiveness, even if you've been treating it properly since you've gotten it. He did have some slightly better response back at the end of August.

Finally, just wanted to say "wow!" at all you've been doing for Chester! As I said, I've been following the story, and I think you've been doing an amazing job with him!

 

@Kris & Teasel Believe me, I am taking deep breathes and trying to relax. I've got a cracking headache from all of this so have been lying down for the last 2 hrs. Ches has been left well alone to chill in the kitchen.

I'm out of my depth. No experience of this st all. That's why I need reasoned thinking here. I wouldn't have a clue! It just seems one minute we're reducing the dose, next going up. It's Ches's life n I'm terrified

@Squalliesmom Hes not on an appetite stim as he's not really needed one tbf. Once on fluids at the vet he's always eaten well.

I did ask yesterday at the vets but didn't get an answer. We were talking bout pain meds and other bits at the time

 

I had the same thought and asked in an earlier post. Her reply was :

"This vial I've had about 2 weeks. I've only been his devotee for a month and a week...
Insulin is refrigerated- in the middle of the fridge and rolled every time it's used. "

 

I'm glad you're taking a break for now. I stand by my advice to try the dose increases as a first step. That's my reasoned thinking from a long distance away (Canada) from your immediate situation. You have to try something and that seems a reasonable way to go.

Check hydration level with the scruff pinch test or touch his gums to assess for tackiness. Pinch that stays up or tacky gums = dehydration. Given his issues and the way he can turn on a dime, why not ask the vet about meds at home: antinausea meds like Cerenia or the human chemo drug Zofran (ondensatron), appy stimulant like mirtazapine (can make them act weird) or the human antihistamine, cyproheptadine. You have pain meds. Many here with complex kitties keep a whole pharmacy at home once they're experienced in using the meds.

 

@Nan & Amber Thank you.

I have only just picked up the pen yesterday but not used yet because of the inbetween dosing.

Bottles have always been in the middle of the fridge, always rolled before use. Always put back in after.

The last bottle is about 2 weeks old. The only other thing I could do is maybe start using the vial from the pen

 

I'm cat walking Kris- or at least watching. He's parked off under the hedge now.
I don't have pain meds as in the uk Bupe is only available in injection and vet, much as he trusts me, won't let me have it in case he were to react badly, on an off chance.

I've given him a Famitadine. I might have to beg for appetite stim again before surgery closes

I've also given him 35ml subq a few hrs ago, to be on the safe side

 

OK re pain meds. The other meds would be good for you to have. I can get Cerenia and mirtazapine here from the vet and cyproheptadine is (or used to be) a non prescription behind the counter med at a human pharmacy. The rules are probably different in the UK.

 

I used the injectable Bupe for my other kitty when he had pancreatitc flare ups and it worked well. My vet would give me prefilled syringes with the correct dose according to his weight. Another pain option is metacam. The UK version for kitties is a lower dose/strength than the US and although there are some concerns with using metacam many UKers have used it for pain control with no side effects.

 

Mirtazapine works and some kitties tolerate it with no side effects. The weird effects include yowling, restlessness, etc. Can you buy cypro at a human pharmacy? People here could advise on dose.

 

Ajay, I have been following too...know you both are being covered with prayers and love .

 

Cypro isn't available in the uk as an active ingredient

I've put a call in with the vet just now and I'll try again for a pain med I can give at home as emergency

 

Catching up here.

I agree with everyone else. I'd try increasing the insulin slowly until there is some movement in the numbers. Would the vet be agreeable to putting Chester back on ProZinc since they are so dead set against Lantus or Levemir? He was on it before, had better numbers and while it's still an in and out, it doesn't tend to be as harsh and lasts a bit longer. Chester's numbers have progressively got worse on the Caninsulin. You have enough readings to prove the vet is crazy thinking Caninsulin is going to make it easier to stabilize him. If anything it has destabilized what had been accomplished. While I agree that any inflammation or infection can wreak havoc on BG levels, the vet has not found any concrete medical reason to explain this turn in his BG control so the most likely culprit would seem to be the Caninsulin.

 

Thanks all.
Yes, I do agree that the Caninsulin isn't helping. I kept the vet from consulting for over a half hour yesterday

Their argument was that he performed perfectly on the curve whilst in with them

It wasn't this practice that put him on the Caninsulin, but the comment was "I would have done the same" :'(

It really was a circular conversation that did nothing to make me feel any better

I pretty much begged for Prozinc. The others would not even get a look in with this practice.

On these high numbers, he is just going to end up inside again.
If I could afford it, I'd have him in to the Animal Health Trust. But what that would do to Ches is too scary

He's due for his shot in about an hour if anyone is around. I'll be testing in half hour.
Wish me luck

 

Slight down turn.. ches isn't using the litter box but letting it leak out where he is

 

Ohhhh! Did he just dribble a bit or let go of a full bladder? Have you checked for ketones today?

 

He's been dribbling where he is just twigged.
Not caught him today - this explains why

 

Sounds to me like the little guy may gave a bladder infection and perhaps needs antibiotics....an appropriate one for bladder infections NOT Convenia. Ideally they'd do a culture and then prescribe. It's something to look into and could certainly explain the elevated BG. I'd also ask them for the BG curves they supposedly did while he was at the clinic to see how well he was doing there.

 

Ches is going in

 

I'm so sorry Ches is headed back to the vet, but fingers and paws crossed that, this time, maybe they can truly help him. Please keep us posted because we will worry. (((Hugs))) to you, AJay, and prayers and healing vines for Chester.

 

Update:
Ches was admitted last night. Just had call from the vet. Bg's 31 Eating well and bright.
Last night she checked his urine and didn't find anything to suggest UTI or DKA. Not to say there aren't struvites or indeed an infection. From dribbling round the kitchen floor, he did a big wee at the vets :-/

Interestingly, after my very strong convo with her (not Ches' vet) she is considering sourcing Prozinc from any nearby practices. Also she is going to look into a referral practice for him. In her words, "we are in week 3 of trying to stabilise him and it's just not happening."

Keep those vibes coming... Lotto numbers anyone??

 

Hurray for Prozinc and a vet willing to go outside her comfort zone to help find answers for Chester!!!! I hope she can get the Prozinc and it makes a big difference for him. Also hurray on the referral, I'm thinking things might finally be looking up a bit for Ches and you. Fingers and paws crossed, sending tons and tons of prayers and healing vines!

 

This seems to be a couple of steps in the right direction. Keep us posted, Ajay. Sending positive energy your way.