Jett - Hospitalized

Jett has been at the hospitalized since 9/30 with pancreatitis. They put a feeding tube in and he has started to eat on his own. The vets at this clinic have changed his food to RC Diabetic wet and dry. I communicated my concern with the dry food, but they assure me that it is okay for diabetic cats. They believe they have the pancreatitis under control.

You can see on his SS that he has been on Lantus since July. The vet changed him to Humulin N a few days ago and Jett's BG #s are still in the 700 range !! They started with a 1.0 unit dose of Humulin N and I believe took it to 1.5 last night and his AM PS was out of range I am so worried. Should the vet try another insulin? What can be done to help Jett?

My husband is also hospitalized and has had 2 surgeries during this time, so I really cannot bring Jett home until his BG is more stable, since I cannot test him frequently.

Thanks for your help,
Patti + Jett

 

Replied on your Humulin thread:

With the BG that high it is possible he may be having ketones and possibly DKA, which requires immediate ER treatment. I would suggest an ER vet and have them run tests for DKA. Jett may need to be on IV with fast/rapid acting insulin and intense monitoring. The regular insulins will not work fast enough. You have so much on your plate right now...the best place would be at an ER vet. Regular vets do not always know how to deal with serious situations.

Prayers for your DH and Jett and for you

 

So very sorry to read this Patty, I know you have been valiantly managing both since early on in Jetts diagnosishoping Jett's stay is brief and that your DH has better days ahead.

 

I just want to add prayers for Jett and your DH, too....

 

Sending prayers for Jett and your DH.

 

Sending lots and lots of vines for Jett and your DH.

 

Prayers to you all.

 

Could you try again to get the vet to feed Jett what he was eating at home? I'd argue that since that is what he has to eat your food at home, it would be best if he is eating that in the hospital before he comes home. And getting rid of the high carb and dry food may help his numbers. Ask them to humor you, he's your cat and you are paying the bill.

Is the vet resistant to using Lantus? On your last post here, Jett had earned a reduction down to 1.0 unit, so it should be pretty easy for them to measure out. He actually earned that reduction on the 21st.

As for Humulin N, it doesn't last as long in the cat as Lantus does, so you could very well have higher preshots as the insulin wears off. Are they doing any mid cycle testing to see how low it's taking him?

Piling on more vines for you, DH and Jett.

 

Sending you lots and lots of vines for Jett and your husband. I like Wendy's suggestion to tell them to feed him what you feed and know is lower carb.

 

(((Patti)))
I'm sorry to hear this is happening.

*Usually* the reason behind switching a cat from one of the long-acting insulins like Lantus to a fast acting insulin like Humulin N or R is that the insulin can be administered as necessary (sometimes every few hours or so)... unlike Lantus. It's not a method that can safely used at home, but can be effective in a vet's office where they're equipped to use an IV drip to keep kitty from bottoming out.

Are they administering Humulin N more often than every 12 hours? If so, keeping him on it may help.

Whether they should try another insulin or not depends on if they're using N to it's potential. If not, they may be better off with using using Humulin R with an IV drip until they are able to bring BG numbers down to a lower range... a range of numbers that Lantus can grab onto.

I agree with Mary Ann. If they're not checking for ketones... they should be.

Lantus has trouble pulling high numbers down and keeping them down... especially with a sick kitty. You almost have to incorporate the use of a bolus in addition to Lantus under similar circumstances. Although, I've yet to see a vet or an ER use a bolus/basal insulin combo to pull numbers down quickly. They just don't have enough staff to monitor kitty as needed when using a basal/bolus combo. Using frequent doses of N or R (usually with an IV drip) is a more efficient use of a vet's time in a clinic or ER setting and if used correctly, you'll see favorable results sooner than one would with Lantus alone.

I also wonder if they've done any mid-cycle tests to see how low the N is taking him. If he's going too low, Jett may be bouncing. Hence the high preshot numbers - OR - if they're only shooting every 12 hours... the insulin could be wearing off, as Wendy said, which could be a reason for the higher preshot numbers.



Just a few thoughts.
Sending hugs, positive thoughts, and healing vines...

 

{{{Patti}}}

I have nothing to add to the excellent feedback you've already gotten, but I just wanted to let you know that you, Jett and your DH are all in my prayers. Hang in there.

 

I'm glad Jill posted because this was all along the line of my thinking. I would only add that if they are checking his BG at about the +6 time when the Humulin N "might" wear off, they could give him another shot of it if numbers are still high as there is no depot.

But I've also seen good results when R was given via IV. I echo that they need to be checking him for ketones and potential DKA. If he were mine, I'd also take his normal food in and ask them to feed it to him and also be sure he is getting something, like buprenorphine, for pain.

Sending prayers and vines for your DH and Jett.

 

Just wanted to add that when Harvey was hospitalized, they gave R and it worked pretty well.

 

I don't know what the vet is thinking, but there may be a method to what seems like madness here (feeding higher carb food)...

they *may* be feeding higher carb food in an effort to get more insulin into him without bottoming him out.

It's strictly conjecture on my part...

 

I hope you are right Jill. The comment they gave Patti:
"I communicated my concern with the dry food, but they assure me that it is okay for diabetic cats."

almost makes it sound like they are following the same trap a lot of vets fall into with using "precription" foods, even if they are not the best choice.

My other concern is why they would go with Humulin N rather than one of the "R" insulins. Even if there are no ketones...which I don't know if they have tested or not... with numbers staying that high my thought would be to pursue a more aggressive approach with "R" and with constant monitoring so that they don't get to the point of DKA.

 

You could very well be right.

I don't know. The reason could be something as simple as they had a vial of N sitting in the fridge.

 

Sending healing energy thru the ethernet to you, your husband, and Jett.
Hugs are yours as well

 

I wanted to come back to this because I neglected to mention some vets do follow an aggressive approach with N. "We" don't think in those terms, but a vet may use either R and N in much the same way.

Having said that, I have no idea how often/how aggressive Jett's vet is with Humulin N. It's why I asked Patti if N was being administered more often than every 12 hours.

 

Thanks for that information Jill. I wasn't aware that "N" could be used aggressively as well. With numbers that high I would have thought they would be using the "R" insulin. In either case I certainly hope they are doing an aggressive, well-monitored approach. Patti already has so much on her plate that she is trying to deal with, so I hope Jett is getting the best care possible.

 

I was more concerned about the dry food than the HC food.

 

Pancreatitis is so horrible. Gizmo has been hospitalized twice with it. First time was 8 days, 2nd time was 6 day. It is good that Jett is eating again on his own.

Know that he is at the best place he can be for both you and him (and DH). Trust your vet to know what they are doing so you can get some rest and concentrate on DH.

Prayer for all.

 

A big THANK YOU to All of you sweet, caring people for your virtual hugs, comments, observations and words of wisdom. I am numb and so incredibly exhausted and scared from all that is going on with Jett and my husband. The vet clinic called and wanted me to come get him to see if his #s would stabilize at home. I just picked him up and they have switched him to Royal Canin GlycoBalance wet and dry food. Is this crap food? I have always been appalled at the junk ingredients of the prescription food, but I haven't had time to look up the details. What do you feed your diabetic kitty?

In terms of Humulin N, I'm so confused. They actually called in Novolin N, which they say is the same but the Walmart Pharmacy says it is different. The Walmart pharmacist also said that they have a generic that is much cheaper. Does anyone use this generic insulin from Walmart?

Thanks for your help!
Patti + Jett

 

Patti I can't imagine how totally worn out you must be, dealing with so much all at once.

I am not very excited about the clinic sending Jett home yet. As far as the food goes what was their reason for changing...quite frankly that is NOT the best choice for a diabetic kitty. Also why did they change to Humulin N. Humulin N is basically the same as Novolin N, just made by a different company. Whether it is Novolin N or Humulin N, neither of these insulin tend to give a full 12 hour coverage. They usually fizzle out at +8-+10 after shot. Also they tend to be a harsher faster acting insulin, than Lantus, which means that it is best to be able to test at +2 or +3 to see if the numbers are dropping too fast.

Did they ever check for ketones? With numbers that high especially after a pancreatic episode the changes of developing ketones are much higher.

 

I asked if they had checked for ketones and the vet said that the clinical signs were not there and she did not smell ketones. She said that they could test if I wanted. I was very frustrated by this and said that I wasn't the doc but that with BG that high, I knew that ketones and DKA were a concern.

I'm guessing (like someone else did above) that the Humulin N was in their frig, so they used it. I asked numerous times why Humulin N and they said that many of their cats are on it. I also got from one of the docs that it is cheaper and that is why people like it. I don't want to use an insulin because it is cheaper, I want the insulin that is best for Jett. I'm so upset about this and I don't know what to do.

 

We do have at least one member @OrangeTrioMom who was given Glycobalance for her cat Joe. She has been gradually switching him to lower carb food and his insulin needs are coming down.

Do you know what the name of the generic Walmart insulin is? How many times per day did the vet want you to give insulin. In my opinion, an insulin you already have in the fridge is much cheaper than a new one you have to buy. But I would ask the vet if there was another reason than cost for Humulin. It would be good to understand their thinking on that.

 

MY GOD!!!! They should NOT be waiting for clinical signs of ketones/DKA to test and not all kitties will have the "ketone" smell on their breath.

I don't know where your financial situation is, but my thought would be to have Jett at a 24 hour ER clinic where they actually know what they are doing. You have far too much on your plate to be dealing with the "treatment plan" they gave you. I am just infuriated at this clinic!!!

 

Just to add... either Humulin N or Novolin N would require more testing because they can hit harder and faster than Lantus. You are certainly not in a position to be able to do additional testing at this point.

 

Patti

If you have any of the test numbers from the vets can you put them into your spreadsheet. Thanks

 

Just fyi...Humulin N and Novolin N are the same, just manufactured by different companies. Walmart's 'generic' was Humulin N 3 years ago but they changed to generic = Novolin N since then. I imagine a lower contract wholesale cost. If I'm not mixing up cats, it's not a 24 hour facility so likely no insulin support or testing during the pm cycle. I wonder, are they concerned about giving the R near closing time so using N so there'll be longer, bit safer overnight cycle? Just throwing idea out....

HUGS and prayers continue...

 

Thank you! I have pages and pages of vet notes, so I have to sort through it all to input the BG #s. I will try to do that tonight. In the mean time, he is due a shot tonight in 30 minutes. I have 2.0 units of Humulin N for tonight and 2.0 units for tomorrow morning, and then I have to decide to get the new insulin or go back to Lantus.

 

Thank you so much for the hugs and prayers!! We need them! You are right that it was not a 24 hr clinic, so no overnight testing. I had the same thought - that the inability to test is why they did not use the R insulin. I'm guessing you can't switch back and forth between the two (R during the day and N at night). I'm at a complete loss on what to do. How can I spend thousands of dollars and not have any clue on the right insulin?!?!

 

The "R" insulin could certainly have been used during the day. It is a rapid acting insulin and wears off after about 3-4 hours. It does require frequent monitoring to make sure the glucose levels do not drop too low. Many people will take their kitty when first diagnosed into a vet clinic for several days and they use a combination of rapid and longer acting insulins to stabilze the glucose levels and then are sent home with a long acting insulin to use at home. The clinic obviously treated the pancreatitis, but did little to stabilize the glucose levels.

Does Jett still have the feeding tube or is he eating on his own now? I am still fuming about the fact that they did not test for ketones. It is a simple blood test that could easily have been done, especially with all the high numbers Jett is getting.

 

They COULD use both but I don't know if it would do as much good keeping numbers low during day while allowing them to be up higher at night. It would also sort of present a danger of multiple people mixing up insulin and dose.

Like Jill said above, one of those insulins would work better right now than Lantus. If they decided he could come home by how he was feeling a morning, they wouldn't want YOU shooting the R at home but you could use the N.

 

Certainly no one should use R at home unless they are VERY experienced and even then it is something to be very cautious about.

Lyressa...one problem with using the Novolin ( or Humulin) N is that Patti is not able to monitor much at all, because of other life situations and because N or H is a harsher, faster acting insulin than Lantus she would have no idea what would be happening during the cycle. I don't know what the right answer is, but I am still concerned with the lack of ketone testing.

 

I'm concerned about lack of ketone testing too - why are they being so wierd about that? It's not like it's time consuming, hard to do or even really expensive.

I agree Mary Ann that N isn't the target insulin, Lantus is much better but that would mean trying to refill the depot with him still in high numbers. Until he's eating again, I'm concerned the it would cause a setback in his healing. I'm not sure he should be coming home permanently yet either.

Patti, maybe home overnight then back in the mornings?

 

I agree with this Lyressa. But perhaps a different vet clinic, maybe a 24 hour one, in the eventuality that Jett may need some longer term care. I am so upset with the refusal to test for ketones. That is a given when a kitty is under intensive care at a clinic.

I don't know if Jett is eating totally on his own. Patti mentioned in her first post that they had put a feeding tube in but Jett was eating now.

 

Hi there PJ

were you provided with any instructions for home care ? Any medication for pain?

How does Jett appear to you now that he is back home?

Sending tons of vines your way.

 

I have no wisdom to add, but lots of healing thoughts going your way. Your husband and Jett both ill at the same time - that's a lot to deal with.

There are blood ketone meters which can check for ketones with a blood drop and glucose at the same time. The strips are more expensive than just glucose strips, but it's so easy to get a ketone check with them that I think it would be worth it. I've seen the NovaMax brand - I know there are others as well.

hugs, Patti! hang in there!

 

Hugs to you Patti..it sounds as if Jetts stay has added more to your plate of stress rather than lightened it..I am so sorry..

 

THANK YOU for helping me!! Jett has eaten this evening and has used the litter box #1 and #2. Jett's PMPS was 'hi' which was concerning. I gave the 2.0 units of Humulin N and then re-tested at +3 and BG was 294. Will test again in a few minutes at +4 to see if he is going down further. I hope not!!

 

+4 BG was 312, so I hope that means he is okay for the night. Thanks everyone for your help!

 

No words of advice from me but I just wanted to send you a heap of vines Patti as you have so much to deal with, and some extra prayers for strength at this very stressful time. I hope both your boys make a speedy recovery.

 

Patti, if you think you would be able to do it, you can test for ketones yourself. Go to a pharmacy and pick up some Ketostix (or their store brand if they have one - ask at the pharmacy counter if you can't find it). You just stick it in the urine stream and within a few seconds the pad will change color if ketones are present.

Sending you still more healing vines, for both your DH and for Jett, and many s.

 

Thank you, Tricia! I do have ketone strips, and I was able to get some urine on it. It didn't change colors after a few minutes, so I left it on the side of the sink. I came back a few hours later and the strip was purple, which means ketones. The directions say that the strip should indicate ketones within 40 seconds, so hopefully, an hour later is just how it dries over time!!

 

More prayers on their way to you from across the pond.




Mogs
.

 

As long as your ketone strips are not out of date and have been kept closed up in their bottle, the reading you initially got should be reasonably accurate. Most of them say results should be read at 15 seconds. I never looked at them hours later to see, but I can imagine that they probably dry to a darker color.

 

Patti - check it at exactly the time it says on the side of the ketone strip bottle for ACCURATE results. Leaving it a few hours later means NOTHING! None at the 40 seconds (most says 15 seconds) means NO KETONES!!!!

HUGS and HUGS! This is much better news.

 

Sending lots of prayers and thoughts of healing and comfort for you and your sick baby! I do agree that it is very odd that they did not test for ketones, especially as my kiddo has had two cases ofpretty severe DKA and has never had the acetone smell on his breath.. Hope he recuperates well and that you get some peace for yourself!

 

Love, love, love and healing thoughts to you and Jett. Thank goodness you have the wonderful, thoughtful, helpful souls on here who can help you by making these excellent suggestions. Hang in there. I hope everything is settling down for you guys.

 

As long as the strips aren't way past their expiration date and were stored properly, it sounds like a negative, which is great! How is he today?

 

Yes, be sure you check what the bottle says....most say read after 15 sec. I have noticed that the color starts to change rather quickly after much more than that meaning any reading over the test time limit is invalid.

Sending more vines and hope he's better today.

BTW! Do you mind taking the 911 down please? Thanks, Patty!

 

Sending vines.

Marilyn and Polly

 

Lots of vines on the way this evening. I hope that Jett and your DH will be doing better very soon.

s and scritches,

Ella & Rusty

 

Hi Tricia - Jett's appetite is great and he ate well this morning and evening. I have had 2 "hi" readings and one 593 on 2.0 units of Novolin N in the AM and PM today. I hate that his #s are so high and I'm not doing anything about it!!

 

So sorry about the BG buy yay that he is eating!
You will get the AbAg back in line, the important thing is that he is eating and doing so happily!
Tons of supportive vines going out to you....

 

Patti

Just a question about the Novolin N. I know this is what they were using when Jett was hospitalized at the vets. When you got the Novolin N was it a fresh unopened vial you purchased or did the vet clinic give you what was left over from the vial they were using? Just wanting to make sure the insulin has its full effect.