Melissa and Sassy

I know some of you have been watching Melissa's other thread. She is asking if she should give insulin. Sassy was at 95 this morning, so no shot. She is at 250 now.

 

And since Sassy is not eating, it is just the diabetes that is making the BG go up?

 

I just don't know what other advice to give!

 

Did she have any ketones, Rhonda?

 

I don't know yet. Melissa's phone was dying. Will try her BF.

 

@BJM - BJ are you on the board? Any chance you could weigh in on this thread, please?

 

She is not aware of any ketones.

 

@Wendy&Neko , @Ella & Rusty & Stu(GA) any chance you could add any advice? I'm out of my league here.

 

A thought: 250 on a human meter is above the renal threshold. Glucose spillover is going to put the kidneys under more pressure.

@Meya14 - Are you online at the moment? Could you look at this thread please if you are (Melissa and Sassy's new 911 thread).

 

She is thinking a half dose.

 

I don't have enough experience to know what to suggest. All I have is an opinion that some insulin is better than none right now.

 

Inflammation/infection/pain can also increase the numbers, as can stress. I had a civie register over 220 at the vet and 53 at home the next day.

Will she be able to assist feed and get any food in Sassy tonight? Will she be able to test her?

 

She is able to test for a period of time, but she has to be at work at 5:30 am, and she is going to try the assist feed.

 

I just got a copy of the invoice, but no test results. They gave her a Convenia injection.

 

From what testing I can see on Sassy's SS, the 2.0 units is too much insulin. Do you know if she got any insulin yesterday at all or how much? There is a 95 listed on a test last night too. Sorry to be asking so many questions.

 

Did she manage to test the night before last? That data - if available - would help.


ETA - Ignore the above. Just saw the spreadsheet link. (Thanks, Wendy.)

 

I don't think Sassy has had any insulin for at least 24 hours. And I feel absolutely horrible for this, but I have got to get some sleep. Long night last night, long day today and longer tomorrow. I am keeping my phone with me, and will post any updates that I get. I will check on the shot.

 

Her last shot was Sunday night.

 

If she can't test much after any shot, we don't know how much food she can get in her, she can't post here for help, and green numbers possibly 24 and 36 hours after her last shot, I wouldn't shoot - provided there are no ketones.

 

Need to feed my furry child. Will check back when done.

Just a thought: it did take Sassy a fair bit of time to climb back up to tonight's PS level.

 

My concern with not trying to lower the BG even a fraction is the concern about Sassy being over the renal threshold and that putting a further strain on her beleagured kidneys.

 

As far as I know, there were no tests in between, so I don't know.

 

Back as soon as I can ... must feed my girl and give her her meds.

 

If Melissa can test for at least 4 hours after the shot and is pretty sure she can get some food in her, then I'd try for somewhere between 0.5 and 1.0 unit. Has she gotten any food into her?

 

I have sent the link to this thread to Melissa. Unfortunately, I have to go to bed. But I will keep checking as I can.

 

No luck with the food last I heard.

 

Melissa is looking over the posts now. Hopefully she can some more info.

 

Thanks for the update again, Rhonda. Hope you get some decent rest.

I can stay for a little while but not much longer. @Wendy&Neko - are you able to keep watch?

 

Giving 0.5 units may nudge the glucose down and help trigger some appetite.

 

Unforunately, I get up at 530 am, out the door within an hour and a half, I drive 45 minutes to work.
Reminder, I am in a rural community and there is nothing that is close to me.
I work until 530 pm and have another 45 minute drive home. I stopped at the store for baby food after work.
I have had about 9 1/2 hours of sleep in the last two days combined and all on top of starting a new job.
I am doing what I can, but I can't test her frequently throughout the day if I am not here.
My fiance is keeping an eye one her but has no knowledge of testing her, shooting her or any of her medical care.
We have both tried to force feed, we have tried many foods, grinding, chopping, you name it.
Her only interest is in water. But she is not always keeping that down.
I have decided to give her a half dose, at this point it cannot hurt her.
My decision is based on the fact that she is already suffering and in pain and she is going into renal failure.
Her elevated BG will only make all that worse.
I need to get rest. I will update with her numbers on the spreadsheet in the morning, that is the best I can do that early in the a.m.
Thank you for all your support, prayers and well wishes.

 

(((Melissa)))

I feel for you.

If you could manage it, getting some Pepcid AC or Zantac 75 might help Sassy with the stomach acid. Cerenia might help her with the vomiting if you were able to get hold of some and that might help her with drinking and maybe eating a little. Any fluids she can hold down might hydrate her a bit and make her a bit more comfortable.

If you have any lab test results from the vet visit it would be great to know a bit more when you're able to post again. Also, does her breath smell of urine/ammonia at all?


ETA - I hope you manage to get some bit of rest.
.

 

Can you teach your fiance to test? I know this is all less than ideal, but if he could learn it quickly and can keep an eye on her for you while you're at work (and maybe for a bit tonight too so you can sleep) it would surely help. I know my hubby got the testing at his very first attempt - you never know, he might find it easy to do.

Our CRF girl, Shadow, has been in crisis with renal failure twice (once when she was first diagnosed and a second time when she needed more medication but it wasn't identified as a problem quickly enough). Although Sassy no doubt feels pretty rough right now, Shadow is 19 - she's been CRF for 3 years (diagnosed at stage 3, so she must have had it longer than that overall) and pulled through beautifully both times. She's now a happy, although very obviously senior kitty. Never give up - renal problems can make them feel horrible, but they also recover quickly once they get leveled out.

I would agree with the Pepcid AC. And if you have a copy of the blood work results, those would really help too.

 

I've got to take a sleeping tablet and try to sleep (tired/wired brain & body is shattered). I'll check back when I wake.

Hoping Sassy has as comfortable a night as possible and that the insulin might trigger a little interest in food (and that she can keep something down).

 

I just got home, and saw this new thread. I would have given the insulin as well, how much depends on the current situation with BS and eating and monitoring, so I feel like it's dose-by-dose.

There are two types of renal failure. Acute renal failure is a temporary issue that can occur from infection, dehydration, DKA, or other issue that causes decreased blood volume to the kidneys. Treatment for ARF is supportive IV or subQ fluids to maintain the blood pressure/hydration so kidneys can recover. Some permanent damage happens with ARF, but a (mostly) full recovery is possible once out of the acute phase. Lack of insulin will not allow the organs to work properly, so insulin supports recovery.

Chronic renal failure is usually a slow process, but can be a cause of ARF. Others here probably know more about treatment of CKD and crisis.

I think at this point what I would do:
- Keep giving insulin. Use small amounts of honey on the inner cheek every couple hours to keep blood sugars up so you can give insulin. Sugars can absorb right through the gums if she's not swallowing. Careful not too much at a time in the mouth if she's not swallowing.
- Keep trying to feed. Any little bit is good. If she's still drinking water, then mix either wet or dry food into the water to make soup.
- Ask the vet if you can give SubQ fluids at home and how much to give. A bag and set is around $20. They are pretty easy to give.
- Get some anti-nausea meds. This makes all the difference sometimes.


Praying for your baby.

 

The renal failure I know - better than I'd like to with Shadow, and now Rosa just confirmed as diagnosed in the early stages of CKD today. I would agree with giving small doses of insulin - you really want to keep Sassy under the renal threshold so that there isn't any more pressure on a system that's already struggling. I know less about acute renal failure, but I believe the treatment is generally the same as for a crisis in a CKD cat (or at least that's what was done with Shadow when she was in crisis).

SubQ fluids should really help - while her kidneys are in crisis, she can't concentrate urine so she'll dehydrate without being given fluids. The recommendation is usually hospitalization and IV fluids, but when you want Sassy at home with you, SubQ can be done instead. Depending on her blood results, she might also need supplementation of one mineral or another - with our Shadow, it's always potassium that she's low on but that can vary depending on the cat although low potassium is a fairly common problem for kidney kitties.

Food is really important. Even if you have to syringe baby food - or anything you can mix with water to help with her hydration levels too. We haven't had to do anti-nausea meds with Shadow - she does get Pepcid AC, but that's to stop the possibility of the potassium she's on upsetting her stomach, not because it's already happened. But if you want a gentle option, the Pepcid AC can be given long term and is easy and not too expensive to buy.

 

Has anyone given you the link for assist feeding?

 

Thinking of you all ...

 

Just a quick post, she is more alert this morning, took a nibble at the baby food, and has been getting up to drink water on her own.
She was at 286 and I give shot her this morning. I am taking it day by day. I was in bed by 10pm and back up at 5:30 so a little more sleep than I have been getting.
Unfortunately the vets office has not given me much at all. No test information, (what they tested for or the results).
Not real happy with her care there, probably will not go back.

 

Yeah, sounds like it's time to go vet shopping... A good, caring vet will happily give all of the information you need to be able to give your fur baby the best possible care. BJM has some good tips for interviewing a new vet.

 

The vet interview topics are in my signature link and were compiled from many of the questions members suggested asking the vet when looking for a new one (credit where credit is due and all!).

 

Low potassium could contribute to severe lethargy and could hinder eating. There have been some people who have used plain pedialyte, the one without sweetener and without artificial sweetener, to support the electrolytes until tests can be done to check for the need for supplements. Also, if you haven't, call your vet if you can, and ask if the test results showed a low potassium and if your should supplement. The pills can be crushed and added to the food you are syringing.

 

Thank you for updating us, Melissa. I'm glad you managed to get some bit of rest - you have so very much on your plate.

I was heartened to hear that Sassy was nibbling at some food. If you could manage to get some Pepcid AC or Zantac 75 for her today, maybe that might help her a little. I wish I was nearer to you so that I could get some to you. Also Meya's suggestion about unsweetened Pedialyte is maybe something you could find today. Tanya's Site recommend that, too, but they don't give any guidance on dosage (they say to discuss with a vet). Maybe someone here might be able to give you an idea about using it.

@Meya14 , @manxcat419 - Would some B12 supplement mixed into Sassy's food help? I know from Saoirse that it helped her to eat.

Sending positive vibes to little Sassy...

.

 

I use unflavored Pedialyte when my cats are dehydrated/vomiting/not eating. It doesn't take the place of subQ fluids but can assist with the lethargy and low electrolytes/potassium. I was never given a set dose; the vet instructed me to give as needed. You'd want to give it throughout the day, as much as Sassy can tolerate but you also want to be sure Sassy is eating as well. You can find Pedialyte in the baby food aisle at any store. I stock up on it for emergencies.

 

If you are going to call the vet, I would start writing all the questions down and then ask away. I would make sure that they answer all your questions. One of the questions would be giving Pedialyte and how much. I think that is a great suggestion. I recently had to give my 31 year old horse electrolytes daily and it has made a world of difference. At least have the vet send you in the mail all of your test results and Sassy's records. They are yours and should have it all in your possession especially if you are going vet shopping after this has all settled down. If you request it tomorrow, you should get it the next day being so close. Maybe they can scan and send via email or even fax the test results to maybe at your work. But be sure to get all her records too. Other questions may be performing SubQ fluids at home, what CRF stage, potassium level, etc.

So glad that Sassy had a little to eat last night. What baby food did you end up getting Sassy to eat? Just curious as I think I am going to get a jar of it (just in case).

Melissa, you are doing great. I can't imagine all this happening while starting a new job. My prayers go out to both of you. Be sure to take care of yourself so you can take care of Sassy.

 

Hugs to you and Sassy, Melissa. I've been thinking about you during this very difficult time. Hang in there. You are doing a great job of taking care of Sassy.

 

This is very good news!! Sending good, healing thoughts for Sassy. Sorry to hear the vet wasn't more helpful.

 

Great news that Sassy started to eat a little. I noticed that you shot the full 2.0 units today. On the night of July 20th, you shot 2.0 units and she was 46 the next morning. That earned her a reduction. You might want to try reducing her regular dose a little, down to 1.75 units or maybe 1.5 units. Let's see how she does today.

 

@Merlin I have baby food in the house for giving things like probiotics and Viralys and "just in cases". I get turkey or chicken only with nothing else in it. It's pretty easy to find in the baby food aisle of any grocery store. I try to pick the one that has the least salt. I have learned that the cat won't eat it if it's been open for longer than about 4 days.

 

I guess it might - we've never used it, but anything that's helped another cat is worth a try. I can't imagine it doing any harm since diabetics tend to be a little low in B12 anyway.

 

S

Sounds good to me, shoot me those questions, it certainly can't hurt

 

Ok, another day at the new job done and I am pleased to report that my fiance Bill has been doing his best to monitor Sassy and try and get her to eat.
He decided to dilute the baby food, since she was having no problem wanting to drink.
She ate about 2 teaspoons of food diluted today. Her number this evening after shooting her this morning is 108, no shot tonight.
Going to keep trying that, she is still lethargic but she is more alert and responsive, she responses to me when I talk to her.
Breathing a sigh of relief, this is the best news for me to come home to.
Thank you for all your ideas, researching and most of all prayers and support. We need all we can get right now.
I will rest again before I go to bed and report her numbers and if she has eaten more.

 

Oh BTW, I saw the posts about Pedialyte, I will stop tomorrow on my way home and grab some from the store. I wish I had been able to see the posts before I headed home from work.

 

@mfrancis69, so glad to hear she's showing some interest in water and food!

@Merlin, I get plain chicken with chicken broth baby food. No veggies or garlic or onions. I always have a jar on hand in case of emergencies.

 

I'm so happy to hear that Sassy is feeling a little better and has managed to eat something. That really is good news and must have made your day a whole lot better when you got home to hear about her progress!

 

Melissa, I am so happy to hear that Sassy is doing better! That's great, and you should be proud of yourself and Bill!

 

Yes, do get the pedialyte. I suggest getting several.

 

I am wondering if there's a high calorie nutritional supplement like Nutri-Cal but without the sugars (corn syryup, molasses, etc) that Melissa could get tomorrow to feed Sassy.

 

So glad to hear that Sassy is responding when you talk to her & starting to eat! Keeping fingers & paws crossed for you ...

 

Feeding frequent small meals of kitten food (higher protein and fat for growth), like Fancy Feast Kitten Turkey & Giblet may help

 

She will not touch her cat food at all no matter how we make it.
She did eat a little more baby food (diluted). And she is drinking water on her own.
One thing that I did forget to mention, her breathing does not sound labored anymore.
She has the normal motor running, and still is responding to us talking to her.
Another day down, tomorrow's another day.
Goodnight all, and thank you for all your support, it really is appreciated.

 

Will she eat any dry food/treats? Some cats find these more tempting. Keep making kitty soup if that's what she'll drink. Its some calories at least. When max was very sick, I put dry food in his water and mashed it all up and he was able to drink that.

 

That's a really heartening update, Melissa.

Baby food's good news. If you can warm up the baby food/water slurry a little that might help. Maybe dilute the food with some warmed water, perhaps? (Not tried this method, but when Saoirse's a bit queasy warming the food seems to make it more appealing to her.)

Remember to pick up some Pepcid AC or Zantac 75 and maybe a cat-friendly B12 supplement (Vitacost?) when you're getting the Pedialyte.

Wishing you a peaceful and refreshing sleep.



ETA: Now that she's drinking under her own steam it may make it easier for her to get the Pedialyte down easily when you get it to her.
.

 

Hi Melissa,

Just checking in to see how things are with yourself and Sassy.

.

 

She will not touch her cat food or any treats. The diluted baby food was working yesterday. Today not so much.
It warmed my heart and gave me hope nut last night she climbed into bed with me to snuggle, a normal bedtime ritual.
She snuggles up like a child and I wrap my arm around her, she nuzzles my arm and touches my face.
Today no on the baby food. After Bill tried many things to get her to eat, he found a can of Newman's Own dog food in the back of the cabinet, and she ate it, at least some of it.
He didn't dilute it either, all good signs though.
Her number was high tonight at 315, after a morning shot but I attribute that to the fact her was trying any kind of food he could think of to get her to eat.
I gave her an evening shot and she is resting comfortably on my bed, waiting to snuggle at bedtime again.

 

Love the snuggles. And at least she at something!

 

Delighted to hear Sassy's snuggling with you and doing some 'Sassy things'. What a lovely image of her reaching out to touch your face.

How is she behaving around the food? Did you manage to get her some Pepcid? (I don't mean to sound like a scratched record, but I think it might help her with eating.)
.

 

I'm so glad to hear she ate some food. Dog food may not be nutritionally complete for a cat, but it's food, and she needs food in her.

 

Whatever she can eat, that's what is important right now. I think Nutri-cal for cats or something similar would be worth a try. It is high in carbs but it also has vitamins and is a high calorie supplement. I have used Nutri-cal when my cats aren't eating and are ill to "jump start" them again. Just don't give too much if CKD is involved because of the high level of Vitamin A in it. But right now, she needs whatever nutrition she can get in.

 

Hi Melissa. Thinking of you and Sassy.

 

Just talked to Melissa. She got Sassy to eat some dry food today, but no go on the baby food, dog food, etc. Turned her nose up at the Pedialyte, so I suggested mixing 1/4 to 3/4 with water, since Sassy is still drinking.

 

Thanks so much for the update, Rhonda. Great to hear the little one's still hanging in there. Did Melissa get anywhere with the Pepcid?

 

Maybe try a new jar of baby food. My cat won't touch it if it's older than about 4 days??

 

Just heard from Melissa. Sassy is hanging in there. She has gotten some Pepcid and crossing fingers!

 

Happy happy joy joy!


I'm praying very hard that it will help little Sassy. Thank you so much for keeping us updated, Rhonda.
.

 

Aine, I just had vision of Ren and Stimpy running through my head.

 

Encouraging news!

 

Luvvit!

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Hello Everyone, Sorry I have been off the grid for a few days. Thank you to Rhonda who has kept you update to date somewhat on everything that is happening.
Sassy is still alert, responses and still wants to climb into bed and cuddle with me. Not sure if the Pepcid was helping much, she still wasn't really eating anything.
Pedialyte failed, even diluting it she wouldn't touch the water if anything was in it, it is flavorless and odorless, not sure how she knows. So, I switched her back to water. Now she is drinking again.
Her sugar levels have been extreme high or extreme low. So not sure what is happening there. Just shooting as neccesary.
On a good note I got her to eat some canned dog food today. You can tell the things I bring her she has an interest in but then she turns up her nose and won't eat.
But she did eat some on her own even and I plan on giving her some fresh this evening for dinner. I still need to test her for the evening, and get dinner going for us.
Thanks for all your support and prayers.
Oh, also before I forget I found a vet close to my new job and have an appt to drop her off Monday morning, maybe we can find out what might be really happening.
I applied for Care Credit and with poor income over the last few years, I was declined. We will have to see what happens, they won't take payments either.
But after reading about the vet, I have a good feeling. Fingers crossed.

 

Very happy to hear about the new vet and Sassy eating and drinking whatever she can. Will continue to keep fingers and paws crossed.

 

What Cat Ma said.

Rooting for you both. Assuming they're not contraindicated, push for anti-nausea meds with the new vet.

 

Well, one thing I liked about this vet is she doesn't push prescriptions. She also does some holistic treatment as well. Maybe without spending a fortune on meds, she can recommend things I can give her I already have.

 

I second the anti-nausea meds. I used Ondansetron which you can get at Costco (without a membership) pretty cheaply (like $0.33 a pill) and I used to give 1/4 pill twice a day, but it depends on the cat. I'm so glad you found a vet you might like, and I wish you The Best Of Luck with them.
The next time you get a 27, please test again in like 15 minutes to make sure she hasn't gone lower. 2 units is too much, obviously.

 

I second Dyana on a dose reduction. 2 units is way too much insulin. You want to find a dose you can shoot every 12 hours and the dose is based on the nadir, or low point, not the preshot numbers. It's hard to tell with the skipped shots, but even the 1.0 unit got her two low. How about trying something like 0.5 units?

Good luck with the new vet.

 

Melissa, I just looked at your SS again, and noticed you don't have a Preshot column?

 

Thanks for keeping us updated, Melissa - we're sending you some AZ sunshine + healing vibes for Sassy. Hoping your experience with the new vet is a good one!

 

I hope the new vet can help with Sassy. On a side note, this thread caught my attention because my sister's name is Melissa and her cat is named Sassy.

 

Hear, hear!
.

 

Small world

 

Melissa, you are up early. How are y'all doing? And I see notes from last night, that we have appetite?????

 

Ok, this week has been a busy one, but we are making progress.
Maybe the Pepcid helped but it took longer because WE HAVE APPETITE !!!! YEAH !!!
She is not eating a lot but she is eating, she nibbles on the canned dog food,
last night I changed her back to her canned food to see if we could ease her back into eating her normal diet, she ate some of that as well.
I am only giving her about a tablespoon at a time, so it doesn't go to waste but she eats most of it.
And during my quest to find something she would eat, I bought some dry cat food, what I used to feed her before she was diabetic, she ate almost a whole bowl,
again, not a large amount but what I gave her was almost gone when I got home from work yesterday.
Now I have to get her sugar back under control. I have only need to shoot her once a day because she is either off the charts or way too low.
I sure it has something to do with the food, but I am going to adjust the does today and see what happens.
Her vet visit is Monday, fingers crossed that this is the vet I need to dive deeper into what is going on.
I still think it is a parathyroid issue. But after mentioning that to the vet no one has tested that yet, go figure.

As for the pre-shot column, I got out of the habit of using it because I was offline so long that when I started recording again,I wasn't putting it in that spot.
I always test before a shot, and usually never test right after, waiting maybe at least an hour or two before testing again.
It is easier for me to track when I test the way I have it set up. I like knowing time frames etc.

 

My new work schedule gets me up early now, and it is hard to sleep in when I don't have to get up.

 

Did you get the test results from the ER vet?

 

Sassy is definitely more herself, I have had her confined to my room to keep the stress of the dogs and household day to away.
Before she would lift her head and meow but not much else. Yesterday, I came home from work and opened the door, she meowed and came running to me.
She is still weak, and wobbles a little but was happy to see me and wanted me to come in and spend some time with her.
I took her out int the livingroom, thinking she night want a little socialization, but only to sit her on my lap to watch some TV, she jumped down and wanted to go back to the room.
I guess not quite ready for all the commotion the dogs bring to the table.

 

Yes they finally came in the mail, but never got the emailed copy. At least I have what I need for her visit on Monday.

 

Good. And I don't think I realized that you have dogs. I know you mentioned the dog food, but I never put it together. Who else do you have in your household? Inquiring minds want to know!

 

Sassy is the only cat and she is 16, we have a Maltese Chihuahua mix (Raider), she is going to be 19 this winter, and we have
a mischievous 3 1/2 year old German Shepherd, Shadow.
He is smart and protective, but always wants to play. He is like have a 2 year old in the house going through all of the curious stages and rebelliousness.
They all get along great. Sassy and Raider became family to each other 9 years ago and them being close to the same height the would play and chase each other.
Sassy has grown up around a dog in my previous marriage, they were the same age and grew up together, they were best of friends, so dogs don't bother her at all. She keep them in their place.
Shadow, although beautiful and extremely smart, he is our wrecking ball and only male pet. He is not fixed yet, maybe after that happens he will mellow a little.
He is gentle with Sassy and Raider, and they are all our fur babies, that we love like our children.

 

Houston, we have an eating kitty! Yessssssssss!!!



What a wonderful SITREP, Melissa! And such a relief. I hope you're doing OK yourself. The tone of your posts sounds so much brighter.

I enjoyed hearing about your furry family. Scritches and fusses all round.


Mogs
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Thank you, Yes, much less stressed, and hopeful that the new vet will shed some light on the drastic changes she has been going through.

 

I'm very glad to hear that, Melissa. Fingers and paws crossed that the new vet will be able to sort things out. You've done a wonderful job caring for your precious girl - and in such stressful circumstances: starting a new job is always a challenging time.