Need help - sick diabetic.

Long story short - my 14 yr old Ruby, who's been diabetic for over two years now, is one very sick little kitty with pancreatitis, UTI, possible kidney infection/kidney stone....and near as I can understand - may or may not have been starting hepatic lipidosis. She's been in/out of the ER and her regular vet from monday to wednesday.....thursday, she got admitted into the ER and stayed there for two nights for further testing and inpatient 24-hr therapy when outpatient IV's/therapy weren't working. While she was in, she developed high blood sodium levels - they got them down to high-normal, but cautioned me on additional sodium of SQ's, or even pedialyte or tuna juice. They want her to drink water.

~She got discharged back into my care last evening, and I'm nursing/babying her as best I can until I -either- have to take her back to the ER or get her into see one of her regular vets this week.....

She's still on the vetsulin.....long frustrating story...... the ER Clinic basically got her to eat whatever she'd eat, and that happened to be "dry junk food" - Deli Cat. They gave me a sliding dosing scale for the vetsulin based on bloodsugar vs. how much she eats, if at all, to use until a follow-up with her regular vet is scheduled...it's as follows:
<175 - no insulin
175-225 - 1 unit
225-325 - 2 units
>325 - 3 units *****if she doesn't eat and BG>225, give half of the recommended doses according to scale


I got her to eat about 3-4 kibble of the Deli Cat this morning, and a tsp or two of Purina kitten chow....she's turning her nose up at her previous high-pr/low carb foods she had been eatting prior to getting sick.

1. How high is a too high BG? Her BG this morning is 459.....and that's the highest it's ever been. I know alot of that has to do with this sugar laden crap she's eatting, but right now they tell me to worry less about "what" she;'s eatting - it's important that she eats. How high can it go before I start getting wiggy and take her back in?

2. She is arthritic and has been on meloxicam for the last three years. She has been off of it for a week now, and three days in a hospital cage has done one hell of a number of her arthritis. She's stiff, hurting and uncomfortable. I'm having a hard time distinguishing between that and the pain of pancreatitis. The hospital wants me to go easy on the bupronex, since it could slow down her gut and she hasn't had a bm since last monday..... Anyone have any good indicators how I can tell between the two, until I can get her in to talk with her vets about alternative arthritis relief?

3. I think I'm going to try syringe feeding some bland pureed chicken/broth to supplement with nutrition intake and I'm hoping the portein will help even out her blood sugar abit.....would I be complicating things by doing that?


Thank you.....this is tough.....trying to wade through just what I can take care of at home and when I should take her back in. All these vet visits, on top of being sick, are sure doing a number on her......last night, as soon as she got home, she hid in the closet and wouldn't let me touch her.....and she hasn't done that in years and years. She's finally settling down this morning and returning to her favorite sleeping places, and purring abit for me.

Lisa and Ruby

 

That should be fine. She needs to eat, last thing you need is HL and/or DKA in addition to what's going on. Just keep in mind the sodium caution, if you're using a commercial brand chicken broth. (((Ruby Kitty))) (((Lisa)))

 

Sorry to hear of your kitty's sickness. I'd check in with Yahoo's group, Feline Assisted Feeding. The cat needs to be on a antinausea med, antibiotics and pain med, as well as IVs, for the pancreatitis. Possibly a feeding tube if she won't eat to ward off lipidosis. God bless Miss Ruby. Donna

 

Thanks Donna and WCF -

Ruby was discharged with a script for compounded bupronex for pain/pancreatitis (which I can't get filled until tomorrow at the earliest), pepcid 1/4 tab twice a day, cerenia as needed for vomitting, baytril for kidney infection and UTI, and mirtazapine(sp?) to stim. appitite if anorexia reoccurs. I'd been alittle afraid to do much else on my own, that I might aggrevate things and make her worse or something......but ya know what? I got a grip and put my big girl panties on, and went with my gut...

She's not vomitting at all, today, so I made her some sodium free chicken/ broth, and syringe fed her a small amount (9cc) of that mid morning. Then I got bolder, added a small spoon of A/D to the pureed chicken/broth, and gave her a good 20 cc mid afternoon. By this evening, she's nibbling her dry food better - and she's back to her Royal Canin/Wellness....albeit a little here, a little there...but that's something.(I've got a small spread of dishes laid out with a variety of kibble/canned foods.....looks like a small buffet down there!) I also want to see her pee more, she's not pu/pd by any means, and although I see her drinking at her fountain, I started giving her 10cc water by syringe every few hours and when I have to give her medication.

Her am BG, this morning was 459 - I gave 3 units.
AT 4+, she'd dropped down to 189,
at 8+ she had climbed to 359 and I ran a bloodketone check - it was 0.2 - called ER, and since no clinical signs - the dr. thought perhaps it was just transient ketones, and wasn't real worried about it. I actually lucked out, totally, when I was able to slip a lid under her bum 1/2 hr later for a urine, and ran a keto-stix, it was between trace and 1+. THAT was the ultimate intrusion.....now she looks to see if I'm following before she climbs into her litter box.
at 12+, she was back to 459 and another bloodketone check was 0.1. Knowing that I had supplemented her food intake today, esp. with good protein, I took it upon myself to give her 3 1/2 units of vetsulin. I'm planning to check her BG/ketones one more time tonight -4+...(more if I have to) and still hit her with more chicken/broth/A/D/water via syringe at that time.

My poor babe has had it, for one day.....and I'm rather on her sh*t-list right now.....but she looks a lot better this evening. And boy did she perk up when I promised not to bother her anymore for a few hours. I really think her pain is from her arthritis....she's handling the food really well - no "meatloaf position" after eatting....but getting up and being able to walk around here at home has even eased that up....the stiffness, anyway. Baring no unforseen problems overnight, I actually think I can go to work tomorrow, and be ok with it.....have to see if I can get her in to see her vet tomorrow afternoon for follow-up.

Thanks again for being here.

Lisa and Ruby

 

Wowza.. what a crazy time for you both.. I have no advice to give other than you've got a zillion things going on and trying to balance an impossible stack of issues (and conflicting ones as well.. picky eating/need to eat/high bgs/etc.. from your description it sounds like you've got a pretty good handle on things.. so all I can really do is say it sounds like you really care about her and are giving her a fantastic shot to pull through.. it's really up to the powers that be at this point I think.

Many hugs.. Hope Ruby gets well soon! Also, don't forget.. you need to eat and sleep too!

 

Lisa, based on your first post, I was going to suggest AD, but see that you have that.

I am wondering about the vets might think it a good idea to shoot the Vetsulin more frequently than twice a day (BID). She's not getting a full 12 hours out of it and the 400s is a hard place to be. Just wondering whether they and you might feel comfortable shooting her PRN (maybe every 8-10 hours) when her BG level is in the 300s and on the rise?

Hugs to you and Ruby.

 

Hi,

My cat has pancreatitis...the doctor gives him prednisone for this. It does raise his BS, but I was having success getting it down by just giving more PZI (when I had it). That buprenorphine...I was given that once, but decided not to use it. The pred helps with the inflammation.

I dont agree with no insulin at 175. 175 is high, I would give what you find works at 175. Yes, he has to eat...give him anything he will eat at this point, and adjust the insulin according to what & how much he eats. This is torture, I know. This is my life too. I wish him well & peace for you.

 

Re: sick diabetic responses - question for tramadol users

Amy, Venita, and Dawn - Thank you so much! Ruby actually seems to be on the mend. She's eatting more and more on her own, and I haven't had to use the cerenia or the mirtazipine. She went yesterday to her regular vet clinic for a followup, and the pending urine culture came back clean, so she switched Ruby from Baytril to Orbax - much smaller pill and easier to take.

EH? - allowing her to graze all day and the supplemental syringe feeding is what makes it real tough right now. The vet actually praises numerous small meals throughout the day for pancreatitis cats, and doesn't want her stomach to be empty for any period of time....but the wonky pancrease and frequent meals make regulating all that much harder. Instead of injecting every 8 to 10 hrs, the vet kicked her vetsulin up to 4 units....warning me we will probably still be doing quite a bit of tweaking on her insulin in the days to come. Last evening her BG was 495, and I gave the 4. This morning her preshot BG was down to 350-something (can't remember the exact number right off the bat. - but I have never been so happy to see her in the 300's like I was this morning.)

The only thing.... when I mentioned my concern over Ruby's arthritis pain vs. pancreatitis pain - she suggested I not even get the bupronex filled and put Ruby on Tramadol 1/4 50 mg pill twice a day. I gave her the first dose last evening. Well, it worked - Ruby was loose as a goose and feeling REAL good.....but MAN was she tripp'in. It didn't make her groggy or sleepy - it made her high. She developed a slow tic and was doing the strangest things - staring at her paws like they weren't her's, watching things on one wall like a kitten - things only she could "see" - (and she's 3/4 blind). She went to get a drink from her water fountain? - and started rubbing her head all over the flowing water on the dome. I kept one ear open all night long just incase she decided to climb the artificial tree or decide she could fly, or something!

I kicked her back to 1/8 pill this morning, and have checked on her since to see what planet she's visiting "today".....no more tic, thank goodness.....she's awake, but resting comfortably in one of her beds listening to her music. Anyone who's using tramadol for their cat - have you run into any symptoms like this? Will they ease up and resolve over time with use? Ruby definitely needs pain management - of that there is no doubt - but I can't have my old gal thinking she can leap tall buildings in a single bound, either!

Lisa

 

Re: sick diabetic responses - question for tramadol users

Great news!!

Actually, I believe frequent meals is good for diabetics. Frequent small meals is what human diabetics do, and I have been doing it with my diabetics since about 2 months in. Serial feeding (as I call it) helped get Max OTJ, and helps to keep Ennis level on Levemir.

Oh, yes, Ennis tripped out on Tramadol. I don't know if the symptoms will resolve over time, because Ennis's use was brief--for dental pain after an extraction. For Tramadol, Jess and Earl (a vet tech) is my go-to person. You might want to PM her and invite her to this thread.

Best to you and Ruby.