Discussion in 'Feline Health - (The Main Forum)' started by christoph, Feb 5, 2015.
Retest BG every 2 hrs you think?
I think that will have to be the minimum if you can manage it. Then depending on if there is a drop and how fast it is happening then maybe more. Sorry. I would have various alarms set on your phone in case you fall asleep.
When would be a safe time for me to get about 3 hrs continuous sleep? Had 2 45 minute naps in 48hrs
I would dearly love to be able to say 'right now', Chris, but that's not the case...
It's going to be important to test over the next few hours. A test at +2 (2 hours after the shot) can often be a good indicator of what's going to happen in the rest of the cycle. If the blood glucose is dropping much at that point then it would mean that a closer eye needs to be kept (more frequent tests perhaps) in the following few hours.
After that, you may well be able to get some serious sleep.
I am so sorry you're going through this.
But you're doing a great job. And it was encouraging to see that the ketone level had dropped in the last test.
I don't know I am sorry. Usually the early part of the cycle is usually the best but you are in unknown territory at the moment. So straight after the shot. Then usually again after the peak has occurred but the trouble is you are dosing more than normal and hence not getting that rest.
How about taking a reading now and posting back the results? Where are we+1? If you get food into him as well then that will help hold up the level somewhat.
Edit to add please go with what Elizabeth says, she is much more experienced than I am.
That's not a bad idea. Would be good to know, if you're up to that, Chris?
As Sarah said, we're in unknown territory here.
Just took +2 BG 214. Shot was @ 3am test was 5am
Shooting on a TID schedule (or similar) can be really tough on a caregiver, especially so if you're still trying to work out the cat's response to insulin.
I shot Bertie on a TID schedule for a while, giving shots at 5am, 1pm, and 9pm.
And now a +2 of 214.
So, the insulin has started working and has dropped 54 points.
It's good to see a drop. But that amount of drop at that point might indicate that we're in for an active cycle (ie, that there may be quite a drop in the next few hours).
Let's see what the next test says, and that will give us some info about the rate of drop now that the insulin has started working.
So reconvene for a +4?
I'm having trouble understanding the calculations. So you ad 10 to the difference between the last 2 test numbers to get the drop rate?
No we are looking at the drop from one test to the next to see how fast he is dropping so Elizabeth just subtracted 214 (your +2 test) from 268 (the previous test taken just after the shot) and got 54. So in the last 2 hours poncho dropped 54 points. That indicates it might what they call an active cycle.
About 1.5 hrs from now....no +3 test needed?
I thought it was 258.....not a big deal I guess.
@Elizabeth and Bertie isn't online any more but I tend to think a +4 will be okay. You might need to step it up after that. Up to you ofcourse but at the moment I think it would be alright. Could you get some shut eye till then?
Sorry Sarah, I am here. (Just a bit slow!)
Yes, I agree with your advice.
(That initial drop wasn't as much as first thought)
BG +4 275 Had a forced meal Hills ad about 1 hr ago 10 ml syringe
So, a bit of rise at this point. (Maybe due to the food).
Maybe there'll be a drop a bit later. Let's see.
Well done, Chris.
Okay so in essence the same number again. I would get some more shut eye and do another test in 2 hours. Keep up with he food and sub q's though when you can.
Or as Elizabeth pointed out a slight rise, maybe food related
ok in 2 hrs BG test
Will feed/do fluids
To handle the more frequent shooting, just use 1 line per shot, start on the left, and grey out the unneeded part.
You'll need to adjust the date and put a note on the right that you're shooting TID / every 8 hours.
Right now, you're feeding higher carb food than was used at the vet for the curve attempts. That provides a buffer of safety against going too low. the ketones are going down.
@phlika29 and @christoph -
I don't think the Royal Canin Convalescence support food is available in the States (it's not on the US RC website product list and also a couple of us went hunting for a US supplier recently to help another member's kitty - we all came up empty.)
IDEXX recommended Abbot Healthcare's Clinicare liquid food in their pancreatitis treatment recommendations. Also, one of the members here recently recommended another liquid diet called Virbac (sp?) Rebound. I don't know whether the nutrition profile is right for a cat fighting ketones. Here are links to the nutrition info for both products. Maybe someone with ketone experience could look at them and give an opinion to Chris, please? I've included some basic info below for 'at a glance' convenience (Hills data sheet is difficult to interpret).
Abbot Clinicare Canine/Feline Liquid Food
Data sheet notes 25% calories from carbohydrates, Metabolizable Energy (ME) 1 kcal/ml (1065 kcal/kg)
Virbac Rebound Liquid Diet
ME 0.84 kcal/ml - low carb
Hills a/d Canned
ME 1151 kcal/kg (my calc is c. 17% calories from carbs based on their DM values)
I have a tid SS I can do for you and post it in your signature and also send it to you. It will make it easier for you to use and us to see what's happening. You can't see daily patterns dosing tid and putting it on separate lines.
BG 375 +7
Gave fluids will feed soon. Can his antibiotics affect glucose or insulin (clavamox, doxycycline)
I'd really appreciate that Marje and Gracie....Thank you!
If it is one of the antibiotics for kids that has sugar to mask the flavor, then yes, it can spike the glucose. Check the packaging.
I hope you managed to get a little bit of rest.
This is Clavamox liquid from powder made up at the vet clinic....I'll check the box. Not sure about the other....just a measured amount to go 10 days also from clinic
Thanks....a few hours so far not counting nodding out.
Next shot time approaching fast....right?
At times like this, Chris, any sleep is a gift. Rooting for you both.
You're quite right! Thanks, Critter Mom
I will have it set up within an hour.
So is the consensus to increase the dose in response to the higher numbers we have had during this cycle. As Chris has pointed out the 8 hr shot time is fast approaching and he will need some advice on what to dose.
What are people's opinions Chris is getting food into poncho.
Chris do you have another ketone test result? Have you given fluids?
I have given fluids.....hoping therefore to see him head for the litter box to pee. He's sleeping on the couch with my dogs instead of his usual sleeping area I set up for recovery....lights out....but now he has to eat before a shot. I wish there was a way he could just need 2 shots daily......maybe we can transition back to that after he's out of the woods.
The intent is to get the glucose under control so fat breakdown will cease and stop ketones from being formed. As the food is a recovery type product, it is higher carb; thus, the insulin dose needs to adjust to handle it.
After he stops throwing ketones, is back to eating low carb food on his own, shooting every 12 hours should be possible.
Yes I am sure you can but not just yet. I think you need him to be eating and drinking on his own, with no ketones before that happens. If you are going to get another test before his shot do it just before you feed him.
I really wish you could get hold of some anti nausea medication it would make feeding so much easier I am sure.
Can someone give an opinion on dosage. According to BJM suggested sliding scale it would be 1 unit. How does this sound to members? Or 0.75??
This is a draft of a sliding scale for dosing. Right now, it looks like pre-shot numbers
over 300 could get 1 unit,
250-300 could get 0.75 units.
200-250 could get 0.50 units, and
under 200 could get 0.25 units.
- this is just a draft/estimate.
Are you happy to go with this scale for the next dose? Going on your +7 result it looks like your next dose will be 1 unit unless your preshot dose is significantly different. We must be getting close to the next insulin dose time.
I'd like to do a pre shot test but I just fed him 10 ml Hills ad. I got a ketone test in and it's still moderate 40 but a tad lighter than the moderate color so they seem to be receding. Should I go ahead with pre shot test anyway....I'm ready to shoot asap.
Yes I guess so. Do it now.
I would think the one unit (from BJ's proposed sliding scale) sounds about right as long as Chris can continue to get the same food into Poncho as he's been doing.
The only question in my mind is about overlap. Even though the insulin in Poncho's system at the moment isn't enough to drop his BG currently, it may be sufficient to boost the next dose. (Even so that may still be OK if Chris feels up to dealing with any lower numbers should they arise...?)
BG 410 after small feeding. Gave 1 unit insulin.
Good job Chris. Now try to get some rest and retest in 2 hours.
I might even make it 3 hours.
Just in case what is the reading that warrants intervention for hypo and how much honey would I use on his gums? I'm going to feed him again soon and I'm not sure I got the amount of fluids so might give him a little more....his skin/fur makes it difficult to stick. I'm going to try trimming the fur so I can see better.
Wow, 3 hours rest, Chris. Luxury!
If he gets under 100 mg/dL, you'll want to start steering the numbers with food by feeding modest amounts of what you're giving now, which is medium carb.
If he gets under 50 mg/dL, you'll want to go with 1-2 teaspoons of high carb syrup (Karo) or gravy and checking every 30 minutes, repeating for as long as he stays low and its before +7.
So test BG @ +3? Will honey suffice if needed...it's all I have... and how much.....a teaspoon? I'm too jittery to sleep now. Going to feed him every hour.
Its all written up here: How to Handle a Hypo.
That is all I used to use. Honey mixed in his normal food. But don't panic we aren't anywhere near that yet.
For all helping Chris, I've done a tid dosing SS for him and have linked it so it is the first one you see. The bid dosing SS is the second tab if you need to look back at that one.
Chris - BREATHE! And another big slooow breath. Compared to what you've already gone through, a 'hypo number' isn't a big deal, it's just a low glucose number. There's no need to go into panic mode, it can be handled easily. All you need to do is get some 'sweet' into him just like a human diabetic eating a piece of candy when they feel weak and shaky. The panic part is when you don't anticipate it and suddenly have a dangerous situation on your hands. You're already prepared 'just in case' - you'll just be doing something different than what you've been doing. Rubbing honey on his gums is a LOT easier than giving those fluids!
BREATHE! HUGS too! You're doing AMAZING!
Another ketone test....somewhere between moderate 40 and small15.....maybe down to 25?
Thank you! I'm sure I can handle it fine.....I agree about the giving fluids....I hate sticking that big needle in. It got easier tho after I trimmed down his fur so I could see what I was doing. But he can feel it I think.
WONDERFUL!!! I know how good it feels when they start going away...been there, it's time to DANCE!!! You've almost pulled him out of a very critical period.
Just tested his BG 206@ +3
Is he dropping too fast? I'm going to syringe feed him again.
It seems okay to me but I would keep feeding him as you are doing. Am sure others will be able to advise on the drop. We want him in these lower numbers.
Syringing him some LC right now is fine. You might want to check him at +4 as long as the food has had at least 30 minutes in his system just to see the exact rate of the drop.
If there is any way on monday that your Vet (the one in St. Louis) could call in a potassium supplement and an anti-nausea med to a pharmacy, and give you dosing instructions this would help. His potassium is probably low at this point (due to insulin + diuresis + fluids) and usually supplementation is necessary for a day or two.
If he starts eating normally, you can forgo the suppliment. The anti-nausea will really be the magic bullet to allow you to get more sleep and allow him to want to eat on his own. If he's a dry food junkie, now is the time to leave a bowl out and see if he'll eat during the day.
You'll want to get some labs done pretty soon to see if there are any other issues going on and prevent a recurrence.
Also, when he is back to eating and feeling better, you might want to ask a vet about changing your insulin to lantus or levemir. These provide better protection from DKA in a cat such as yours, and won't send his blood sugar down so hard. These would be twice a day dosing.
Sarah, his last dose before the 1 unit was 0.5 unit right? I must have put 1 unit on my SS in error.....sleep deprived I guess. I'll go back through the
By LC do you mean low carb?
I think he'd be ok with that....or a mobile vet I use but he's hard to get ahold of. Thanks for the useful info. I'll put out a bowl of dry to see if it will help his appetite.
Christoph, what is the fluids you're giving him? I glanced thru the posts and just see 'subq fluids' but likely missed it. If it's 'lactated ringers solution', that will have potassium in it...
DANCE!!! WOOT WOOT!
Yes...lactated ringers. The right stuff?
Yes Chris before tonight you gave 0.5 units. Do we have a +4 yet?
That 182 is really nice. And the lowering of the ketones is really, really good.
BG +4 ....30 min after 10 ml Hills ad feeding.... reading was 182
On a reasonable track?
@Meya14 - since it's LRS, would he still need additional K supplementation?
Yep - has extra 'goodies' in it for his body! You've managed to do what a lot of vets swear can't be done outside a vet's office...You win the Mirror Ball 2015!
That's encouraging.....thanks BJM. He sure doesn't feel better it seems. Guess I'm impatient to get him back. Should I test every hour until 8pm (?dosing time?)?
I'd go for every 2 hours and just watch him. If you see something concerning - ex dilated eyes, vacant stare - then test.
He dropped only 21 mg/dL between +3 and +4.
So the next test is a +6.
Yes +4 BG 182 30 minutes after 10ml Hills ad
Yes, supplementation beyond the lactated ringers is usually needed at least until the oral intake improves. It's hard to say how much to supplement, however, because really this is something you'd track through labs. Too high is just as bad as too low, but right now, a little bit extra is going to support all the potassium his body is wasting.
That's great. It looks like the 1 unit is working well. I don't think you need to add dry food just keep going with the low carb wet and as BJM said retest in another 2 hours at +5 unless you see something that might indicate he is going low.
I don't think he will go low but just be aware of these symptoms. If you do get concerned don't forget you can always edit the title of the original post by going back to the first post and editing it. Again I don't thankyou will need to but just in case change it to today's date and put low blood glucose help needed.
Some cats may have NO symptoms whatsoever, but here are the most common ones:
Sudden ravenous hunger
Weak or lethargic
Trouble with vision... bumps into furniture
Poor coordination, such as staggering, walking in circles or acting drunk
Changes in head or neck movements
Behavioral changes, such as aggressiveness
Convulsions or seizures
You are doing great. It will be a while before Poncho begins to perk up so don't get disheartened. Just keep going with the fluids and the food.
I will leave you now as it time for my bed. Please look after yourself and get some sleep when you can. I am sure others will be about to keep an eye of you. I will see you in seven hours.
Just my opinion but I wouldn't suggest starting potassium supplementation until blood work can be done to find out that level. Too much can adversely affect the heart, too low will cause muscle weakness. I just wasn't sure how much K was in LRS.
Per Renal K (a dog cat/supplement) the dosage is 2mEq/10lbs given twice daily. Since the lactated ringers has potassium in it, less then this would probably be ok until he starts eating. It's hard to say without seeing labs, but listlessness is a sign of low K+ (and everything else going on).
There is a "naturemade potassium gluconate" over the counter supplement from walgreens (550mg - 90mg k elemental) that is about 2.3mEq per tablet. You could crush 1 tab a day and add to food.
The potassium in lactated ringers is lower than the potassium that is normally in the blood therefore, overtime of giving LRS, this will still lower the k+. In addition, diuresis and insulin lower k+. I feel it's safe to add a small amount of supplement for a couple days until he can get labs drawn. The likelihood and risks of low are outweighing high at this point, until he starts eating.
But how does that compare to mEQ - milliequivalents? That is a vet question as too much or too little potassium can affect the heart and interfere with its function ... fatally.
I've been looking in on this thread now and then, though I don't have anything I can add on dosing/food etc. But I would second BJM and Squeaky & KT on how tricky potassium dosing can be. Our CKD kitty is on potassium every day plus lactated ringers twice a week. The potassium pills come with very strict dosing instructions - including timing of doses to make sure she's not in overdose even for an hour because of how dangerous it would be. We use Tumil-K on prescription from the vet. Although we buy the pills in bulk and therefore they look quite expensive per batch, I don't think the price per pill is all that high overall. I'd be inclined to ask your vet for bloodwork and a prescription rather than take any risk of giving too much.
Each tab of the OTC mentioned above is 2.3mEq. I agree with the comments regarding safety, but that's why I'm bringing it up. Everything we are telling him to do is going to drive him low. Labs do need to be done. 1-2 days of k+ supplement is not going to raise him that much, until he can get labs drawn.
yeah no more than 1 per day. I wouldn't do it more than a couple days (blindly) without seeing a lab. However, he may be verging on heart-attack territory from being low, and this needs to be addressed.
Chris, can the mobile vet draw labs?
With the BS and ketones decreasing, he really should start to perk up and not be as listless. I suspect if he remains listless it's an electrolyte imbalance (and probably not sodium as cat food has plenty).
guys, let's be careful about crossing the line between helping a caregiver of a diabetic cat and giving medical advice. We are not veterinarians and can only responsibly do so much.
BG @ +6 160
Aren't electrolytes in sub q fluids? He is still getting over an upper respiratory illness and has 5 days to go on the antibiotics Clavamox and Doxycycline. That illness was full blown when they tried the curves unsuccessfully. I'm sure the mobile vet can draw labs....it might take a couple days to have him call me back.
A drop of 22 in 2 hours; slowing down. A nice safe blue number.
Is this good? Getting ready to bounce?
Come up, probably; bounce, maybe. Keep in mind you are feeding a medium carb food which will push the numbers up a bit faster. It also lets us give enough insulin to help prevent the ketones.
I can't hope to catch up with almost 300 posts.
But I will say this, because my cat was DKA, and he got potassium supplements for weeks due to low K levels in his blood work.
Excessive potassium can kill a cat.
NOBODY HERE is a licensed vet.
NOBODY HERE is qualified to advise that you give your cat potassium.
You should not give potassium until your vet tells you to, and it has been verified BY YOUR VET that potassium is indicated.
After that, you will need to bring the cat back in for blood work so that his potassium can be monitored to keep it within the normal range. Too high is just as bad, or worse, than too low.
Telling a caregiver that "I feel it's safe", or " X amount should be okay" doesn't cut it. Not unless you are ready to take personal responsibility for the life of their cat, or plan on covering the vet costs for "bad" advice.
Full body extreme weakness will occur before that point is reached...he's not near that point so let's not scare Christoph. Unfortunately I know way more about the effects of potassium in the body than I EVER desired to know...hubby has 'hypokalemic periodic paralysis'. Our lives revolve around potassium...
Yes electrolytes are in Lactated Ringers fluids. Potassium levels are included in about every blood test.
Sorry, I guess I'm jumping the gun on all this/thinking aloud too much in my previous posts. I guess my point is - the potassium is likely pretty low with everything going on, this could be very serious, get labs ASAP.
Chris, I just want to add a little moral support. You sound tired and you're getting a lot of advice right now. I would find it overwhelming.
Please continue to work closely with your vet - whichever one will work with you, to help pull Poncho through this. I would continue testing a couple of times a day for ketones as well.
Bob suffered from full body muscle weakness due to hypokalemia. Can't hyperkalemia also lead to a heart attack at some point?
@Carl & Polly Hypokalemia is low potassium. It begins with general muscle weakness and moves to full body muscle weakness involving all the skeletal muscles. Altho' the heart is a muscle, it is not affected nearly as quickly as the skeletal muscles. The muscles supporting breathing are also not affected as quickly altho' it can cause shallow breaths due to weak diaphragm muscles. The body is basically flacid and skeletal muscles unable to contract before the heart muscles begin weakening. The heart won't beat as fast but there are many signs that something is very seriously wrong before the heart muscle becomes weak enough to quit.
Hyperkalemia, high potassium, does quickly affect the heart by causing the heart to race and blood pressure to be extreme fairly quickly. The more potassium given when high, the harder the heart beats until it can't stand the force and stops.
Potassium is the main ingredient in lethal injections used for the death penalty.
Boy I couldn't agree more with this statement. It's one thing to give fluids with potassium under a vet's orders; there's not enough potassium to generally do harm in the fluids. Supplementation with potassium absolutely must be done under a vet's supervision with close monitoring.
I need to do Ponchos +8 BG test. I will post and want some input as to insulin dose. Still using the scale and is it based on 8 hour doses? Thanks.
Still using the scale; for now, it can be used with any time frame. We're still learning what works for Poncho.
When do we get to see a picture of sweet Poncho?
BG @ +8 1/2 is 370......fed at 7pm which was very stressful as usual .....it really jumped. Do I give 1 unit?
Yes. It looks like it could be safe. Checking about +4 should let you grab a nap of 3 hours.
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