Seeing progress. Hopeful cat dad

Hello, new member here. My name is Aaron and Jasper is a white and grey British shorthair (10yo.) Thank you in advance because I was up stressing last night learning and reading and this seems like an amazing community already and one that I wish I had found sooner. Back in about January he was diagnosed, went in with I think a 620. Was put on basaglar at first (2 units am/pm) and then I switched to lantus somewhere mid way through. I've used the pen the whole time (aside from times syringing the last from the pen or random times running out of tips.) He eats royal canin glycobalance dry (which has always felt not quite right and not to mention soo expensive. I know you guys won't like that lol but that's for another time) I'll probably miss something detail wise but I'll try my best, I'm just mentally exhausted.

Jasper has been in the hospital for a day and a half now with fluids and insulin because he had a spike (high 600) After countless variables I figured out that my pens mechanism wasn't depressing, and I can imagine it was that way for two or three days (guessing.) It could also be "bad" as there's no way to test it as far as I've found. Also, I was never aware of "priming," thus overlooking an important step, in hindsight. Anyway, the vets have been bringing him down with novolin, because I wanted to eliminate my pen as a variable and he is doing better. My overall question among many is, should I go back to lantus right now at this moment. Not as like an ideal thing, I know it's the better insulin. But has his "shed" worn down over this and he will climb again when I bring him home and continue with lantus?(new pen) That's my biggest worry and I'm apprehensive because I know insulin isn't to be messed around with lightly (that's the reason I'm in this situation.) I can tell the group stresses lantus but don't know if I should continue novo being a fast or back to lantus being a slow. Any thoughts/ suggestions would be very helpful and thank you

 

Welcome. Longer-lasting insulins are the better choice overall.

Do you know you can use syringes and pull the insulin from the pen? This allows you to give doses that are not in whole unit increments - which is often needed with cats - and you do not have to prime. It would be easier to see that the shot has worked.. no more worrying about the pen's mechanism. Also, I understand that you are not supposed to refrigerate pens if you are attaching needles to them and using them that way since it can mess up the mechanism; however, if you are just using the pen like a vial, you can refrigerate it which could extend the life of it.

 

Update.. Jasper is home for tonight. Will likely be a very rough one for me. Vet suggested taking him to a 24 hour so he could be monitored but I just quite simply have no way to afford it. I sincerely hope not to be one of the ones on your forum that was misdiagnosed from the start and have a fatality only because he mentioned the possibility of euthanasia to me he seems far better than when he went in (no more eyelids, less stumbly) but he still won't eat. I'm getting ready to force feed a cat. I'll post numbers below if it will help anyone. Also, if this is in the wrong section of this website can someone please notify me? Thank you from a worried, withering fur parent.

 

You are in the right place. So sorry you’re going through this! I have no experience with DKA but you are certainly right to be concerned.

You might want to add ‘DKA’ to your thread title and make it a 911 to get some more experienced eyes on this. Did they give you any at home instructions?

 

Thank you for your concern and help. Make it a 911? He said he needs to eat tonight with no insulin (I just forced half of a can/broth, hopefully no puking. Will finish in a few) and he needs to eat in the morning with insulin. He peed A LOT shortly after getting home and has been drinking

 

I'm glad you got some food into him but your vet was wrong if he told you not to give insulin (but it's probably too late to give it tonight)

The recipe for DKA is Not enough insulin + not enough food + infection/inflammation.....the last thing you'd want to do is withhold insulin.

As long as he's above 150 in the morning, I'd give his usual dose of Lantus. Lantus doesn't usually start to "kick in" for 2-3 hours, so even if he doesn't eat at shot time, you'll have time to assist feed and get food into him if you have to. (I'm hoping he feels better and eats on his own!)

 

Well they've been hitting him with insulin (novolin) all day, I also don't want to overdose him. "Too late" is relative, it could be his life. His last shot was at 8:30pm and I just don't know what to do. Both insulins on standby

 

What time would you normally shoot (Lantus)?

What's his blood glucose now?

 

It's too soon to give insulin again if he had it at 8:30 tonight.

Also, we're all over the world here, so 8:30 doesn't mean a lot....How many hours ago was the Novolin given?

 

Hello Aaron. I do have some experience with DKA as my Harley had it twice before he started insulin. It is terrifying. The second time, I had him home after being with Vet all day for fluids. I seriously thought he would die as he was still so lethargic, would not eat, could barely walk. I seriously thought to bring him to emergency clinic in the middle of the night as I thought he was suffering. Thank God I didn't as Harley is doing well now. I did bring him home as finances were a huge concern. I did give sub cutaneous fluids for several days until appetite returned. I also frequently pushed wet food into his mouth until he resumed eating. If I recall it took a few days. I tend to mentally delete bad things so I can't remember specifics. I will list a few things to consider to try to help you through this.

-Were you sent home with fluids? If not, I would suggest you call your vet in the morning and ask for a bag of fluids, tubing and needles. It is a very easy procedure to administer fluids under the skin on his back. Jasper needs to be hydrated to flush the ketones out; needed especially if not eating. Your vet can show you how or there are videos on You Tube.

-As you were already using Lantus I would continue with same if it were me. You can use the same pen but draw up your dose with a U-100 insulin syringe. Look on the Lantus forum at the top of page for the yellow stickies, you will find a great deal of info.

-Are you checking blood glucose at home? if not please start, it is imperative for Jaspers safety.

-Please purchase Ketone sticks. You will want to periodically monitor for ketones so you know if you need treatment.

I understand finances or lack of. I avoid Emergency Clinics like the plague. I took my dog once and they wanted $2000 just to get started. I left and returned to my regular vet at 0800. I saved $1500. You can get everything you need at Walmart: Relion brand meter and test strips, alcohol pads, syringes, Ketone test sticks. Lantus can be purchased from Marks Marine Pharmacy in Canada.

For tonight please keep offering food as often as possible. If necessary smear a tiny bit on the tongue.

Hold steady, keep calm. You will get through this.

 

The novolin was given 6 hours ago. I would normally shoot him with lantus around 4 hours ago

 

I’d like to clarify that you have Novolin N there and lantus, correct? And you gave Novolin N at 8:30 pm your time? So how much did you give? What was his BG before you gave it and what is it now?

With a DKA cat, he needs to have insulin and, going forward, I would avoid skipping shots unless he’s too low to shoot Lantus (below 50). You don’t want to shoot Novolin N that low.

Normally, with a DKA cat, we use Novolin R and Lantus because it’s easier to avoid the nadirs overlapping.

What dose of lantus was he on when you took him in, when did the vet suggest you restart it, and what dose did the vet recommend?

I see you just posted that you gave N 6 hours ago....if you did not give lantus as well and if his BG is headed up, you could give him more N. But pls respond here before you do so we can discuss it.

Two videos to help you:
How to give Subq Fluids
How to Assist Feed

 

I asked Marje to stop in …..she has a lot more experience using Novolin and she can help guide you tonight.

You can trust her judgement completely.....she's one of the people who helped teach me!!

 

Hard to read and reply to all. Yes I have both insulins here. He was 322 when he left the vet (six hours ago.) I unfortunately don't have a glucometer here. I didn't stop for one on my way home because he said insulin wouldn't be an option until the morning, so I naively thought I'll just do what they say and await the test in the morning. I'm thinking he's okay to have another N. I'm also going to feed him again but more this time. After feeding should I go one or two of which insulin? N?

 

I plan to head to a Walmart tonight for any supplies I would need after I feed him but am also apprehensive about leaving him

 

Without testing him first, I’d be concerned about giving him N. While he’s very likely gone back up, I don’t want to take a risk with your kitty so whether you give N without testing first, is up to you.

If you can get to Walmart and back quickly, you could test him and then give the N as long as he’s above 150. It looks like they’ve been giving 2u of N. Is that what they told you to do? I would not give lantus tonight. actually...if you are going to Walmart, you could buy R. It’s only about $25 and it would be easier for you to use with the Lantus. At Walmart, you’ll want to ask for Novolin R if the pharmacy is open. Novolin R lasts about 4 hours as opposed for N which is about 6.

I’m sorry but I’m going to need to go to bed so I’ll leave you some info.

With DKA, you will want to:

• Get as many calories in him as you can; it’s best to give him a high calorie canned food but you don’t want to completely stop the dry. Bottom line is he needs to eat and whatever you can get him to eat, then give it. You want 2-3 times his normal caloric intake.
• Subq fluids are good if the vet gave them to you with amount and frequency to give. If he didn’t, get as much fluid in him orally as you can. You can give him tuna or salmon water as long as there is no vegetable broth, onions, spices, etc except salt.
• Ideally, you would restart lantus at the dose prescribed by his vet and also give a bolus, short acting insulin. With any short acting insulins, if you are also giving lantus, you must be sure the nadirs do not overlap. It sounds like the vet told you to give both insulins...is that true? If so, you should follow their directions but if they didn’t, I’d rather see you giving the Novolin N by itself until an experienced member here can be available here to help you give the two together or better, give Lantus and R together.
• Lantus can not pull down high numbers and so the goal is to give the bolus insulin (N or R) in a manner that it gives the lantus a better starting place. Usually, a good time to give R is two hours before the Lantus because it will bring the numbers down a bit by the time you give lantus. As the R is waning, the Lantus is onsetting. If you are giving N, you could give it 3-4 hours before you give Lantus with the same goal as above. It’s imperative that when a bolus insulin is given, that you test every hour until the N or R starts to wane. If they drop the BG lower than 150 by Lantus shot time, you’ll want help on whether to shoot the Lantus or not that cycle but he’s got to have some insulin each cycle and that might be a bolus or the lantus at a reduced dose.

At Walmart, you’ll also want to get U100 0.3cc syringes with 1/2u markings either 30g or 31g. You can use this syringe for lantus and/or R or N.

 

I've never done two insulins nor did he tell me to, I just know for tonight specifically, (1) its what they were bringing him down with and (2) it's faster acting. I have the lantus as well because it's here normally. His typical 2u am/pm lantus would be about 5hrs ago, 7 away. But that's not considering the N he's been getting. Also anyone that missed that picture above it's the only data I have

 

Then I would suggest that for tonight and tomorrow, you just give the N but you need to be sure the BG is coming back up before you give the next dose. While it typically runs its course in six hours, it can go longer. You don’t want to cause a hypo.

While lantus is a better insulin, it takes too long to build up a depot where it can address the higher numbers. That’s why, in my humble opinion, I’d give the N instead of lantus until we can, in the next day, hopefully, teach you to shoot Lantus and R together. You can give the N more often than lantus as long as you are testing and see the BG coming up.

If you can get R, we can teach you how to give R and Lantus and that’s going to help him the most besides getting extra calories and fluids in him either orally or Subq if the vet prescribed it.

Please continue to post here so we can help you even shooting the N until we can get you going with getting the lantus back on board hopefully with R as the better bolus.

If all that is clear, I’m going to go to bed. Many prayers for your boy. He’s lucky you’re his dad. I’ll check back once more in case you have any other questions.

 

I’m sorry but I need to sign off for tonight. I’m sorry to dump so much info on you but I wanted you to have something to look back on since I’m on PDT and won’t be up until long after you shoot. I’ve asked another extremely experienced member, Jill, if she can check in on you in the morning.

Recap:

• Get as much food and liquid in him as you can aiming for 2-3 times normal calories.
• Shoot prescribed dose of N in the morning; it’s up to you if you give more tonight but just be aware that without testing him, you put him at risk if the N hasn’t waned before you give the next shot.
• If his BG before his shot tomorrow is 150 or below, please be sure you post for help. He will need N but we’d need to adjust the dose. You can also call the vet.

Tomorrow, I can set up a spreadsheet for him and we can talk about using lantus and a bolus which would really help him. But, you have to have a level of comfort as well and be able and available to test.

Hope you both get some rest.

 

I'm sorry. I am unable to commit tomorrow morning. Please check in here and ask for advice.

 

Thank you for your help marje. I'm about to leave for Walmart. I imagine he will be in the 300s so I plan to shoot N. If he's lower than that i wont? His next shot wouldn't be for about 4 hours. Is this wrong?

 

I would shoot anything above 200 but he needs food before you give N. You could shoot 1u of N if he’s between 200-300 just to give you a bit more comfort but pls test him hourly after the shot until you see numbers flattening.

It’s a good idea for you to grab some sleep and shoot the N in the morning when he’s next due. You can’t take care of him if you are exhausted.

I’ll check in tomorrow. Take care and try to rest.

 

Since you have never tested the bg on your own, please watch the link I have in my signature showing how I test my cat CC at home.

You'll want a
1. Relion micro or confirm meter or some other brand that requires a 0.3 size sample

2. Box of 100 extra test strips

3. Box of 26 or 28 gauge lancets


Do you have syringes at home? If not get u100 3/10 syringes with half unit markings.

 

He is at a 244 as of 6am. Obviously all of the procedures needed learning but it went fine. I am quite relieved to see 244. Im going to blend some good food for him

 

That's not bad. Keep up the great work. Add lots of water to the food.

 

8:30am - bg 231
Am giving two units of N at 8:30am, after that I have to finally get some sleep

 

Can you please get a test in? While Lantus doesn't reach nadir (lowest point in the cycle) until approximately 6 hours after shot time, N works a lot more quickly. A Lantus cycle is 12 hours; N has about a 6 hour cycle. So, you need to check BG numbers more often with N to make sure that Jasper's numbers aren't rapidly dropping.

Did Jasper eat before you gave him his AM shot? Again, N is different than Lantus. You need to have food on board before injecting N.

 

Aaron

I hope you got some rest. Pls be sure and read Sienne’s post above (#27).

I need to do a little investigative work here so we can discuss options going forward. Your help is greatly appreciated.

• Jasper was on 2u bid when he got sick, correct? Do you remember his starting dose when he was first diagnosed, and how fast he went from 1u to 2u? I’m assuming there were no in-between doses prescribed by your vet?
• Did your vet do any curves to determine when and how much to raise the dose? When was Jasoer’s last curve? Do you have any of the blood glucose (BG) data from the curves?
• Would you be willing to use Novolin R instead of Novolin N, as needed, as we start up the lantus? It’s a bit shorter duration and would allow you to give it more often than N if needed. It costs $25-35 at Walmart. No prescription is required.

It would be good if we could get him back on lantus within the next day or so but you will need to keep giving N until then.

Depending on your availability, you could give N every six hours as long as the BG is headed up.

 

Hi there

When we were in the thick of it, more than one vet recommended the final solution.
Hang in there and hang in here.

Although your kittys current situation may seem bleak, restoring his health is possible. Getting him there however will require a period of ‘intensive care’.

Please tell us what time zone you are in-
It will help us better support you.

 

Slept for far too long, I was exhausted. I am in eastern time zone. He ate as much as I could shovel in before the N. His original dose was 2 u am and pm. There was never a curve done. It's been 6 hours, test incoming

 

As of 2:15pm, 241 bg. This makes me happy as he didn't climb that much through the night. I'll be starting right in on food, and my thought would be 2u of N afterward. Yes I suppose R would be an option, I was just really apprehensive about switching/adding insulin and there's been money flying everywhere. Thiugh, if you tell me that's what I need I'll try to make it happen

 

That’s really good!!! How does he seem to be feeling? Is he eating on his own and is he eating enough calories? Giving him 2u of N after he eats is a good idea.

I know he probably doesn’t feel like being tested and you are just learning but the value of testing him hourly is so we can get an idea of his curve with N. When does he onset, when is the peak and how low does it take him, when does he head back up. This is important as we move forward with decisions on bolus insulin, restarting lantus and what dose to restart at, and what dose to use in the bolus insulin. Obviously, once you restart lantus, you have to back the bolus dose down but it’s a very fine line so the more info we have, the better.

I believe someone mentioned keeping an eye on his ketones. It is important, if you don’t have any urine ketone strips, to get some and test daily. You should let us know if you see even a trace as it takes a bit of time to see them in the urine after they are already showing in the blood.

A few other questions:

• did vet send you home with subq fluids and instruct you to do them? If so, how much and how often?
• were any labs done at the vet and do you have those available?
• did they do any treatment for him other than fluids and giving N?

I understand your concerns. However, you have to restart lantus at some time as it will be the better insulin for him long term and you are going to need the depot to re-establish. If we start him too low on the lantus, we run the risk of putting him back into DKA if he doesn’t have enough insulin. That’s where the bolus insulin really comes in handy as you can shoot the higher BGs down until the lantus starts to do it’s thing.

I do hate for you to spend extra money especially because you might only need a small amount of R and you have to buy a whole vial. The option would be to start him back on lantus with a very small dose of N (perhaps 0.1u) knowing we can up the N dose after six hours if we need to do so. I would like to get your thoughts on what approach you’d like to take.

Also, because we are all on different time zones, it’s standard that we talk in terms of how many hours since he received insulin instead of actual local time.

I’d like to get a spreadsheet started for you so I’ll send you a private message to get info. Check your inbox in the upper right corner.

You’re doing great!!!

 

He seems to be feeling much better. He's more resilient when I pick him up. Still not eating on his own, however, he's fighting me about the syringe now which to me shows normality and energy.

Ketones: I got a strip under his urine probably 5 hours ago. It was closest to the "trace" color. Id say by guess probably a 6-8 mg/dl

Didn't send me home with subcu, that's my goal today. No labs we're done as I couldn't afford it. Just a urinalysis, shown above. And yes, the only treatment he got there was IV fluids and N

 

Thank you for the info. I’m working on the SS for you but I have to leave....an appt.

I would suggest continuing with the N today with the goal of starting L tomorrow. I’ll be back later with some options. It would really be best if you can swing the R. I’m glad he’s doing better.

 

R is a fast acting right? It's not an issue introducing new insulins to his body like this?

Also marje, thank you beyond words, don't feel rushed or burdened at all by me. I'm learning that I should have been doing all of this myself this whole time, grateful is an understatement.

 

Correct and that’s why we can use it with Lantus and levemir. It won’t hurt him to be changing the insulin.

You’re welcome! We will get him on track.

 

R is the insulin typically used to treat DKA. The fast acting is the advantage. One just has to start with a very small amount.

 

I am so glad to hear Jasper is feeling better. Hang in there! You are getting great information here. I wish I had found this group just a bit earlier than I did. As I stated in my earlier post, I almost took Harley to Emergency Clinic in the middle of the night to have him put to sleep as he looked so horrible. I just couldn't do it, he is my baby. After much force feeding and SQ fluids he started to perk up. It did take about 2 days before he would eat on his own. Just keep plugging away and hang in there. You sound like you are on the right path.

 

So happy to hear that Jasper seems to be feeling better!! Hopefully he'll eat on his own soon too!

Learning how to safely use N or R isn't easy so it's great that you have Marje to guide you. I'd be OK helping with just Lantus, but she's one of the few members that has experience with the fast acting insulin's and how to use them both safely and effectively.

I'll be keeping an eye on you, but will leave the dosing advice to those who have more experience than I (at least for now!) …...that's one of the reasons this board is so great!!

 

Aaron

You’ve done a great job today! With you sending me your great notes, I was able to do the SS (linked in your signature block) and get it posted so others can see and offer suggestions.

Jill and I corresponded over some options to present to you and here’s what we’d like to propose (remember you hold the syringe and so it is your decision and we will support you):

• discontinue N (we talk about timing of this depending on when you want to restart Lantus)
• restart Lantus at 2u bid and have R ready to give 0.1u if necessary (if the PS is higher than 250, for example)
• continue to test for ketones at least once daily
• continue to feed as much as you can get into him; fluids either subq if vet has authorized it or orally in food, tuna juice (no vegetable broth),etc. If you need suggestions, ask and we can help but we want to be sure he gets extra liquid on board

You can choose to restart Lantus tonight if you want but it is pretty late and I’m not sure you want your shot time to be so late at night or so late in the morning (9:30/9:30). It might be best to give him another 2u of N tonight as this dose wears off and start fresh with the lantus dose in the morning.

One option suggested by Jill that you could consider to fill the depot faster (and you would reduce the need for R) is to shoot Lantus every eight hours (so three times a day instead of two times a day). You would shoot 1.25u every eight hours for a total of 3.75u a day. However, this is very intensive and would require you to be at home and testing a lot. It’s for that reason that we don’t suggest it often and it’s absolutely ok for you to shoot 2u every 12 hours with R as needed (we can teach you how to do that if you choose to go that route). Don’t worry about saying three times a day is too much for you. You have to have a life, sleep, and work so it’s no problem....it’s just an option for your consideration.

What might we expect to see when you start lantus? We might expect to see the BG go up since the depot has been drained and that’s why we use R in small increments (0.1u) to bring the BG back down. Our goal is twofold:

• strive for an R dose that drops the BG by 100 mg/dL throughout the R cycle
• shoot R in a manner that gives the lantus a lower BG to start from

There are a lot of tips for using R but I don’t want to throw everything at you right now. I’d like you to absorb the info and ask questions. Let us know what you would like to do. We do feel moving away from the N is a much better option for you and him.

I’ll be around this evening to check in, answer questions, help any way I can.

 

Okay all, I just got back home and he went up a little bit again. If what I took today speaks for anything, N takes two hours then works for 2 hours. Obviously his lack of food is another variable. I've been syringing him tuna, tuna water, soggy (dry) glycobalance, brothy salmon cat food, all blended.

Long story short though, I came home with both nacl and R. From this point moving forward I'm absolutely willing to lose N but would like recommendations for how to proceed from here. 10pm on the chart will be current post time. When should I feed? When should I give (which) insulin? And when I lose you all for the night, when would be the next ideal injection? Also, marje, his standard was right around 10am/10pm. I'm not an A person so I had him on a slightly later schedule

 

If you shot at 10/10 with lantus and you want to get him started tonight with it, that works. We can see what he does. We were suggesting 2u bid (see above).

I’ll be up until +5 your time if you shoot the lantus about now. Even if it’s not in him until 10:30, that’s ok. You can still give it at 10 tomorrow morning. If you go with the lantus tonight, no N. You can test him, give the lantus, and then feed him.

It’s up to you. If you want to hold off on the lantus until tomorrow, then I’d test him and see where he is, feed him, and we can talk about giving N again tonight after a bit. Your call. I’m standing by.

 

Cutrent

 

I think starting lantus is a good idea, and I'll monitor every hour. Also, the vet was busy when I went in, I have the fluids and am going to watch a video about to administer it, but any tips/tricks/ dos donts? If there is a "flow rate" I should consider

 

Scroll back in this thread to my post #12 and I linked a video on giving subs fluids that should help you. Some cats will see their BG drop with subq fluids. NaCl might sting.

Once you get the shot in him, you can add his updated numbers to his SS. I sent you instructions in a PM. If you have problems...let me know and I’ll do it so you see how it’s done.

 

Aaron

Not sure what you did tonight but if you gave lantus, you might want to wait and do subq fluids tomorrow just in case the fluids affect the BG.

Hoping for an update.

 

Sorry, update..

9:50p bg 286
10:25p 2u of lan
11:15p bg 254
12:15p (right now) 245

Just made up a batch of food. Was geared up to do fluids after. If you think I shouldn't I will just feed? Wouldn't the BG drop be a good thing? For the lantus?

 

Excellent!

Why don’t you take the night to watch the video and just give him extra fluids orally as you’ve been doing. Jill felt that will give us a better chance to see what he does on lantus tonight without the influence of the subq, if he is one that his BG is affected by it.

It’s fine to shoot at 10 in the morning as 30 mins difference won’t matter this time.

Why don’t you feed and try to get a couple hours sleep before you test again? It will be fine. If he’s flat or up at the next test, just call it a night for you both.

 

How did it go last night and how we doing this morning? Did you shoot 2u lantus?

 

Feeding has become a nightmare, he has all of his fight back here is an update from last night/this morning. The black dot could potentially be a raised "stressed" result as it took me quite a few tries that time, unfortunately (and the intake obviously, just noting.) Am gearing up for fluids now. The 197 made me very happy!

 

Update

 

Great news. With numbers like these, we will hold off on the R. Great job testing. Is he not interested in eating on his own yet?

I know you are busy but the Spreadsheet is the place for these numbers. Can you please keep track of them there? The reason is because the SS stays with your signature so every time you post, we can always see the SS. However, the pictures you take do not so if I want to look back to see his numbers, I have to scroll back through the thread to find the photos....time consuming.

Is there any reason why you don’t want to use the SS? If you have questions on its use, just let me know.

 

He didn't want to eat, no. And okay I filled them in

 

Thank you!

I’ve got to run one of my kitties to the vet and I’m not sure how long I’ll be but you can let him go on the testing until +3. If you have any questions, post and change the thread title to add “need help pls” so it will catch some attention. If I have to wait long at the vet, I’ll check back in.

I hope he starts to eat on his own. We can give you some tips on that.

 

I'm curious about how much fluids I should give him per sitting? Marje I thought your video was excellent btw, Gus was adorable and the video was well informed, so thank you. They were busy at the vet when I picked up the bag. The only thing on my paperwork is 10ml/hr? Give him 1/10th of this bag and then do it again in an hour regardless of bubble? I think the 10ml/hr was intravenous

 

If the bag is 1000 ml then 1/10th is 100 ml. You would not want to do that more than once a day and that might even be a bit on the high side.

I would call the vet and verify the amount per day. It does sound like they were talking about the way they administered it via IV, it will be different subq.

 

They said 100 ml a day, hopefully around the same time. +3 test was 209, he's staying low 200's. I'm eager to start the fluids but don't want to set 2pm as "the time"

 

Also, I'm feeling so bad for his little ears :/ is the pad of the foot more comfortable for them? Not that it really could be, I understand. Sharing the load between the two? What's the general consensus around here

 

A little Neosporin with pain relief ointment (not cream) will help heal those pokey holes up quicker. His ears will get used to it too....as you poke more and more, new capillaries will grow in and it'll get easier and easier to get that precious blood drop.

I've been poking China over 5 years and you'd have a hard time telling which ear I poke! (I can only get blood out of 1....the other is like getting blood from a turnip)

You can use the pawpad, but a lot of cats don't like having their feet messed with (worse than having their ears messed with)…..it depends on the cat. I also worried about the possibility of infection from litter boxes

 

It’s ok to vary the time but I’d try to do it after mid cycle as it’s less likely to affect his BG.

Are you warming his ears before you poke and massaging them a bit?

I’m at vet, waiting, but when I get home I can post some testing links.

 

A little trick someone passed on to me a long time ago...
Have food (with as much water added as he'll tolerate) ready to put in front of him as soon as he's finished getting fluids. I don't know why, but a lot of cats will eat immediately after receiving fluids. Jasper may be one of them. It's worth trying!

 

A compilation of testing links: Hometesting Links and Tips.
Be sure to check out Marje's Testing and Shooting Tips.

 

Thanks for posting that, Jill. We were gone longer than I expected.

Aaron...looks like Jasper is having a good day. I’m liking that +7 and I hope he can stay nice and flat. I’ll be around the rest of the day and evening so we’ve got a couple sets of eyes watching in case he gives you a blue number at PMPS.

Because of his DKA, we will encourage you to shoot but if you get a 150 or below, it might be good if we make sure one of us can hang out with you tonight on the board in case he goes lower; I am certainly available.

The Royal Canin Glycobalance is 14% calories from carbs so that might help bring up any lower numbers as his BG improves over time. And as numbers do improve, you might want to have some HC food with gravy around....like some of the Fancy Feast varieties with gravy and some Karo or honey. It pays to be prepared if numbers start to dip lower. Even though he might not be eating much or any on his own right now, sounds like you can syringe him.

Once he’s doing much better and is eating well, we can help you find a better, canned food for him that isn’t much less expensive and lower in carbs. Many members here have had great success in gradually getting kibble addicts onto canned food but it’s not a “cold turkey” thing as it can cause a big drop in the BG.

How did the subq session go? Thanks for your comments about the video and Gus. I hope it helped you....it will get easier with time but let’s hope Jasper will recover quickly and won’t need subs very much.

 

Subs went okay, obviously just beginners difficulties. He moved after a while and pulled it out but he didn't freak out. I' unsure if he got the full 100 only because of the bag. Do you gauge when to stop while the bag is hanging? Or lift it up to gauge it? Obviously two completely different volumes as the bag expands.

 

Certainly to be expected. We all had beginner’s difficulties and even as many times as I’ve given them to various cats, I’ve still had the needle pop out. It’s fine if he didn’t get all 100 mls....even 50 helps.

You gauge how much you’ve used when the bag is hanging. I know there was a ton of info in the video but, each time, you want to mark on the bag, as it’s hanging, where your endpoint for that session is. Just use a Sharpie. That will help.

 

Update. I'm excited about the 141, however, he still wouldn't eat the food offered to him after fluids or as of yet. I certainly will, but force feeding him is a pain at this point. His pm is due in an hour, advice on feeding/if I should dose him?

Should I be at all worried or is that a good number? (all considering)

Is there any way this could still be a failure of some sort? Or would we see signs other than blood if it were kidney problems? (as far as the appetite) I only ask because it wasn't eliminated by blood test for me

 

It would be best to give him his 2u as long as you can be sure and syringe food into him. If you are worried about that, if you don’t have enough test strips to potentially test often tonight, if you are too exhausted, then you could shoot 1.5u. But you’ll still need to be able to get food in him....you can’t afford to skip a shot.

You shouldn’t be worried about such a great number. It’s possible it dropped due to fluids.

Without labs, I can’t tell you if he’s got a kidney or other issue going on but the BG, by itself, doesn’t throw up a flag to me that he could have some other type of issue going on.

If you have any blood tests from the vet, there is a lab tab on the SS and you can load the values there and I’ll look at it for you and see what I can tell you. I’m pretty good with labs.

You’ll need to be sure and get a good meal in him after you shoot and please be sure to count on testing at +1 and +2.

Edited to add: did you see my post about having some foods with gravy like Fancy Feast? You can drain the gravy off and syringe it to him if his numbers get lower. Do you have any syrup (not sugar free) or honey there?

 

126 before 2 lan. Switching over to feeding now

 

Sounds good. It’s important you get food in him.

I’ll be here all evening to help you if you need it. Pls be sure you get a +1 and post it for me.

Thank you, Aaron. You rock!

 

How we doing at +1?

 

98 should that alarm me? I have fancy gravy/honey on hand. I gave him a full bowl of food (watery, blended tuna/Sheba bag/soggy glyco)

 

He’s still in safe numbers but he’s likely going to have an active cycle. We want to be sure we don’t get him too full.

Did you feed him the full bowl of food before the 98 or after? If you gave it before, you might want to give him just a tsp of gravy now so we can slow him down just a bit. You want to be sure and test at +2.

If you fed the full bowl of food after you got the 98, let’s see what he is at +2.

Question: shot time is 10:30, right? So aren’t you just about at +2 now?

 

I fed him right after the lantus. 0-0.5

 

Ok then I’d give him a tsp if gravy to slow him down a bit. I’d retest 30 mins after you give the gravy. Sound good?

 

Yes, will do. And yes it was, my lan went in closer to 11 so I was trying to be accurate with the hours. 2 hours since the lantus will be half hour from now

 

Perfect! I’m going to make a tiny adjustment on his SS so you’ll see how we do it if we shoot off the normal 12 hours.

I’ll be waiting in 30. Good luck with the gravy.

 

Gravy took a second to separate, was in for probably 20. 92 at +2. Could the bubble being absorbed be keeping his bg down?

 

Good! Much better. He’s at onset time about now. I’d like to give him an hour before the next test but I also don’t want him to drop anymore. OTOH, I don’t want to skyrocket him and I don’t want him to get too full.

When would you normally feed him again?

 

Just for clarity in details, the liquid bowl at 0-.5 was probably 50% of a typical meal (after the blending) and the gravy was only a syringe full, wasn't all of the gravy that was in there. Had he eaten a full bowl of his dry food I typically wouldn't be feeding again until 10-11 tomorrow (whole bowl)

 

Too full is a worry, but him puking up what I've given him is also a worry. I thought he was going to send the gravy back up. Tests don't hurt my feelings (just his ears) I'm just reading next to him, so the frequency doesn't matter, I can go to half hours

 

With FDs, we find more, smaller meals work well but we can discuss that after he’s eating.

Since we want him to keep food down, the most conservative thing is to test him 30 mins after the last test. The gravy will have had plenty of time to work. If he’s dropped, then we can feed.

 

+2.5 is 103

 

Perfect!

Gravy does wear off. Do you know how many mls of gravy you gave him in th syringe?

I’m thinking you might want to feed him a little more of his regular liquidy food in 30 mins and then test at +3.5. If he’s coming up still, you can give him a bigger break.

What do you think about that idea or is there something else you’d prefer to do? You’re with him and know what it takes to feed him but since he’s new to these numbers, we aren’t really sure what will happen when the gravy wears off.

My goal is to keep him above 100 and give you a nice mid to high blue number in the morning although I won’t be up when you shoot.

 

Can I prick the spot on his arm that is already shaved at the moment?

Not sure about the gravy. I'll do just that, I'll feed again at +3 and test at +3.5

 

Ive never done that or known anyone who has. It might have too many nerves and might already be sore from the IV. Are you switching ears? You can also poke on the inside of the ear (side without hair) as long as you stay along the edge. Did you see the photos on the links that show the sweet spot?

 

Yeah I've been doing all inside sweet spot, both. I'm up to 25 tests though not to mention the ones I've botched. Just feeling bad is all, it has to be done though

 

I know....I hated every poke that I had to do on my sweet baby for 5.5 years. She was always so great...she’d even sleep through it...but it broke my heart.

I hate to poke him too much but we just don’t know what he will do and he’s got 2u of insulin in him. Let’s hope he’s up enough at 3.5 that we can give him a nice break.

You are doing great.

 

74 I seriously don't know what to do. This low doesn't make sense to me and I'm exhausted

 

Yeah not what I wanted to see either. He responded well to the gravy before so I’d give him twice as much and retest in 30. Let’s try to carb him up.

I’m sorry.....I know you are really dead tired...you’ve been doing all this by yourself.

He’s still st a very safe number so don’t be scared. You’ve got syrup and testing and those will help keep him up.

I’m not going to go to bed until he’s up and staying up so I won’t leave you to deal with it alone.

 

70

 

I did more gravy but it only had probably 15 minutes. Should I be looking at honey? Has 2 units been too much since he was diagnosed?

 

And that was with 2 syringes of gravy? At least he’s stopped

I’m hesitant to use honey at 70 because it really wears off fast. I like to save it for numbers below 50. Do you think he could take a couple more syringes of gravy or can he keep down some food with gravy?

It’s probably worthwhile to drop his dose to 1.75u and see if we can keep him in blue numbers so you can rest and so you aren’t fighting green when he doesn’t want to eat. We can take him back up if we need to. I’d reduce his dose to 1.75u in the morning.

If you can get a couple more syringes of gravy in him or a little food with gravy, let’s try and let him go an hour after you feed. What do you think about being able to get gravy or gravy/food in him and have him keep it down? If you think he’s too full, then just gravy.

 

I gave him roughly 2 tbspoons of normal food and gravy. It's +4.5 right now, if I'm going to test at +5.5 I might have to nap

 

Bowl

 

Ok. That’s a good idea. I’m hoping with the food and gravy and getting near nadir, he will come up and stay up.

I’m going to nap, too, but I’ll set my alarm and be back in an hour.

He’s such a lucky kitty to have you. See you in an hour.

 

Sorry this is effecting your sleep as well but thank you. +5.5 was 78

 

No worries.....and you are welcome.

I wish he was up a bit more but glad he’s not down. My thought is to give him more gravy and you try to get a couple hours sleep. The only reason I wouldn’t leave him until AMPS is the gravy could wear off. He is close to nadir and should head up but they don’t always read the rule book.

What would you be comfortable with?

 

I guess another thing of gravy and test at +8? (2 hours 15 min)

 

Ok. I’d give a little more gravy than you have been.

Would you like me to wake up then? There should be a lot more people on the board by then as it will be 7 EDT. But I’m happy to wake up again if it helps you.

 

You're okay marje, thank you. I really hope he doesn't fall that low, if he does there's honey. I'm just my wit's end I thought I was close to being out of the water