Vet report. 3/1/16 Smokey--AMPS 85; +3=103; +5.5=106; PMPS 346; +3.5=205

Yesterday's Mews

http://www.felinediabetes.com/FDMB/...1-2-5-51-3-5-39-4-44-4-5-51-5-55-6-61.153530/

I did not shoot this morning. Apparently he still coming up from last night I did not risk it. I will do an 18 hr cycle if I can. No vomiting since last night.

@julie & punkin (ga) thank you so much for being there.

I'm calling the vet this morning to see if I can get him in today. If not there than the ER if the internist is on to do ultrasound.

 

So sorry you had such a trying/scary evening. I was reading but didn't want to comment and clutter up your condo. Sending mega vines for Smokey and please keep us up to date.

 

I hope Smokey is doing okay and you can get him in to see the vet today. Sending prayers.

 

Just read yesterday's condo now. I am glad to hear that the vomiting stopped and that you were able to get him back into safe range. Very scary when they drop low, vomit and won't eat. Sending lots of vines for Smokey! And Kudos to you for handling that crisis so well - I think I would have been a total basket case.

 

Vetty vines speeding Smokeys way

 

I am so sorry I bothered you last night -- I didn't know what was going on with Smokey, how scary...
prayers....

 

Oh, Paula, just got caught up on last night's condo. Sending Smokey healing vines and hope all will be well. Please keep us posted.

 

Paws crossed you can get him to the vet today. Sending vines to Smokey.

 

At vet now, still waiting to see Doc. He iS squeezing us in so he is trying to see the others so they don't wait to long. Im ok with that. New intern did the intake. He seemed nice enough. I like how he handled Smokey so far. Smokey lost 1.5 lbs. But he feels heavier to me. He is now sleeping on the table.

 

Watching here, too. Good luck, Smokey!

 

No need to apologize. You couldn't have known. I didn't want you to think I had ignored you. Did everything turn out ok?

 

Close to being a basket case. Was dressed ready to go to ER if needed. And I'm not one to rush to the vet or ER. I will usually wait 24 hrs, most of the times they are ok in a few hours.

 

Let me get this question out first then I'll report on vet.

I didn't shoot at AM. Vet agreed with that. Since it took so long to bring him up last night. I said I would do 18 hr cycle if he is high enough he said reduced dose if he is higher. That would be in 10 minutes.

He is 106 now, should I shot 2.25u now or wait til normal time which is in 6 hrs? It's been 18 hrs without insulin and he is still normal.

 

I don't know Paula, but perhaps reflect it on your title, 108 18hr cycle Ok to shoot? Might get more eyes on it.

Good luck with responses

 

So vet report. Smokey lost 1.5 lbs since 12/30. I have to get new scale, he lost on mine but the next week it was back. Very touchy scale. Not dehydrated.

Dr. Is concerned about the muscle loss and he hasn't seen him since October. Saw associate in December. I did notice how bony his spine has become the last couple of weeks. There is no pain, no guarding of abdominal area. No mass or stool felt. Smokey had a stinky poo on way home though.

The vomiting is not related to low numbers. He thinks it's nausea gave me a sample pack of Cerenia. I'll ask more on that a little later.

He said he thinks Smokey is converting. Asked what he meant. He said converting back to non diabetic state. I don't think he can go from 2.5u to none overnight myself. So he asked his lab people if they had a SNAP in house but they didn't so he drew blood and sent it out rush for a pancreatic lipase test. Will have results tomorrow. Then based on that whether we do ultrasound.

On the cerenia, his drug of choice. He said it takes 24 hrs to work. He said it can be crushed and added to food. But if he spits that up then it's wasted. Since Smokey ate normally this morning wait until he needs it. I only have 4 pills. He said if Smokey walks away from his food or eats very little then give 1/2 tab for 4 days. Does that sound right? If he has pancreatitis this is new for me.

He said Smokey looked good overall. His coat is shinny, smooth, eyes clear and alert.

 

@julie & punkin (ga) Thanks for being with us last night. Even though I know what to do, Smokey threw a wrench in it. You helped me tremendously.

 

Paula, I just looked at your SS and you have shot lower than that number with that dose (99) Hope someone "wise" weighs in. Hate to see you lose momentum.

 

Quick response because I'm at work: What mg is the Cerenia? I gave Marshmallow 1/4 tablet of Cerenia, once a day. I think I had the 24 mg pills, so it was 6 mg when I cut them in quarters. I just pilled her and gave them to her whole. If she was nauseous, she wouldn't eat so it would be pointless to add it to her food if she would eat it. Can you get pills into Smokey? I don't know about whether or not you should shoot or wait until tonight.

 

Me to but like Dr. said it took so long to get him up last night. And he is still normal range right now with no insulin on board. If I don't hear from anyone else soon I will wait until regular time tonight. But I don't want to go past that. I figure 18 hr is better than 24 hr but if I need to wait I will.

 

You have to be comfortable with shooting.

 

They are 16 mg tabs. He said to give 1/2 tab daily if Smokey walks away from his food.

 

Hi Paula,
I just finished reading your saga. To my eyes it looks as if you should just wait until the usual PM time for Smokey's shot (and it looks like he has earned a .25 reduction). His numbers without insulin are good this morning. If you were to shoot now at 18 hours, your next shot would be tomorrow morning at AMPS. Smokey has finally come up in bgs from the low numbers last night. If you shoot now, even with the .25 reduction to 2.25U, he might tank again (because his depot is still at the 2.5U dose). If you shoot the new dose (2.25U) at his usual PM time, I think it will be less disruptive. (Just consider the no-shot this morning as a "fur shot").
See what others think, but that's what I would do (I believe!).

Ella & Rusty

 

What a scary night! I am with Ella, it'll be fine to go 24 hours between shots. For some cats 2 18 hours are better than a complete skip, but ECID. You could even shoot a little earlier tonight if you want and are home (say +22) so you can get to bed at a decent time and back on schedule tomorrow (+14).

One time when Neko went off her food, I also got 16 mg Cerenia tabs and was told 1/2 tab a day. I just did it two days then she was back on her feed. Paws crossed Smokey is back on track soon.

 

I would agree with Ella, that number is not high and you can give that depot a chance to drain off a little bit more.

As far as the Cerenia, the old dosing used to be 1/4 tab once a no matter the size of the cat. Since they have been approved for use in cats for the shot, even though the dosing on the tabs is not published but vets have received guidance and higher doses and longer term use is now accepted practice.

 

I believe you can typically dose between 1/4 to 1/2 of a tab. The recommended dose is 1 mg per 2.2 lbs of body weight. Tanya's site also notes that Cerenia shouldn't be given in a Pill Pocket or in food because it may impede it's absorption. I was always taught to give the pill about 30 min before you want to feed your kitty.

 

Thanks good to know. I've never had to pill him before wonder how he will be. So far today no vomiting and he's eating on schedule.

 

Ella, I'm waiting until tonight to shoot. Can't wait to see what his reading will be.

 

So glad he seems better! Hope you get good results tomorrow and it's not P'titis.

 

have never had a pet (5 cats, three dogs) refuse a pill that was wrapped in just enough American cheese to cover it tightly. The thing is down the hatch before they realize there is a pill in there. We used to use laughing cow but that was messier. I think the key for us has been fake cheese. Real cheddar, etc, was never the hit with them.

 

I have good success with cheese for my dog Ricky.

 

He likes cheese. He gets a tiny piece every morning when we DH & I have breakfast. He has been refusing it last 3 days. I will try it .

 

I would try pilling. Since you've never done it before, Paula (lucky you), here's a video showing the most common method. Some cats don't need to be restrained. Of my four, only Harvey has to be, and sometimes I can do him without his cat sack, too, if I'm quick.

I've always given 1/4 tablet of Cerenia, per my vets' instructions. If I have an option when I give meds, I prefer to try the lower dose first and see if it's enough for the cat. That's just me, though.

Sending lots of good appy and tummy vines.

 

I was told 1/2 to 1 and start with the 1/2. I will watch the video. I have pulled others, just not him.

 

I'm just getting back online now and saw your tag. You are so welcome! I was happy to stay with you last night. Even when you've got plenty of experience it just helps to have someone else there when you've got something so unnerving going on. Vomiting is one of the worst, especially combined with low numbers. Fortunately, you handled things right and everybody is fine!

Yay for getting into the vet today. I agree with you - going from 2.5u to nothing isn't typical, but if he can get into normal range and stay there, there's always the possibility his pancreas will heal and put out some insulin again. That's one of those things that just happens step by step. For now, I'd simply reduce his dose to 2.25u and see how he does with it.

Whenever you reduce the dose, however, you do want to be on watch for a kitty to fail the reduction, so if he does, you can take it right back up to the "last good dose" before you lose momentum. See what he gets to when he clears the inevitable bounce and that will let you know if he's failed it or not. You said that he didn't do well at this dose before - i hope it's better this time.

We had very good luck with Cerenia as well. We always gave it in pill pockets - I hadn't heard not to. I hope it helps Smokey. How is he feeling tonight? Any more vomiting? Let us know about the results of the pancreatitis test when you have results.

Hope tonight is much, much quieter at your place!

Oh, by the way, I saw your question in yesterday's condo about "3 times under 90." I haven't seen that written anywhere - first I've heard of it. I suspect someone's invented that as a counterpart to the Tight Regulation guideline that says if a cat has failed reductions, or is over 1 year post-diagnosis, you can choose to let the cat drop 3 times under 50 before reducing the dose, instead of 1 time under 50. People make things up here, in case you haven't noticed, lol. I would ask someone to provide you the source for that, if you see it being advised.

 

@julie & punkin (ga) I reduced for PM shot. He was 24 hr without at that time. When we returned from vet he was only 106. He was 103 before we left. So no stress. The PM +3 he already dropped quite a bit.

He's had no vomiting today. So I haven't given cerenia yet. Vet said wait til he refuses or vomits. He only gave 4 pills to see how they work. He is eating fine so far today.

I thought I read it was below 40, so the 90 threw me. Smokey is long term and hasn't held in the past. I can never find the protocol even though I've bookmarked and have the table printed. Maybe it's one of those unwritten rules.

We'll just follow his lead where ever that takes us.

 

Julie, that's the difference in SLGS and TR. For long-term diabetics, SLGS says 3x under 90, TR says 3x under 50. I'll find the info tomorrow and post a link to it....

CORRECTION POSTED BELOW!!!

...

 

@Squeaky and KT Lyresa, I'm rereading through the link on SLGS - and not finding anything in there about 3 times under 90. SLGS is different than Tight Reg in that there is also no provision for a failed reduction. Doses are held for a week unless the cat drops below 90, and that triggers an immediate dose reduction. At least that's how I interpret it.

This is the only reference on the sticky about reducing the dose:

Hold the dose for at least a week:

• Unless your cat won’t eat or you suspect hypoglycemia
• Unless your kitty falls below 90 mg/dL (5 mmol/L). If kitty falls below 90 mg/dL (5 mmol/L) decrease the dose by 0.25 unit immediately.

​

 

Paula, I forgot to answer you about Smokey's dose reductions. I know it can be hard to find info on here - you know you've seen it somewhere, but can't put your finger back on it!

From the Tight Reg sticky, under reducing the dose:

• If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit. See additional notes in the next paragraph about drops into the 20s and 30s. Alternatively, at each newly reduced dose... try to make sure kitty maintains numbers in the normal range for seven days before reducing the dose further.
• Please do not let yourself become complacent or blasé about drops into the 20s or 30s. Please ask for advice immediately.
• If your cat drops into the 30s, a full reduction of 0.25u is recommended. There are very few exceptions given for caregivers who have collected years of data and KNOW their cat's response to the combination of insulin and food backwards, forwards, and inside out.

​

So yesterday's trip into the 30's would mean a 0.25u dose reduction for him.

 

Thank you. I would think it would be other way. TR drop to 90 and SLGS drop to 50 because your going slower.

I unknowingly combined the two. SLGS and drop to 50 3xs.

 

The difference as I understand it (step in and correct me, Julie, if I am wrong) is that TR is a protocol that follows a more aggressive method, meaning you want the cat's BG to be as low as possible at nadir and still be safe. So you skate around in the mid greens but when you hit a 50, that's the stop sign. It says this dose might no longer be safe. By dropping to a lower dose at a higher nadir, you are keeping in less dicey waters.

I think it is worth remembering, too, that TR is an actual protocol based on a lot of controlled, scientific data and SLGS is a system devised based on the experience of people "in the field" so to speak. TR has built into it safeguards and breakpoints that I tend to take pretty seriously!

 

I found myself guilty of 'parroting' wrong information above so want to correct it. I know this is an older condo but if someone comes along later and reads it, I want this here too.

TR:
Long term diabetics - more than one year since diagnosis

• reduction *earned* after a single drop below 40 mg/dL for those following TR, or
• reduction *earned* after three drops between 40 - 50 mg/dL on three separate days for for kitties who have shown they do not hold reductions well and following TR, or
• reduction *earned* when the cat regularly has its lowest BGs in the normal range of a healthy cat (50 - 80 mg/dL) and stays under 100 mg/dl overall for at least one week and following TR.

• reduction *earned* after a single drop below 90 mg/dL for those following SLGS.

We highly suggest taking a reduction any time any kitty drops into the 30s or below. There are very few exceptions given for caregivers following TR who have collected years of data and KNOW their cat's response to the combination of insulin and food backwards, forwards, and inside out.

SLGS
Once under 90 calls for reduction.

.