Which way..

Hi
I posted this to health and will post to Lantus, too. viewtopic.php?f=28&t=36256
Appreciate your thoughts and support.. Thanks..

mami

 

Hi Mami,

please remind us, how are you treating the pancreatitis?

That can be a very painful problem and kitty needs some pain meds. Pain can make BG's go higher.

I would be concerned about giving more insulin than the .4u b/c he has gone so low at least twice recently on that dose.

When my PK had pancreatitis I gave buprenex ( pain killer) and fed the lowest fat wet food watered down- I had to synringe feed as his tummy hurt too much for him to eat on his own.

I also gave sub Q fluids- lactated ringers- all this as per vet and the FDMB message board.

Please tell us what treatment you are giving for the pancreatitis and how long ago that was diagnosed.

I do also wonder if there is some need to lower that dose more- that the high BG's might be bounce, but I tend to lean more toward this being a result of the pancreatitis...will wait your response before commenting further.

I know there is a bit of a language translation issue, so if you want me to clarify something, please tell me.

hang in there!

 

Thank you, Melissa.

I replied to Lantus. viewtopic.php?f=9&t=36262

I occasionally give him famotidine, the same ingredient as Pepcid AC. He does not seem to be in pain right now with that 6mg/dl, but pancreatitis might be brewing again..yes..possible after staying highs for very long. I talked with the vet tonight without taking Akane. She always seems very relaxed? with everything. She was not surprised and did not show concern when she saw Akane's recent numbers and just seemed convinced as if it was natural to see those high numbers. When he was DKA, her colleague said to me that it was well anticipated because he was a "late stage of diabetic". And she suggested me it was a due course for him to be in a state of nearly dying. They just do not focus on how to improve his condition but just accept the current status and let it be.. So no sub q fluid, no phosphorus binder and no insulin management advice.

Akane played with a string just before I write this and purred. Good boy.. It made me feel less worry ..

 

Posted this on the Lantus ISG:

I agree with Melissa that more insulin is not the way to go. Getting to 80 and 62 on that dose indicates that it is not too little insulin. It is possible that he dropped lower later last night. He did drop to 25 on the .3u dose a month ago. The 300s/400s are probably rebound/bounce.

However, did he suddenly start acting like he is getting a pancreatitis flare in the past few days? With Beau that was always a decrease in appetite, but other kitties will act like they are sick or in pain by withdrawing, "meat-loafing", or being grumpy (growling when touched, hissing when picked up, etc.). It seems like his last flp test was 6 weeks ago? A lot can change in that amount of time. If he is acting ok, as you indicated, it doesn't sound like a p-titis flare to me. Also, when Beau flared, his BG actually dropped and he needed less insulin because he wasn't eating as much. But pain can raise BGs. So, every cat is different.

I would suggest watching him very closely for signs of feeling ill (loss of appetitie, etc.), test for ketones every day and hold the dose so it can settle out of the rebound. The 62 and 80 are beautiful numbers (although they were arrived at rather quickly in 3 hours from the preshot), but he isn't used to them yet so they are causing a bounce.

Please try for some later numbers after he goes to 60-90 before +6, even if you have to set an alarm and get up to test. He may be dropping even lower than 60. That would explain staying in the high numbers today. If he is dropping lower, you may need to back off on the dose. It would depend on how low he is going.

 

Can you just ask for subq fluids? He is only 13 - not an end stage cat by any means. Hydration is so important to cats and it can help with so many of the issues that diabetics face because of the tendency for them to get dehydrated from trying to "off-load" the extra sugar.

I add water to my cats' food - about a half can of water to one can of food. They all get it, even the youngsters. The only cat that drinks extra water is my very senior hyperthyroid kitty. Jeddie occasionally drinks when his BG is higher, but I haven't seen him drinking for a while now.

 

(LOL! Sheila and OI posted at the same time. ;-) )

Hi Mami,

I don't mean to monopolize the thread...others will be along as they can this afternoon, I'm sure.

I wanted to address what I "hear" you writing from your vet.

It is common among our experiences here on FDMB to encounter vets similar to yours, with the relaxed attitude you describe and the fatalistic thing- "oh, he is old and sick, so this is normal"... Nonsense! Our animals are part of our lives and our family and old, sick or perfectly healthy, we want what is best for them!

It is a rarity when one of our members has a vet as concerned as we ourselves are. I think it is common for many animal owners to do minimal effort to keep the animal comfortable, so when folks like us come along- the proactive and involved caregiver willing to go to special ends to meet our cats needs, they don't know what to do with us, or might not even recognize we WILL do these things.

It is my opinion that YOU know your cat...you are with him 24/7 and are familiar so you will know BEST what he needs. Tests are parameters to go by- heavy suggestions, but if you look at the individual, he might need more or less of whatever...

In this case, your Akane may be experiencing a mild Pancreatitis attack among other issues, even with such a low indicator, and so may need some comfort measures like pain meds, pepcid AC, syringe feeding, and yea, sub Q fluids.

You may be able to get subQ fluids without Vet Rx, but I would want my vet involved just in case. You want to be sure to consult them about how much fluid is needed...a Vet that visits here on FDMB says to divide the daily subQ ration into 2 or 3 parts so that cat receives constant rather than one big overload that pees out anyway. Many vets will say just once a day, but again I think they don't know we'd be willing to do it more often if needed. Generally between 25ml and 100ml at a time depending on the cats needs...again to consult your vet would be ideal.

When you decide on fluids, we can help guide you with specific supplies that work better than many vets will guide you towards and there is a great web page with lots of hints and tips to make it easier and more comfortable.

Is it possible to "request" the vet prescribe the fluids? and the pain meds? Buprenex is good, but not sure what you have there and buprenex is a controlled narcotic, too, so some are hesitant to Rx...usual dose of buprenex that I have seen between my vet and this board is .05ml/cc to .3ml/cc (that is in hundreths and tenths of one ml/cc, not a full ml/cc or 3 whole ml's) , however one of my old skinny civvies gets .03ml/cc or less, so it is a very small amount but works very well...most say to give twice a day, but my PK needed it 3 times a day through the worst parts.

Most vets here seem to prefill syringes, but my vet will Rx a vial for me to pull from as needed...you'll need a 18-22g needle to attach to end of 1ml syringe with hundreths and tenth markings, remove needle after you pull dose and put dose under tongue. I understand you can shoot subQ as well, but the tongue works well here. or inside cheek .Consult your Vet for best procedure. ( I just squirt and run before I get bit or scratched!..it works)

As far as binders, I have 4 old kitties in various stages of renal failure and treatments. I do NOT use the binders for various reasons, but try to get foods with the lower content and provide water and subQ as needed...occassionaly one needs pain meds to get over a bout of cystitis.

If you really would like to use the binders, I don't think you need a Rx- I could be wrong about that, though, and again there are some great sites we can link you to for more information. It would be great if your vet could be on board- maybe you can request instead of waiting to be advised?

I don't suggest you rush into vet with bad attitude or mean, but rather to remember that your Vet works for you, not the other way around. YOU pay them...it IS okay to request things and the worst that happens is they refuse to meet your request....If they think poorly of you after your request, that is the Vets shortcoming, not yours.

Maybe you can learn more about the several issues that bother you and take some copies of the information or email them to your vet if that works and see if they will discuss with you.

You may also mention that you are aware the vet feels these are end stage issues (not that I agree or think that, but you said your vet does), but enforce that you insist your cat be as comfortable as possible and this is how you want to make that happen...subQ's, binders, pain meds., etc...

Hopefully you can be assertive without offending the vet and you two can come to some agreements.

If all else fails, you can explaine to your vet that although your vet may feel it is a waste of time or money, it is YOUR time and YOUR money and you'd prefer to do it anyway.

I think as long as you are not dragging on a life that isn't sustainable- and Akane sounds NO WHERE near that, I would think your vet would just think you are too protective, shake their head in wonderment but prescribe these things anyway...that's what mine does! :lol: LOL!

What do you think about all that?

Also, remember others will be along soon and see what they say, too, before making rash decisions. ;-)

 

I did..every time I take him to the vet, I ask and the answer is "not yet". I know a vet who does sub q fluids as treatment for diabetic and also allows it at home but it is a little far so I was postponing to take him there. I will call nearby vets to find if any one allows it.

End of the stage remark was awful. It showed their ignorance, I think. I was ignorant at that time myself so I was devastated to hear that.

He has not showed any signs of p-titis flare up, to me at least. I will keep watching him closely and will try to test during the night but I do not think he dropped more after reading 60. From what he ate after that and from his response that I have known ..

 

Thank you, Melissa for all the info and encouragement. I will need sub q fluids at home for his kidney in future so I am now trying to find a nearby vet that does allow it. We cannot get the fluids at pharmacies. In the meantime, I am adding some water to his food and he is eating well. Sorry I wrote perhaps in a very negative tone.. I was upset. I can talk with our vet quite frankly and have asked many things to her including to be a receiver of imported syringes for us. She is a nice person but there are areas that I cannot push more against her views. And the common practice here is perhaps different from in US and probably behind..

ETA
He was 295 this morning. Held the dose. I will test him during the night at +6 today. It is always this dose - somewhere between .3 and .4 and he always seems to be stuck in the 200's range. I talked with the vet about dilution again yesterday. I found a topic in the old FDMB archives and found Pamela's name there regarding the same subject. Here in Japan it is thought to be OK to use diluted lev among vets and also Novo Nordisk told me so. (The words they (mfr people) used was "should be ok" because it is used when treating human with IV fluids. No data on either human nor cats.) Pamela, would you share your info with me? If it is inappropriate to talk about it here, would you PM me?

 

I order mine from http://www.bricomedicalsupplies.com/ , my needles, too. I use the 20g Terumo- much easier on the kitty. I order in quantity as buying 12 from them is equal to buying TWO from my vet directly! If I don't use them fast enough, I donate to shelter in need just before expire date.

I wondered about the general manner of communication there...I understand it to be more reserved than USA...so I wasn't sure how forward you could be with your Vet...also wasn't sure of animal status there- if animals are respected as property or loved ones or somewhere in between.

Here in WV, animals are mere property, however there are some Vets that are more inclined to see them as family members..my new Vet is like that and we appreciate it!

I am sure you are doing everything you can! I don't think there is much difference in advancement in US regarding FD....it seems the very rare vet that is up to speed with current practice...most here are "old school".

Thank you for sharing and feel free to share as you need to.

 

I think you just found a post of mine where I mentioned that Dr. Bernstein, in his book which I have a copy of, talks about diluting Levemir (and some other insulins, not Lantus) for children since sometimes they require such very small doses. Then he gives instructions on how to do that based on your doctor's recommendation of how much to dilute, i.e. 2:1, or 3:1 or whatever.

So I was just wondering what did your vet say the dilution was for Akane? I wonder also why he felt he should do that? No one here on this site does this for their cats so there is not much experience with it.

 

I'm sorry you're dealing with a complacent vet. If I had been told that Gandalf was end-stage at 13 I would have been a balling/screaming mess. He was diagnosed diabetic at 12 and he will be 18 this May. Unless a cat has other concurrent disease such as kidney failure, diabetes is NOT a death sentence and there is no end stage to it. MOST cats on this board have passed away from cancer or heart problems or something other than diabetes. Does diabetes complicate other health problems? Of course it does. But if treated as well as one can with insulin, diabetes is treatable and manageable to give the cat a long, happy life.

I'm glad to see you are staying with the .3/.4U range as that seems safest with the lows he has had. I'm sorry if others are not familiar with dosing in tenths of units. You are doing fine! Actually it's all over your posts how much you care for Akane and how much he means to you. I'm sorry it is so difficult to find a vet there who cares as much as you do.

 

Hi

Thank you all for your inputs and messages. Today he was hovering around 300 so my mind is a bit cooler.. (Yesterday I was too depressed and down.)

Melissa, it was interesting to know how the things are in US, or WV, too. I found out that now only a few companies accept order from Japan for medical products such as pet supplements or syringes due to strict customs regulation. I used Diabetic Promotion for syringes but Monoject I ordered have been stopped at the airport and I am now preparing necessary documents for the parcel to be cleared. Here, our vet and many vets still see our fur friends as just "pet", not family. So wrong!

Hi Pamela. Thanks for checking in here. I found a post by pawprint ? (forgot). Our vet said that if his requirement is as low as 0.5, they can dilute the insulin to x 2 for easier measurement. That is all. For measurement. You know that we do not have syringes with half unit markings in Japan. So it is very hard to dose even .5 and that is why she suggested it. And it seems it is quite common to do so here. She said that it can be diluted up to x3. Novo Nordisk people told me that it might be better to use dilution up within a short period of time because the preservatives are also diluted and it could become unstable sooner than the pure one.

ETA
The vet said she is treating a cat who is on diluted Lev and he is quite well regulated. And it does not stated on the package or any leaflets that "Levemir should not be diluted." here in Japan as it does in US.

Vicky. I felt so strong reading your comments. Thanks for your warm message.. I am glad I held the dose.