? Yum is a bit off today. Dose increase? Should I take her to the ER?

Discussion in 'Lantus (Glargine) / Levemir (Detemir)' started by MJW, Apr 4, 2017.

  1. MJW

    MJW Well-Known Member

    Joined:
    Mar 29, 2017
    Yesterday my vet told me to hold the dose at 2u. Since Yum can be spooked, she said prioritize administering the zeniquin antibiotic over the testing until we try a curve on Wednesday. I did get some tests done yesterday as you can see on her chart. She doesn't seem to mind the tests when she comes to me for brushing and massages: I just have to avoid grabbing her or spooking her. I heard her gagging this morning shortly before breakfast---no sign of vomit. She finished most of her dinner overnight (the Fancy Feast and DM Savory Selects that she likes), but not the plain DM clump of food that she likes least. She ate the DM clump yesterday during the day, so her appetite was down a tiny bit last night. This morning she dug into the Fancy Feast and I gave her the shot, but she hasn't made any more repeat trips to the breakfast plate. I got a good urine sample. She is negative or trace ketones: it is so hard to match those colors on the label. When I made the mistake of trying to grab her, she ran outside. She is sleeping on the patio. I tried to get her interested in a treat of sardines, but she didn't go for it. The lead vet is off today. The tech says maybe she needs to go to an ER for IV and regularization with regular insulin.
    My current plan is:
    See if she eats more before noon when she is due for her zeniquin tablet.
    If she continues to be "off", grab her when I can and take her to the vet so the tech can do a good BG and ketone test. (I need to make the most of the "catch".)
    Decide at that point whether or not to take her to the ER.
    I suppose the zeniquin could be upsetting her stomach or making her "off".
    She can be very evasive. I am worried.
     
  2. MJW

    MJW Well-Known Member

    Joined:
    Mar 29, 2017
    Now the tech says wait until this evening to see if she eats before going to the ER.
     
  3. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Aug 17, 2016
    Antibiotics can certainly make them feel unwell and not want to eat. If she prefers the FF give her that. Her numbers are high and not eating along with an infection are risk factors for developing ketones. Good job testing for those!
     
  4. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    Some antibiotics can damage the tummy flora. You might want to add a probiotic to see if it helps. Give it at least two hours away from the zenequin.

    How are her litter box contributions? If she's constipated that could cause some gagging.

    Sending vines, I hope Yum feels better soon.
     
  5. Tracey&Jones

    Tracey&Jones Well-Known Member

    Joined:
    Dec 12, 2016
    She can be off due to the higher numbers, I know Jonesy was - I thought he would eat more in the high numbers but it is kind of the opposite for him, lower numbers he eats a little better and more active.

    I know about those colours! I just went what was closest by consensus in my home, however Jones never tested posted for keytones in the vet checks so I tended to lean in that direction. Sorry, I don't remember, did Yum have DKA before?

    Is decreased appetite one of the side affects mentioned by your vet for this particular medication or if it needs to be given with food? With Jones I tend to wait a 1/2hr to 1hr after eating then give him his pills. I found sometimes he would head back to the bowl if I just waited and ate more. Always offered a treat to with the pills, I even fell back to the Temptations (just 1 broken in two) to ensure he has something in there when he was off. Are you giving any probiotics? I noticed that helped a lot with Jones.

    Feed her what she likes though...I let Jones guide me on what was on the menu (within the carb restrictions of course) even if that meant opening a new can and just putting the other in the fridge for later.
     
  6. MJW

    MJW Well-Known Member

    Joined:
    Mar 29, 2017
    Thanks for the FF recommendation! I popped a can when she came inside and she nibbled at that. Then she went back outside to watch for lizards. I guess she's not at death's door just yet.
    One vet said the antibiotic can upset the stomach, but I don't see that emphasized online. The online instructions don't say dose with food. There are lots of things like calcium she can't have within 2 hours on either side of the antibiotic. Her litter box contained a normal bowel movement this morning.
    Thanks for the probiotics suggestion. I see there are some just for cats.
    I think I read 3 days of trace ketones are okay before declaring an emergency. Is that correct? She might be negative. She is certainly less than "5 mg/dL". She has never shown ketones at the vet. No DKA.
     
  7. Tracey&Jones

    Tracey&Jones Well-Known Member

    Joined:
    Dec 12, 2016
    This is what Wendy (Wendy & Neko) advised when I asked her.

    As for probiotics, I use the Natural Factors Protec, on recommendation of the vet. They are made in BC. You can get the Renew Ultimate products mentioned on the IBDKitties website in quite a few stores around here, from Canadian Superstore (organic cooler section) to Whole Foods to vitamin shops.

    Not sure if you can get them around you or not. It helps Jones out. I just put a 1/2 capsule stirred into this food. Or you can try the purina fortiflora. That help Jones to start with but because of his illness once he decided he was off it I couldn't get him to use it again.
     
  8. GinnyBarr

    GinnyBarr Member

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    Apr 1, 2017
    My vet recommended the Purina Fortiflora. My cat loved it. Mushed it right into her wet and she gobbled it up.
     
  9. MJW

    MJW Well-Known Member

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    Mar 29, 2017
    Her numbers are so high. Should I try to get up in the middle of the night for a test to see if there is a bounce then? I just find it hard to believe she is bouncing since her numbers are so uniform and she has been on this dose for 5 days. The lead vet won't be back until Thursday. Yum is definitely feeling worse today. She is eating and drinking some, but way less than usual. Is it the diabetes or the antibiotic? I just have no idea what is going on.
     
  10. MJW

    MJW Well-Known Member

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    Mar 29, 2017
    Poor appetite and drowsiness are side effects of zeniquin. I will attribute her symptoms today to that. I was thinking they would have come on yesterday after the first dose, but it probably takes time. They are pronounced.
     
  11. MJW

    MJW Well-Known Member

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    Mar 29, 2017
    Now they are thinking I should increase her dose from 2u to 3u tonight. And if her appetite doesn't improve, take her to critical care tomorrow. Any feedback on that?
     
  12. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    She does need a dose increase and normally we recommend going up by 0.25 u or 0.5 u. However, she's been quite high for a while and if she's not eating well, ketosis is a danger. In your situation I'd go for the full unit increase.
     
  13. MJW

    MJW Well-Known Member

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    Mar 29, 2017
    Okay. I guess we'll do a dose increase.
    I did just get another clean urine test. Still between negative and trace (5 mg/dL) in color. She will still eat sardines but she's not cleaning the plate..
     
  14. MJW

    MJW Well-Known Member

    Joined:
    Mar 29, 2017
    What motivates a trip to critical care?
    1. ketones
    2. hypoglycemia
    3. just not getting her bg down? Is this a motivator for ER/critical care? Do some cats fail on lantus? Certainly I will need to see a specialist.

    I dipped another test strip. In natural light, I really can't tell the difference between a water moistened and pee moistened strip.
     
  15. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    If:
    • kitty isn't eating or is vomiting
    • is dehydrated
    • has an infection
    • isn't getting enough insulin because of not eating
    • tests above trace for ketones
    take the kitty to the ER right away.

    If:

    • BG is very low
    • hypo symptoms are present (stumbling, staring, yowling, confusion, walking into things, have a seizure, etc.)
    take the kitty to the ER right away.
     
    Last edited: Apr 4, 2017
  16. MJW

    MJW Well-Known Member

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    Mar 29, 2017
    Thanks for all the responses today!
     
  17. Tricia Cinco(GA) & Harvey

    Tricia Cinco(GA) & Harvey Well-Known Member

    Joined:
    Jul 18, 2011
    Hi and welcome to Lantus & Levemir Land - the nicest place you never wanted to be.:)

    We only recommend increases of a full unit for cats that are already on very high doses (we're talking double digits). A quarter unit of insulin is a lot more for a cat than you might think. If you take such large increases, you risk missing the purrfect dose and end up with an overdosed cat. Too much insulin can sometimes look like too little.

    I always found that my cats did better when I gave an antibiotic after they had eaten. Unless a medication specifically says not to give with food, it's usually easier on the tummy to give it with.

    I notice you have almost no tests at shot time. This is a risky way to give insulin. Remember, it is a hormone, not a drug, and its affect waxes and wanes. We strongly encourage everyone to ALWAYS test before giving insulin, to be sure it is safe to shoot. Never assume, based on earlier tests, or how kitty is acting, that it is safe. We have had kitties end up in the ER with a hypo because the owner was "shooting blind". :eek:

    If you haven't already, I encourage you to read the stickies at the top of the Lantus & Levemir page. There is a lot of info there, and it can be overwhelming, but the more you learn, the better prepared you are to help Yum. Here is a post we put together to help new members get up to speed with using this site and learn how to help their diabetic kitties: http://www.felinediabetes.com/FDMB/threads/updated-tips-for-new-members.173572/

    Ask lots of questions. We love to help!
     
  18. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    I would not increase the dose by 1.0u unless you are planning on being awake for the next 24 hours to monitor. You may not see a dramatic response to that huge of an increase in one cycle. The most we advise anyone to increase is 0.5u is the nadirs are consistently high.

    From the Tight Regulation Protocol:
    I realize you may not be following TR. However, this gives you a sense of what is safe to do. Like Tricia, I would be extremely reticent to suggest a 1.0u increase. That type of increase is 2 to 4 times the amount that would be safe for your cat.

     
  19. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    I agree with Tricia and Sienne, a 1.0 unit increase is not safe at this dose. My Neko got up to a high of 8.75 units, and the largest increase we ever did was 0.5 units.
    For some cats, Lantus is not the best insulin. But for cats that are started on a safe dose and increased safely with appropriate monitoring and careful dose increases, most cats cats will eventually see good numbers with Lantus. You are still early days. The reason we keep stressing the testing, is that it's possible for a cat on too much insulin to have high numbers. Without appropriate testing, we don't know if the dose is too high, or too low. I know you have issues with testing her, but over time this will become easier. :bighug:
     
  20. MJW

    MJW Well-Known Member

    Joined:
    Mar 29, 2017
    Okay. I will try to test her PMPS tonight.
    Unless I succeed and find she is under 400, I will increase to 2.5u. (I understand PMPS is probably not her nadir.)
    3u does seem way too aggressive to me, since: (1) it's night time; (2) her appetite is off; (3) we are hoping the antibiotic will decrease her insulin resistance.
    I will try to test her AMPS tomorrow. Unfortunately, recently, I have not been enthusiastically greeted pre-breakfast.
    Yum is an ex-feral. She probably trusts me with her life, but sometimes she takes some convincing.
    I read and reread the stickies, but they are overwhelming and my mind is clouded by fear and anxiety.
    I don't feel like it's "early days" since she went into remission after just a few days on Lantus (plus. diet change) this past Christmas.
    The return of the disease was an unexpected shock and her case is so much more difficult this time.
    Thanks again!
     
  21. rhiannon and shadow (GA)

    rhiannon and shadow (GA) Well-Known Member

    Joined:
    Jul 9, 2012
    things that might entice a cat to eat....

    fried chicken, peel off the fried skin.
    cheese
    scrambled egg
    deli meat ( without sugar)
    human quality canned tuna
    baby food, stage 1 , meats only, no onions

     
  22. MJW

    MJW Well-Known Member

    Joined:
    Mar 29, 2017
    Well. We're down to 409 a half hour before PM shot. That's lower than almost all her numbers for the past week. Maybe the antibiotic is working.
    Do I increase to 2.5? Or do I hold 2? She ate less today, that might have made it lower. I could split the difference and go 2.25.
     
  23. Tricia Cinco(GA) & Harvey

    Tricia Cinco(GA) & Harvey Well-Known Member

    Joined:
    Jul 18, 2011
    Sorry no one saw your question. Next time, if you change you subject line to reflect the fact that you have a question, you should get a response in time (ask if you don't know how to change it). Good job getting that PMPS! It looks like you stuck with the 2 units. I think that was a good call. If you can get at least one test tonight, maybe before you go to bed, it would be helpful.

    Have you seen this post? http://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/ There are a lot of good ideas to help you with testing. Are you warming the ear first? Are you giving her a treat every time, whether you are successful at getting blood or not? Many people start by just rubbing the ears, then giving a treat when the kitty allows it. Then they move on to testing, always giving that treat. Some cats are very food oriented, and once they figure out there is a treat involved, will put up with a lot. I would try not to "grab" her, but approach her gently and just love on her first. Make a point to do that several times a day, without the test, so she doesn't just associate that with testing. It takes patiences, but you can get her used to it. I used to have to put my Harvey in a towel, burrito style, and later in a cat sack, to give him pills or test, but eventually he figured out it was a lot easier to just let me do it and get the treat. Hang in there!


    This is totally normal. There is A LOT to absorb. We try to give you links to the pertinent parts when a particular issue comes up, so if you try to read those, that might help it seem less confusing. Ask questions when you don't get something. We were all new and scared once, too! We understand.
     
  24. MJW

    MJW Well-Known Member

    Joined:
    Mar 29, 2017
    Lots of good advice. Thanks.
    And just now I found her noon dose of zeniquin on the floor. She must have cheeked it and spit it out. Maybe that's why she ate dinner. Just have to try and laugh and hope for better results tomorrow.
     
  25. julie & punkin (ga)

    julie & punkin (ga) Well-Known Member

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    Feb 17, 2011
    If your "should i take her to the er?" isn't a current question, it would be good to edit it out of your thread title just so people don't worry. Use thread tools at the top right of your screen to make it current.
     

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