2/8 Sid and shooting IM

Sid was not feeling too well this morning and didn't really want to eat. I had to feed him about 50 mls through his tube this morning (food/water).

When I give him his insulin injections SQ, he shows no response the majority of the time. Not sure why this is happening but my vet made a very good point - that Sid has so little body fat that it is likely not absorbing the insulin SQ. He is down to 4 pounds and his skin/bones :-| That is why he is really pushing me to shoot IM and why I feel I have no choice but to try it. SQ injections are not working and Sid is developing ketones from not getting insulin! I keep hoping he will gain some weight back. When his glucose level is moderate (200s or less), he eats really well. He's been averaging about 1.5 cans/day. His order of Max Cal should be in tomorrow and I hope that helps to put some weight back.

I gave him an injection of a small amount <0.5U of R IM this morning and it seemed to work well. Thanks to Carl's advice, I took him to the vet and they shaved little spots on his haunches for me to make it easier to shoot IM.

I agree with everyone about how scary R is - it does bring Sid down super fast and does not last that long, but if he stays high, he develops ketones within a day so I feel I have no choice but to use R if nothing else is working. So far, R is the only insulin that works to bring him down but I can't stay up until 3 am every day so I can test him every 30 minutes and then get back up at 6 to go to work! Tonight I gave him a shot of Prozinc IM and will see if it works because I am working on getting him back on a long acting insulin. If not, it will confirm my thought that Sid needs to be on an insulin other than Prozinc.

Oh and the vet basically in so many words told me that I should keep sid at home and not bring him there every day while I'm at work. I was a little upset about that but honestly, they are right. Sid cannot just be at the vet every day indefinitely.



Hope everyone has a good day or evening wherever you are!






http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=63129

Lydia, sending vines and prayers for Sid and lots of luck shooting the IM. It does sound like you have no choice but to try it.

Best of luck with the IM shooting, Lydia...

and Binks says that the KTSS is on the way with soup, goodies, and some of Tobe's favorite "Cimmamum Cookies"
to help Sid put some weight back on.

May the Max Cal work wonders for him!

celi & binks

((((Lydia & Sid))))

You have a tough row to hoe, Lydia, and I hope that you will soon find the magic combination of insulin, food, meds, etc. to make Sid feel good and want to eat, and to keep those ketones away. I hope, too, that Sid will be able to take an IM shot without difficulty. And I sure hope that you can get a long-duration insulin to work. I forgot why your vet suggested Prozinc as opposed to Lantus. I would think that the Lantus shed would really help in Sid's situation.

It's good that the Max Cal will be available tomorrow. Fingers and paws crossed that it will help Sid put on some weight. I wish we could give him some of Rusty's extra ounces!!

Thinking of you and continuing to send healing vines, etc. etc. Would it be possible for you to hire a vet tech to watch Sid at home while you are at work (or to check in on him several times a day)?

Many :YMHUG: :YMHUG: :YMHUG: :YMHUG: s

Ella & Rusty

Thank you Ann, Celi, and Ella!
Tonight I gave him the prozinc IM and it appears to be working. I just checked him and at +2 he was 268. That is a good number for him!

When Sid was first diagnosed in November, he was on lantus but had a couple real hypo episodes and by real I mean non responsive and showing severe neurological affect and several near hypo episodes along with some very high readings - I know lantus is supposed to be peakless but it did not seem to work that way for Sid. The vets attribute that inability to stabilize to the underlying diseases of IBD, lymphoma, and probably pancreatitis not to mention the probably kidney infection that put him into DKA to begin with. I know some people have mentioned that Sid's numbers on the SS were pretty "normal" for lantus but Jake(GA) was on lantus and we never had these problems.

Whenever I tried to increase Sid's dose, he would end up going too low. When I lowered his dose, he went too high and that threw him right into DKA 3 times in less than a month and experiencing kidney failure the first time he was hospitalized. In fact, the vets told me in the hospital that his kidney values were so high that he probably had permanent kidney damage but now his levels are completely back to normal so far!!

My regular vet wants me to give Sid Humulin N (which I'm not doing) and the specialist wants Sid on a long-acting insulin but does not think lantus is not the right insulin for Sid's chemistry right now. he refers to lantus as too potent for him. I know many people call lantus gentle because it is supposed to be peakless and cats show little to no hypo reactions even in low numbers, but for whatever reason, it did not work that way with Sid. We are trying the Prozinc right now and the next one will be levemir.

I'm sending hugs for you and Sid. I wish you could take him to work with you or work from home. It must be so hard.

Remember to strain the MaxCal. It is very high in fat so you might want to try a smaller tube feeding the first time or two to see how he handles it. I think its worth its weight in gold. You can feed him in the middle of the night even to get some extra calories in. When Maverick was recovering after almost losing him we had to get extra calories in through the night. When he started recovering he needed less calories. For some reason and unwell cat needs more calories to maintain their weight than they would if they are healthy.

I wish I could give you and Sid a real life hug. Keep hanging in there.

Hi Lydia,

I was just wondering what his Prozinc dose is? I am glad you were able to do the IM shot without any trouble. Did Sid act at all like it bothered him getting the shot that way? If your vet's reasoning is that Sid is not absorbing the insulin when given sub-q, did he make any recommendation on dosage (a bit less maybe?) for the IM shots that is different? It will be very interesting to see if the IM shots show positive results quickly! If you need me to take a look at his SS or your condo, just PM me anytime. I'll try to check in each day.

Best,
Carl

Thank you Karrie! I've got my tea strainer all ready. I really appreciate your advice about that. We are hanging in there. My previous job was an hour away so I am very thankful now that I can come home every day on lunch if I have to. I can also leave midday if I need to for some reason so that really helps so much.


Tonight the Prozinc is bringing Sid down really fast too so I'm trying not to panic. I realize I said he was at 268 at +2 but I was wrong - that was +1 and he is now at 176 at +2. Not bad numbers but I always worry he is going to go too low. The prednisolone does not appear to raise his bg levels.

And he will not get away from the food dish. He keeps eating and eating and I'm letting him because he is so skinny. Maybe I'm doing a bad thing - the specialist told me to only feed him 2x per day - maybe 3 if he is going too low at +6 or so, but I just cannot feed him that little.

Thank you Carl! He is getting 1U of Prozinc and if I give R it is about 0.25 sometimes a drop or two more and not at the same time as the Prozinc.

I have not done a good job of keeping up with Sid's SS since he's been hospitalized the 3 times. I test him so much - almost every 30 minutes to every hour and I just don't know how to note all that in the SS. Plus sometimes I give Sid R insulin and sometimes Prozinc - it depends on how high his numbers are. Giving the Prozinc SQ - he was not responding at all so sometimes I would have to give him R to get him down. It seemed that even 1 day of Hi numbers and he would develop ketones. Tonight he is so far in the 150s! Just hope he doesn't go too low. I will have to figure out something about his SS because I know that is valuable information for everyone - just a little overwhelming for me to think about all the numbers I have to enter.

your advice about shaving an area on each haunch was invaluable. Sid did cry a little when I poked him the second time tonight - but he typically cried even with SQ injections. he does not mind the ear pokes at all but he does not like the needle pokes.

OK, so at +1 he was 268, and at +2 he was 176? What was his PMPS number?
Carl

Yay for Sid eating, I wouldn't be sticking to two or three time a day either, as long as he doesn't do the scarf and barf thing. Double yay for the IM injections looking like they may be working better on Sid

From what I have read Levemir is even more gentle than Lantus so that is probably going to be a great option for him. Also plenty of people here that use it that can help you out.

Also yay for Carl and his always being ready willing and able to help out where he can!

In regard to the ss, when I have done multiple tests in one hour (see for eg 02/02 pm on Vyktors ss) I just make the font a bit small and enter the various + whatevers e.g. if you have taken multiple tests after +3 but before +4 I would put +3.25 for quarter past the hour, +3.5 for half past, +3.75 for quarter to. I think you will just have to note the R in the comments section but maybe could also add a * or something where the numbers go to draw attention to it.

That's good advice about the SS Serryn. Thank you! Now I just have to get going on it!

Carl,
Here are the numbers tonight (forget what I told you earlier - I was not remembering correctly - but I am now looking at my notes so this is correct):
PMPS 285
+0.5 357 - ate a small meal
+1.25 268 - ate a small meal
+2.25 178
+3 113
+3.75 75 - gave him a couple whisker lickins just trying to avoid going too low
+4.25 40 - gave 0.4 ml karo + let him lick HC gravy
+4.5 47
+4.75 55

This pattern is typical of what he does on any type of insulin. Tomorrow I will drop his dose a little - around .75 or so and he will probably do the same thing. The specialist told me not to give him any karo until he is clinically hypo but I am not waiting until that point - that's for sure.

Hi Lydia,

I think I'd go along with the reduction to .75.
Kind of hoping he'd stay just a bit higher so you'd have had a chance to find out what the timing of the nadir was going to be without food effecting the numbers. Nice if he'd have a cycle where the low point was a nice low blue or high green.

It's easy for the specialist to say that....he's not sitting there watching kitty drop down to really low numbers.

Carl

Hang in there Lydia, you are doing so good with him. I hope the IM Prozinc works out for sweet Sid! cat_pet_icon

Lydia - I don't know if you know excel, but there is a way to enter multiple values in a cell - I think its Control + Enter does a return within the cell. So you can do +.1 +1.5 etc within a cell. It may help to have the data in one place.

Sending more hugs for today.

Hi again Lydia,
You can also click on a cell and add a comment. First click on the cell; then right click (Control click on a Mac) and a drop box will open up. One of the options is "insert comment". Type your comment and hit the Tab key to close the cell. A small triangle will appear in the upper right-hand corner of the cell. When you put your mouse on this triangle, you can see your comments.

I hope that today will be a good day for Sid and that the reduced dose will help.
Thinking of you,

Ella

good morning, lydia.

one of the benefits of using prozinc is not having to shoot the same dose consistently. dropping the dose to 0.75u is a good idea when you won't be around to monitor, but with sid's history of ketones and multiple episodes of DKA you'll want to get as much insulin into him as safely possible when you are around to monitor... even if it means feeding him high carb food throughout the cycle.

low levels of insulin + inappetence + infection/other systemic stresses is the recipe for developing ketones. when a kitty is prone to ketones resulting in repeated episodes of DKA you'll find you almost have to ride the edge with how much insulin you're giving. with ketones, the BG number doesn't matter. the amount of insulin getting into the cat is what matters. so if you have to feed HC throughout the entire cycle in order to get more insulin into the cat... so be it.

BG numbers and ketones have no connection. a cat can throw ketones at a BG number of 120 or 520. the only reason BG numbers seem to have a connection is that a BG number of 520 sends up a red flag that not enough insulin is getting into the cat while a BG of 120 doesn't arouse concern. a diabetic cat can be in full blown DKA with a BG of 120 from not eating, vomiting, and being septic. most won't, but it can happen.

when you get a chance, please take a look at Grace's ss: https://docs.google.com/spreadsheet/ccc?key=0Ah416fWwiPUwdHc0RzFnRkVZaHlwNkRSYjlVSVpVWkE&hl=en#gid=0.
grace is very prone to ketones. her ss illustrates the need to get insulin into the cat even if you have to manipulate the curve with food to prevent kitty from going too low.

it's imperative to get an adequate supply of insulin + food into him to avoid ketones.


just some thoughts. hope today is a good one for both you and sid!

Thinking of you and Sid The Conquerer today!

Lydia --

I really want to underscore Jill's point. When Desi was dealing with Tawny being DKA, I somewhat jokingly told her it didn't matter if she fed Tawny a hot fudge sundae -- give as much insulin as necessary to beat back the ketones and feed whatever food, HC or otherwise, that she needs to feed to balance the insulin and get calories in. If you consider what they were doing at the hospital, they were giving insulin (R and whatever other basal insulin) along with a dextrose drip to balance each other out, in order to control the ketones. You can shift around the PZI dose -- you're not dealing with a shed which will cause wonky numbers.

Hi guys .. lots of good advice here .. lots of love here for you and sid .. Keeping you guys in my thoughts .. hope you both have a great day!

((((((Lydia & Sid))))))

sending our strongest healing vines Sids way.

with my BK being a 2 time DKA survivor, I'm adding my voice to the "importance of enough insulin & enough calories" chorus.
the insulin will help Sids cells use glucose as a source for energy.

hang in there.

adding my support . . . you're doing such a wonderful job caring for him. i would think you should give him as much food as he wants. with sid at 4 lbs, what was the vet's rationale for only feeding twice a day?

you and sid are in our hearts! :YMHUG: