10/17 Ruby AMPS 136 not eating - skip shot?

Ruby has not been eating well since last night. She ate some of her food so I gave her the shot (increased from 1.5 to 2 U two days ago). Woke up this morning and she didn't eat most of what was in her bowl and now is not interested at all in her morning meal and only took one lap of canned salmon juice, which she loves. Have not given her the shot yet. Should I skip? Gave her a little Mirtazapine.

 

Hi Catmom,

Just seen this. Looking at SS, BRB...


Mogs
.

 

Thanks. Sorry that I didn’t fill in any data for last two days. Wanted to give both of us a chance to recoup from the stress of testing for a bit.

 

I can't see any insulin dose info after the AM cycle of 14 October. So I can get an idea of what's been happening, is it just that you haven't got round to updating the SS or have you been skipping any doses (I'm trying to get a handle on where the depot is at right now).

Also, I see from the spreadsheet remarks that Ruby has been having problems with vomiting and lethargy over the past few days.

Some key questions:

1. Has she been to the vet for the above symptoms?

2. Have you any ketone strips at home?

3. Overall, has Ruby been eating enough over the past few days?


Mogs
.

 

Thank you! Ruby perked up after her dose was increased on Tuesday night. She was eating very well until last night. Her ketones have always shown negative-trace but has not varied from there. I filled in the blanks with her shots but I didn’t do any testing over the past two days.

 

https://www.felinediabetes.com/FDMB/threads/10-17-ruby-amps-136-not-eating-skip-shot.237026/

Just linking your Lantus board post for the duplicate post on both. Not sure which one you want to continue on?

 

If I could continue here that would be great. Should I delete the post in Lantus?

 

I don’t think you can, but I will post on there that you want to continue on this thread. They are linked, so others will know where to find us

 

Keep testing for keytones.

 

OK. She hasn't been drinking much, took a lap or two of some canned salmon juice I put in front of her this morning, so but I will try with the Ketodiastix as soon as she pees again.

 

Oh, ok. On your SS, you can write NS instead of the shot dose if and when you skip. That way users can see that insulin wasn’t given.

No worries though. No food = no shot is the general advice. If you aren’t sure if kitty will eat, it is tough to give insulin in case you need to steer the numbers later.

If you don’t have to stay on schedule, you could continue to stall for another 20 mins before deciding to see if her numbers come up and see if tummy has settled and will eat to be eligible for an insulin shot this am. With a history of DKA and trace ketones, it would be nice to get some insulin on board if kitty will eat after the mirtazapine.

Something to consider, and maybe @Critter Mom and @jt and trouble (GA) could chime in, is a token dose since you are SLGS.

 

SS updated with more notes. Very sorry now that I skipped testing over the past two days...

 

I dont give dosing advice but considering the history, if this was MY cat, I would give a token dose (unless of course you decide to stall and retest...) food and insulin are essential to protecting from keytones.

 

Ok. What would be a token dose? .5?

 

Any luck on getting Ruby to eat a bit?
How long are we past normal insulin time now?

 

Put her in front of her food again and not eating. We are +2 past normal insulin time. @thebigfuzz

 

@thebigfuzz would know better than I

 

Hi again,

Just checked the other thread and the SS again.

I agree with Tanya about skipping because:

* Ruby's off her food today and has had a few GI upsets in recent days.
* She had been lethargic but perked up since the dose increase (otherwise would be even more concerned about ketones).
* You're testing for ketones and thus far results have been neg-trace. (As Jeanne recommended, please keep testing regularly, esp with food issues and a skipped dose).
* The depot for the 2IU dose is just getting going now. Because it's early days of treatment there's little mid-cycle data to enable you to properly assess how low this dose might start taking Ruby.

I hope the mirtz will help Ruby, but if she doesn't start eating well today I recommend you get an AM+11.5 test today and post for dosing advice tonight (probably best place would be the Lantus board - more footfall, especially at weekends). That'll give a bit of time for someone to answer your post and still hopefully keep you on schedule. With the hint of ketones in the mix - especially when appetite is iffy - it's not good to skip much and you should be able to get advice about token dosing if it's needed.

It might be a good idea to also put a call in to your vets to let them know about the vomiting and likely nausea issues that Ruby's been having for the last few days. They'll be able to advise you whether a physical check-up is needed and they should be able to give you something to help the nausea.


Mogs
.

 

thanks Mogs

Ive shouldnt have given an opinion BAAAD jeanne Baaad

 

Thank you. I am going to go out for a run now to clear my head a bit. Ruby's getting a bit annoyed that I keep picking her up to put her in front of her food so I think a run would be good for both of us. I will test at +11.5 today and post in the Lantus forum.

 

I agree with @Critter Mom

It seems like a skip now that we are 2 hrs past normal shot time.
You will have some of the depot in play today during the am cycle, but it will start depleting, so posting before pm will be important.
If Ruby is still lethargic and not eating, I would put a call into the vet - especially with history of DKA and ketones.
Keep testing for ketones through the day, if you can.

For future reference, a token dose is usually 25% of the normal dose. So in your case, that would have been 0.5 units had you given insulin today. I’ll post a link to the SLGS sticky in a bit. It also has guidance on lower than normal preshot numbers and information on how long to hold a dose.

 

Here is the sticky on SLGS as promised some great info there! Enjoy your run!

https://www.felinediabetes.com/FDMB...-low-go-slow-slgs-tight-regulation-tr.210110/

I don’t check feline health board often, but if you want to post on Lantus tonight, I would post on your today’s thread there. Just remind users to check this link if they are advising

 

thanks Tanya

 

Oh, and you might want to do a spot check test after your run. Since the depot is still a bit in play, and not wanting to eat, you’ll still want to make sure the numbers are still in good range for SLGS (above 90).

 

Ok, will do! I just spoke with her primary vet, and he also suggested testing before next shot time and skipping dose then as well if she's not eating and BG is still in the blues. I'm going to pick up some Cerenia from him as well on my way home from my run to give to her to see if that helps with the eating.

 

Truly running out to pick something up!

 

Really glad the vet was able to help! Fingers and paws crossed that Ruby will feel the better for the Cerenia.


Mogs
.

 

Thank you! Just praying she eats so that we don’t have to take another trip to the emergency room!

 

Fingers and paws crossed that she will. This time round, though, you've got the knowledge and the tools to help you combat ketones and your regular urine testing should catch any potential uptick, enabling you to tackle them in a timely fashion.


Mogs
.

 

Hi there , You need to do more tests during the PMPS night cycle, also some of your AMPS and PMPS are not filled in, did you not test ?
Cats seem to drop lower at night, you want to be sure to keep Ruby safe

 

Ahh yes, I was going to mention that after we got sorted this morning. Thanks @Diane Tyler's Mom

On SLGS, you always want to get a preshot test on both am and pm cycles. You want at least 1 mid cycle test on each as well. More, if you are monitoring a lower number and making sure kitty remains in safe numbers (90-150). Reductions of 0.25 are earned anytime kitty drops below 90.

On the pm cycle, many of us grab a +2 test to determine if we need to set an alarm or stay up for more monitoring. If the +2 is the same or less than the preshot, you might (but not always) see an active cycle where you’ll want to monitor more.

If you are a bit concerned at the am test, you can do the same and start with a +2 and go from there. If preshot seems ok, you want to get a mid cycle test somewhere like what @Diane Tyler's Mom suggested so well.

Once you learn how your kitty responds to insulin and the curves overall, it gets easier to know what is best in a variety of situations

 

Thanks for the reminder! I know I should be doing this, but Ruby hates the testing, I have to chase her until she's too exhausted to avoid the prick. I don't know if I'm doing it right because her ears are lined with scabs. I know getting the numbers is important, especially so all of you wonderful people on this forum can help me in the best way you can. I will try to do better!

 

Poor Ruby sometimes I get a nice warm tissue and rub the ears with it.
Do you have Neosporin Ointment with pain relief?
Do NOT but the cream.
You can put a thin layer on her ears.

 

I have the cream, not the ointment. What is the difference between the two?

 

I forget but everyone on here says DO NOT use the Cream

 

The ointment helps the blood drop stay as a bead.
The cream makes the blood go all over the place.

 

I was at the drug store and thought to myself, get the CREAM not the OINTMENT! I totally got it wrong.

I have Vaseline. Could I put the cream on and then Vaseline?

 

The ointment helps the blood "bead up" (think oil and water) where the cream can actually help the blood drop wick into the fur.


I did a search on the board and found what a member said

If you ever want to find something out go to the too and type what you want to find out, or something you may be looking for, you will then see a lot if post that might have the word you search for . That's what Info and find a lit if things I may be looking for

 

I would just use the vaseline myself until you buy the ointment

 

Vaseline works a treat to help the blood bead up. I'd suggest using just the Vaseline for the time being. You only need a thin film so wipe off any excess with a tissue or cotton pad before doing the poke.


Mogs
.

 

Has Ruby managed to eat anything yet?


Mogs
.

 

Are you having trouble because her ears are black?
Are you using 26 or 28 gauge lancets, they will make a bigger hole
Try to get one of those small flash lights and hope it in your mouth and shine it on her ears, I know it sounds crazy but it might help.

I see someone posted the diagram for you on another post, I'll post it again

 

I'm doing the pricking in the right place. Every time the needle touchers her ear though, she flicks it, so the prick goes in probably deeper or it scratches her skin. Her fur is very dark gray on her ears so I can't see very well (have to put on my readers to get close in there!). I use 28 gauge.

 

1. Warming up the ear, as someone already mentioned with the nuked sock filled with rice, is key. Her ear needs to be warm to the touch and then I know I’ll get a nice size droplet
2. Start with a larger lancet gauge like 28 or even 26. They make slightly bigger pricks and you’ll get more blood out. As you get better at it, you can switch to a 30 gauge - larger numbers indicate smaller needle tips
3. I use a few cotton ovals that I place behind the ear for support so it’s a) easier to apply the needed pressure with the lancet and b) it protects my finger in cases the needle does go through
4. Apply pressure with the cotton oval onto the spot after you got the blood out so it won’t bruise. You can also apply some Neosporin ointment, not the cream
5. Always aim for the sweet spot

6. As the ears get used to bleeding and grow more capilares, it gets easier to get the amount of blood you need on the first try. If she won’t stand still, you can get the blood onto a clean finger nail and test from there

 

Yes, she did Mogs. I recounted the story on the Lantus board but basically when I came home from my run I discovered she had left some diarrhea in the litter box which was concerning. I gave her the Cerenia and about a half an hour later she started really chowing down on food and even drank some water. I tested her at +6 and she's holding steady!

 

I read that some people prick on the inner part of the ear, the other side

 

I did that this morning and it bled a lot. I might try it again when I do her +11.5.

 

Really glad the Cerenia's helping Ruby. It's great that the vet was able to give you the Rx quickly. It's much easier to keep a kitty eating than trying to get the appetite going again from a standstill.

If the diarrhoea persists, I'd suggest giving the vet a ring again.

(((Ruby)))


Mogs
.

 

Aww Poor Ruby, these cats can drive us crazy. If you try on the outside again and you get a little blood and she doesn't flick try and milk it.
Get you finger and push underneath where the blood us and it should get larger.

Good luck and I'm glad she ate better