/28April20/+8:59/Will/Can Not Eat

Discussion in 'Lantus / Levemir / Biosimilars' started by bambinaki, Apr 28, 2020.

  1. bambinaki

    bambinaki Well-Known Member

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    Last thread: http://www.felinediabetes.com/FDMB/...etance-vomited-weird-poo.228884/#post-2562770

    I am tentatively grateful and relieved that Maxi is much better now. I earnestly hope he stays that way.

    I worry that his awful symptoms and suffering were due to the cabergoline. I can't simply stop it; it has to be tapered off. I don't know if I should stop it or not. And if I should stop it, how to go about the tapering off?

    Thank you
     
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  2. bambinaki

    bambinaki Well-Known Member

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    Last edited: Apr 28, 2020
  3. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Are you stalling?
     
  4. bambinaki

    bambinaki Well-Known Member

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    If you mean not feeding, no
     
  5. bambinaki

    bambinaki Well-Known Member

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    He's eating now with quite good appetite, but I have qualms about shooting at this number since it's gone down
     
  6. bambinaki

    bambinaki Well-Known Member

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    Last night PMPS 241
    PMPS+2 265
    PMPS+6 156
    PMPS+ 8 167
    PMPS+10 163

    Now AMPS 142
     
  7. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Karen, I really don't know what to suggest. The 142 is quite a bit lower than you have shot before.
    As I said the day before yesterday I don't feel qualified to advise you.
    I know Marj doesn't like BCSs but I don't think I would give the full dose, but that is just my opinion.
    He looks like he is coming off a bounce with those numbers.
     
  8. bambinaki

    bambinaki Well-Known Member

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    Oh, sorry Bron, I thought you felt comfortable about insulin alone. I don't think I'll get a response from the others.
    Not only is 142 lower than numbers I have shot before, it has gone down from the numbers of last night, even though by now it should be back up.
     
  9. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    I am comfortable with dosing issues but Maxi has so many other things going on as well and I don't want to suggest something that might not be a good idea.
    What are your thoughts?.
    I think he is coming off a bounce.
     
  10. bambinaki

    bambinaki Well-Known Member

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    I still have not grasped the what bouncing is.

    I just read this:

    So how do you know whether to give more insulin or less? First you decide whether or not there is any possibility that hypoglycemia is occurring -- if the cat is unregulated and never has a BG reading below 200, you're probably not seeing rebound.

    If hypoglycemia is an unconfirmed possibility, simply decrease the insulin by 20% for three days and see if the spikes disappear. Since food causes blood glucose to rise, it's impossible to differentiate a Somogyi spike from a post-peak food spike -- another argument in favor of restricted feeding.
     
  11. bambinaki

    bambinaki Well-Known Member

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  12. bambinaki

    bambinaki Well-Known Member

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    So, I have no clear thoughts, other than feeling wary of shooting at this number considering it's come down while it should have come up by now.

    If he IS coming off a bounce, what it the protocol for that?
     
  13. bambinaki

    bambinaki Well-Known Member

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    I guess I will have to wing it and trust my own uninformed judgement. I'll shoot 8.75 in a few minutes unless otherwise directed.
     
  14. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Bouncing happens when a cat drops fast, too low or lower than he has been used to.
    Maxi dropped low a couple of day ago and also had a skip.
    Now his numbers are coming back down and sometimes when they come down they can go lower than normal.
    The main thing is to keep Maxi safe.
    The other ladies who have been helping you would probably have a different view from me as they know Maxi and may be more confident of what is happening.
    In my opinion, with so many other things going on with him, I would give a reduced dose.
     
  15. Olive & Paula

    Olive & Paula Well-Known Member

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    Remember, the higher dose is still active. Those blues are not a bad place to be either.

    How about 7 units? If your home to monitor.

    Ollie does this every couple of months. Chasing down ladder. Skipped doses, half doses she will just run no matter what you do. Then you get a break for a day and she does it again. That's the combo of caber and insulin working togethet.

    You don't want to skip to much or you will end up going back up in dose.
     
  16. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Are you able to test during the while cycle, have plenty of test strips and have high carb food and honey if needed?
     
  17. bambinaki

    bambinaki Well-Known Member

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    OK, I'll shoot 7 units.

    PS: He didn't have cabergoline last night.
     
  18. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Yes I think 7 units is a good dose @Olive & Paula. Thanks for dropping in.
     
  19. bambinaki

    bambinaki Well-Known Member

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    Yes.

    Are you still with shooting 7?
     
  20. bambinaki

    bambinaki Well-Known Member

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    Alright, here I go to shoot 7.

    Thank you!
     
  21. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Yes 7 units. Get a+1 and 2 to start with and see how he goes.
     
  22. bambinaki

    bambinaki Well-Known Member

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    I will do that. Thank you, Bron. You're a saint.
     
  23. Olive & Paula

    Olive & Paula Well-Known Member

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    7 it is then. If all goes well, you go back to 9 tonight. As I said before caber because it was a low dose could just be starting to kick in. I think I would give caber separate from food though. You don't know if the ingredients in the binder and the caber at same time are compatible until you Talk to the pharmacist. And all that in the food alone could make Maxi sick.
     
  24. bambinaki

    bambinaki Well-Known Member

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    I just went to disarm my home security alarm, and instead of the passcode, I entered Maxi's last glucose number.
     
  25. bambinaki

    bambinaki Well-Known Member

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    Thank you, Paula. Thanks for answering my plea. I will call the pharmacist now.
     
  26. Pamela & Amethyst

    Pamela & Amethyst Well-Known Member

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  27. bambinaki

    bambinaki Well-Known Member

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    Here's what the pharmacist said:

    • Mixing cabergoline with binder should have no adverse effect

    • Mixing cabergoline with food or giving it straight -- no difference.

    • Even though Maxi was taking cabergoline for a month without issue, the previous few days of decreased appetite and the last 2 days of awful sickness, the medicine might not have made him sick before but did later because of build-up in the body to a non-tolerable point.

    • Even though Maxi got meds yesterday to alleviate symptoms, his getting so much better without cabergoline suggests it was the cabergoline that made him sick.
     
  28. Olive & Paula

    Olive & Paula Well-Known Member

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    Guess the pharmacist would know. But I don't think I would give it up so quickly without trying some changes first.

    Another thought. Maybe every other day would work fine for Maxi. What was his IGF?
     
  29. bambinaki

    bambinaki Well-Known Member

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    I got an answer from the pharmacist that I'll go with.
     
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  30. bambinaki

    bambinaki Well-Known Member

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    Yes, I'm not happy about possibly giving up on the cabergoline. I will give him a reduced dose tonight.

    The pharmacist recommended this tapering off protocol, if I choose to do so: reduce dose by 1/4 every few days.

    If I have it straight, his IGF was 500, and his IAA was 0. I could have that backwards. Anyway, I know one test showed that he does not have insulin resistance and the other showed that he has acromegaly.
     
  31. bambinaki

    bambinaki Well-Known Member

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    So, while Maxi's diarrhea has stopped and he is able to eat again, he still keeps hiding under the bed, so I know he doesn't feel well.
     
  32. bambinaki

    bambinaki Well-Known Member

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    He has come out and purred for me.
     
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  33. Olive & Paula

    Olive & Paula Well-Known Member

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    the IGF is the acro test. Being that high I would not give it up easily. Try giving the 30 mcg every other day by itself. See if that makes him sick. Like pharmacist said he was on it long enough without an issue. Maxi might have just had a tummy upset from anything. You won't know if it's the caber until you try it again. Then if he is sick you know that's what is probably the cause. Ollie has bouts of being sick but it's usually the p'titis or straining from poop after constipation. She has to many good days in a row for caber to be blamed. And Maxi could have been I'll from that stretch of greens he isn't use to and any hc, syrup you might have given.

    There are so many reasons. It's hard to pin point any one cause until you do trial and error to narrow it down.
     
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  34. bambinaki

    bambinaki Well-Known Member

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    Result of yesterday's pancreatitis test: 22.2 (reference range is 0 - 3.5)

    Any advice re. pancreatitis would be appreciated.

    What caused it? What should I do about it?
     
  35. bambinaki

    bambinaki Well-Known Member

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    While the pharmacist said it's impossible to say what caused Maxi to be sick, he also said the cabergoline is suspect -- that it didn't make him sick for weeks but then the build-up of it in his system made him sick.

    I will go ahead and give him his full dose tonight as you said, Paula, and then every other day. It's OK with pancreatitis to do that?
     
  36. Marje and Gracie

    Marje and Gracie Senior Member Moderator

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    I just want to clarify. I don’t like BCS doses for non-high dose cats. Almost all of the time, a BCS dose for those cats is for the CG and not the cat.

    However, for a high dose cat, there can be some benefit to shoot a BCS dose and drain the depot a bit. In this case where the kitty was getting 9.25u, shooting 7u reduces the depot by 2.25u which is a larger dose than many non-high dose cats are on. Yes, that still leaves a large depot to deal with (7u) but it can help and especially when the kitty has been off food. (I’m glad he’s eating well today).
    Did you read the Primer I linked yesterday as that has a pretty exhaustive amount of info for you including treatments. I doubt anyone can tell you what caused the pancreatitis. One possibility is certainly the diabetes connection but I once had a civvie that had one acute case of pancreatitis and never had it again. It was sudden onset, we treated aggressively, and he was much better in a couple days.

    Pancreatitis is much more common in cats than was previously thought. In a large group of necropsies done on cats, over 50% showed evidence of pancreatitis at some time during the cats’ lives. Cause of death was not pancreatitis-related. Good vets will suspect pancreatitis if the cat is brought in because the CG thinks things are “just not quite right”. That means symptoms are subtle....inappetance, lethargy, and generally just “off” for a couple days. These cats may have a very mild case of pancreatitis.

    The fact that pancreatitis is diagnosed doesn’t affect the dose of insulin you give. You need to see where his BG is to make that determination. See how the cycle goes but if he has a nice, flat cycle or comes up, I’d agree with 9u.
     
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  37. bambinaki

    bambinaki Well-Known Member

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    I take it that you agree that the 7 units was the right move in Maxi's case this morning?

    I really hope Maxi's pancreatitis was one of the one-time cases.
    Yes, I read the primer you linked. Thank you.

    So if his numbers don't go down from now -124- I should give him 9 units?
     
  38. Marje and Gracie

    Marje and Gracie Senior Member Moderator

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    Yes on this morning’s dose. Let’s see how the cycle plays out. I hope you are testing again soon because he was still coming down at +3.
     
  39. bambinaki

    bambinaki Well-Known Member

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    AM +5.5: 55 !!
     
  40. tiffmaxee

    tiffmaxee Well-Known Member

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    I thought there was a good chance this is pancreatitis. The pancreatitis primer has lots of info. Max had chronic pancreatitis. At this point I do t know if this is an acute attack or not. In a nutshell though treatment is based upon symptoms. Sub-q fluids, nausea medication, pain medication. Feeding several small meals as opposed to a lot at once is also recommended because when they start to feel better and eat too much they can feel yucky again. Is the stool now normal? With Max he had loose stool only a few times over the ndny years of pancreatitis and it usually was a one or two times and done. Once on a holiday weekend I got flagyl just in case but never needed it. He always became inappetent or fussy about food. He was eating but less when first diagnosed and so it never occurred to me he could be nauseous until it was pointed out to me by someone on a kidney group I belonged to. At that point he didn’t gave kidney disease but the moderators there are so knowledgeable on everything cat.
     
  41. Sandy and Black Kitty

    Sandy and Black Kitty Well-Known Member

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    When, what and how much did he last eat?
     
  42. bambinaki

    bambinaki Well-Known Member

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    Thanks, Elise.

    What kidney group is that? My Maxi also has kidney disease.
     
  43. bambinaki

    bambinaki Well-Known Member

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    About 2 hours ago I rewarded him with 1-2 teaspoons of tuna after taking cerenia. *SEE BELOW He took the cerenia in a pill pocket. 2 hours before that he had some Weruva. Right now he's having Wellness turkey pate. 6 hours ago he had Weruva. He's eaten about 2-3 tablespoons of Wellness just now.
     
  44. bambinaki

    bambinaki Well-Known Member

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    No, the cerenia was 1 hour ago. Along with buprenorphine.
     
  45. bambinaki

    bambinaki Well-Known Member

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    This morning breakfast I thought his appetite was back 90%.

    Right now he's again acting like he would like to eat, but he's kind of forcing it.

    He's eaten almost the full amount of Wellness I gave him -2-3 tablespoons. I just gave him a tablespoon og another kind of Weruva, and he's sort of forcing himself to eat it.
     
  46. Sandy and Black Kitty

    Sandy and Black Kitty Well-Known Member

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    Easy does it with food; you want him to be a little hungry- it’s still relatively early in the cycle and you may need to steer the numbers upwards. Check BG 30 mins after he finishes the meal he is eating right now.
     
  47. bambinaki

    bambinaki Well-Known Member

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    OK, thanks
     
  48. tiffmaxee

    tiffmaxee Well-Known Member

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    Several small meals be best for pancreatitis until back to normal.

    https://feline-crf-support.groups.io/g/Feline-CRF-Support/topics

    The group is moderated so you need to join. Maureen is data and research oriented which I appreciate. She’s always trolling for the most recent.
     
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  49. bambinaki

    bambinaki Well-Known Member

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  50. Sandy and Black Kitty

    Sandy and Black Kitty Well-Known Member

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    Update?
     
  51. Pamela & Amethyst

    Pamela & Amethyst Well-Known Member

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    Love,Light and Healing little man:bighug::bighug::bighug:
     
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  52. bambinaki

    bambinaki Well-Known Member

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    +7.5: 129
     
  53. bambinaki

    bambinaki Well-Known Member

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    Sorry! I was in a work meeting that I had already rescheduled and, not wanting to postpone again, thought I could manage Maxi and the meeting at the same time...
     
  54. bambinaki

    bambinaki Well-Known Member

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    Thank you!
     
  55. bambinaki

    bambinaki Well-Known Member

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    I will be free and on top of this from now until PMPS. I will need advice on what/if to shoot.

    Thank you!
     
  56. bambinaki

    bambinaki Well-Known Member

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    UH OH
    It's back down to 59!

    And he wanted nothing to do with the usually loved test reward treat.
     
  57. bambinaki

    bambinaki Well-Known Member

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    He also won't/can't eat regular food. After I disguised it with a little tuna, he seemed very interested but could manage only a few licks. He keeps going to the bowl. He just took a couple more tiny licks. I don't understand why, if he's nauseous, he would even be a bit interested in food. He clearly wants to eat.
     
  58. bambinaki

    bambinaki Well-Known Member

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    He had cerenia almost 4 hours ago.
    I'll try to give ondansetron now. ---or should I wait until closer to PMPS for the ondansetron??
     
  59. tiffmaxee

    tiffmaxee Well-Known Member

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    That’s how nausea works with them. It’s why I didn’t realize Max was nauseous. Then when I figured it out he wasn’t getting the correct dose of ondansetron so I had to give an appetite stimulant. It’s important to get on top of this or he might develops a food aversion to his regular food and treats. I’d give him ondansetron.
     
  60. bambinaki

    bambinaki Well-Known Member

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    OK, I'll give now
     
  61. bambinaki

    bambinaki Well-Known Member

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    OK, I gave it.

    Thank you!
     
  62. Pamela & Amethyst

    Pamela & Amethyst Well-Known Member

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  63. bambinaki

    bambinaki Well-Known Member

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    Also very torn about giving cabergoline tonight.

    :(
     
  64. bambinaki

    bambinaki Well-Known Member

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    Thank you.

    Wendy is busy with her sick father.

    Sandy said she'd be watching but isn't at the moment.

    Hope Sienne can help.
     
  65. Pamela & Amethyst

    Pamela & Amethyst Well-Known Member

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    PUT UP A 911!
     
  66. bambinaki

    bambinaki Well-Known Member

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    OK
     
  67. Pamela & Amethyst

    Pamela & Amethyst Well-Known Member

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  68. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    I spoke to Wendy several hours ago as she said that you need to resume the carbergoline today
     
  69. bambinaki

    bambinaki Well-Known Member

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  70. Pamela & Amethyst

    Pamela & Amethyst Well-Known Member

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    I think Maxi needs to go back to the hospital Possible HYPO and his tested positive for Pancreatitis
     
  71. bambinaki

    bambinaki Well-Known Member

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    Now 70
     
  72. bambinaki

    bambinaki Well-Known Member

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    I have 2 threads going. I put the other one as 911.
     
  73. bambinaki

    bambinaki Well-Known Member

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    OK.

    Thank you

    I wonder if I should give it now or wait until regular time (3 hours from now)
     
  74. bambinaki

    bambinaki Well-Known Member

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  75. Marje and Gracie

    Marje and Gracie Senior Member Moderator

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  76. bambinaki

    bambinaki Well-Known Member

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    thank you


    I will try

    Isn't 2 mls a lot?
     
  77. Marje and Gracie

    Marje and Gracie Senior Member Moderator

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    First....did you feed the 59 and, if yes, with what or is he coming up on his own?
     
  78. bambinaki

    bambinaki Well-Known Member

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    I just gave 1 ml
     
  79. Marje and Gracie

    Marje and Gracie Senior Member Moderator

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    Please see my question in post 77.
     
  80. bambinaki

    bambinaki Well-Known Member

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    Yes, I tried. Here's the post:

    He also won't/can't eat regular food. After I disguised it with a little tuna, he seemed very interested but could manage only a few licks. He keeps going to the bowl. He just took a couple more tiny licks. I don't understand why, if he's nauseous, he would even be a bit interested in food. He clearly wants to eat.
     
  81. bambinaki

    bambinaki Well-Known Member

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    He just took a couple more actual *tiny* pieces of food.

    Maybe ondansetron kicking in already
     
  82. Marje and Gracie

    Marje and Gracie Senior Member Moderator

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    Ok thanks. I didn’t know that pertained to the 59 because the time stamps made it appear they were further apart.

    I’d retest him 30 mins after the karo. Normally, this is not the method I’d use for a cat late in the cycle. Typically, LC food is best but we have several issues here to consider:
    • High dose cat that got a BCS this morning and still dropped to 55 and again to 59
    • Cabergoline in the mix
    • Pancreatitis and kitty not eating
    We need to be careful with tonight’s shot. The karo should wear off in two hours. Hopefully, he won’t come back down because karo late in the cycle “should” shorten his duration but we have no data to know with him.

    If he’s up enough to give insulin, I’m almost thinking even a lower dose for tonight. But let’s start by seeing where he is 30 mins after the karo.
     
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  83. bambinaki

    bambinaki Well-Known Member

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    OK
    I will test in 25 minutes
     
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  84. bambinaki

    bambinaki Well-Known Member

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    What I gave him 1ml of is honey.

    I did learn that LC food is best, but it's almost impossible to get it in him.

    THANK YOU!
     
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  85. bambinaki

    bambinaki Well-Known Member

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    Since 59 at +8.5 I would say he has eaten 1.5 tablespoons of LC food with a dash of tuna.

    Plus the 1 ml of honey.
     
  86. bambinaki

    bambinaki Well-Known Member

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    Now 108
     
  87. Marje and Gracie

    Marje and Gracie Senior Member Moderator

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    Good. I’d hold off now and test between +11.5 and +11.75.
     
  88. bambinaki

    bambinaki Well-Known Member

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    OK, thank you VERY much
     
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  89. Marje and Gracie

    Marje and Gracie Senior Member Moderator

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    While we are waiting, I’d just like to toss some info out there.

    With any kitty, much less a high dose one, if the BG is dropping by +2/+3, it’s really important to test sooner (1-1.5 hours depending on how fast the drop). That allows you to try and feed some LC food so the nadir doesn’t drop so low.
     
  90. Olive & Paula

    Olive & Paula Well-Known Member

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    Hang in Karen, your doing great. And you will get through this. I had to tend to one of my civvies. I'm caught up now I think.

    Glad to hear glucose has risen now. The low was still the 9.25 in action. That p'titis value is pretty high and safe bet that is why Maxi is sick and not the caber causing it. It sounds like you have all the meds necessary. Keep them on schedule as much as possible. By any chance do you have subqs fluids to give? As Wendy stated, yes give the caber.

    My first diabetic never had p'titis until one day I tried Friskies food. I swear he got p'titis from that. No proof but it was the only thing that changed. Once it cleared his system he recovered and never had it again.

    Ollie has only had 1 normal value in her 3 yrs with me. Nothing and everything can set it off.
     
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  91. bambinaki

    bambinaki Well-Known Member

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    OK.
    Are you referring to today's gap between +3 and +6?
     
  92. Marje and Gracie

    Marje and Gracie Senior Member Moderator

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    :):):)
     
  93. bambinaki

    bambinaki Well-Known Member

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    ??
     
  94. Marje and Gracie

    Marje and Gracie Senior Member Moderator

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    That was a polite acknowledgement. ;)
     
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  95. bambinaki

    bambinaki Well-Known Member

    Joined:
    Jan 22, 2010
    No excuse, but I was in a work meeting that was supposed to take place yesterday, and because of what happened yesterday with Maxi I postponed it, and was anxious about postponing it again, so I went ahead with the meeting this afternoon.
     
    Last edited: Apr 28, 2020
    Marje and Gracie likes this.
  96. bambinaki

    bambinaki Well-Known Member

    Joined:
    Jan 22, 2010
    Thank you, Paula.

    But I'm not doing great. Making mistakes left and right and not understanding half of what's going on / info I'm given.

    The other day, before things got really bad, I put a teaspoon of Friskies in Maxi's food when his appetite started decreasing to entice him to eat.

    I am a wreck but it's not at all about me. It's about Maxi. I want to prevent Angel Maxi from suffering.
     
  97. bambinaki

    bambinaki Well-Known Member

    Joined:
    Jan 22, 2010
    Maxi was so much better last night and even better this morning. (I felt like a new person - the weight of the world lifted.) And now this afternoon and evening, this.

    And he just now pooed. It's not as runny or light-colored as yesterday; it's slightly formed, but still quite runny - not normal. Sorry for the photo. I just want to provide any and all info.

    upload_2020-4-28_20-29-22.png
     
  98. bambinaki

    bambinaki Well-Known Member

    Joined:
    Jan 22, 2010
    No, unfortunately, I don't.
     
  99. bambinaki

    bambinaki Well-Known Member

    Joined:
    Jan 22, 2010
    I had the Friskies in the house for a feral boy I feed, and I don't even usually give that to him. I usually give him Fancy Feast, but 2 months ago when I was doing corona stocking up, I couldn't find Fancy Feast. I gave the spoonful to Maxi out of desperation to get him to eat. Anyway, he took only one bite of it.
     
  100. bambinaki

    bambinaki Well-Known Member

    Joined:
    Jan 22, 2010
    This little boy keeps looking at me, and when I go to him, he's full of love. He wants to be well.
     

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