3/15 Cain PMPS 414 Starting Insulin again

Discussion in 'Lantus / Basaglar (glargine) and Levemir (detemir)' started by Jennifer&Cain(GA), Mar 15, 2014.

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  1. Jennifer&Cain(GA)

    Jennifer&Cain(GA) Member

    Joined:
    Apr 1, 2013
    Hello!

    Previous condo

    I'm considering this BG a +11 cause I'm on a 1:30 cycle. BG was 386. It's almost two hours since Cain's last feeding. I'm due to feed him in a few minutes.

    I changed his bandage today and carefully put neosporin around the incision. I was afraid to get too close so I probably didn't do as well as could be. Couldn't look too close at it either. Cain stayed fairly still, but he's not moving much right now anyway. He's still turning in circles when he does walk around. Hiding his head in dark places. From the smell and feel of the towel he was resting on, Cain didn't make the litter box last night. He urinated on the towel nest I built for him. So no ketone test again.

    I asked the vet techs and the vet that was there today but familiar with Cain's case (via messages, I didn't talk to them directly) lots of questions whether I should continue his methycobalamin vitamins, a few questions about the syringes and how can I give his meds when he has so little food right now. (I was getting air gaps when trying to suck up a med/food combo.)

    I was told not to continue the methylcobalamin just yet. Which pains me cause he's wobbling around, nearly walking on his hocks, front legs slanted. He walks like a drunk in circles. Always circles. He hasn't walked in a mostly straight line since the first few minutes he came home. He just let out a loud meow which I tend to only hear in the carrier and I carried him to the litter box where he did urinate a bit. I was surprised cause I was just guessing it. Unfortunately, not prepared for it which meant that I didn't realize he was urinating until I tried to pick him up. No good samples so yet another missed chance for ketone test.

    Cain's still trying to hide in dark places, trying to rest his head higher than his body. He's not drooling but I do hear him swallowing again. That was before I doing the syringe feeding. All I have is the liver meds the other vet gave me. No pain meds cause they don't want to add to the ones he was given for surgery. I really don't know what he's getting still I just hope it isn't something that several shots could be bad.

    The vet office closed an hour ago, so I hope nothing comes up over the weekend. Really really hope. At the very least he seems to be taking the syringe feeding well enough. I'm feeding him every two hours right now so he can get all the calories he can get. And no on the Ondansetron again. The people I talked to at the other vet office said if he's not throwing up, they didn't want to seem to give him anti-nausea meds. *sigh*

    Oh, Ella, thank you. I'll keep an eye out for your PM. :)
     
  2. julie & punkin (ga)

    julie & punkin (ga) Well-Known Member

    Joined:
    Feb 17, 2011
    Re: 3/15 Cain PMBG +11 386

    Was the insulin pen you have in the fridge partially used, or not yet opened? expiration date on it? if it wasn't used yet, i might go ahead and try it, jennifer. if it's pooped out, we'll probably be able to tell by the lack of response. if it works, we'll also be able to tell by the numbers. some of us are talking about what a good starting dose might be and will get back to you.

    i can only imagine how overwhelming this is.

    i hope people keep in mind that you're doing the best you can in a very difficult situation.

    Great job on getting the food into him!!!

    :YMHUG: :YMHUG:
     
  3. rhiannon and shadow (GA)

    rhiannon and shadow (GA) Well-Known Member

    Joined:
    Jul 9, 2012
    Re: 3/15 Cain PMBG +11 386

    adding hugs and support vines....
    feel better vines for Cain....
    I'm watching for your updates....
     
  4. Marje and Gracie

    Marje and Gracie Senior Member Moderator

    Joined:
    May 30, 2010
    Re: 3/15 Cain PMBG +11 386

    Jennifer

    Do you have any labs for him? Did they mention anything about his kidney values? I know his liver values were elevated but I'm wondering if he's also got kidney issues and low potassium? Low potassium can cause some of the Wobblies plus a stilted gait in the front legs and stiff neck/inability to hold up head.

    If you have any lab results, I'd be happy to look at them for you.
     
  5. Tricia Cinco(GA) & Harvey

    Tricia Cinco(GA) & Harvey Well-Known Member

    Joined:
    Jul 18, 2011
    Re: 3/15 Cain PMBG +11 386

    Jennifer:

    You are doing a GREAT job! Getting that much food into him without his throwing up is an excellent start. :D

    Just curious - is he turning in the direction of the side his tube is on? Perhaps it makes him feel unbalanced and he's trying to compensate.

    You might want to put a pee pad under him to save on laundering.

    Sending more hugs and healing vines. Keep up the good work! You and Cain are in my prayers. :YMHUG:
     
  6. Marje and Gracie

    Marje and Gracie Senior Member Moderator

    Joined:
    May 30, 2010
    Re: 3/15 Cain PMBG +11 386

    Tricia's question is a great one. I always tend to think of the worst scenario but sometimes it is the simplest. Genius and I hope that is all it is.

    How you doing, Jennifer? How can we best help you?
     
  7. Karrie and Maverick

    Karrie and Maverick Well-Known Member

    Joined:
    Oct 22, 2010
    Re: 3/15 Cain PMBG +11 386

    Jennifer have you updated the pancreatitis group yet? I'm extremely woorried about the circling. This could be a sign of something life threatening. With the combined liver values it may be too much ammonia in the blood or other things unrelated.
     
  8. Jennifer&Cain(GA)

    Jennifer&Cain(GA) Member

    Joined:
    Apr 1, 2013
    Re: 3/15 Cain PMBG +11 386

    Wow, I take a nap and a scuffle breaks out in yesterday's condo. :shock: :> I'm just kidding. :) Some are very passionate and I understand that. I'm doing what I can and that's all I can do. I don't blame anyone. :coffee:

    I'm so sorry I didn't update this thread. I was/am exhausted. My dad told me to take a nap and kept reminding me. He wouldn't let me drive again today until I did. He had to come with me this morning so I could pick up some vetwrap and non-stick pads for the feeding tube.

    They're worried in the pancreatitis group too about Cain's circling. I've noticed that while he managed to go to the litter box as soon as he got home, he hasn't been able to since. Only when I carried him over to it. He's light reactive (he'll close his eyes if I shine a flashlight in his face) but if I try to "poke" his eye, I get no reaction until I touch the fur around his eye. I doubt he can see well right now. I was suspecting it last night. And would explain the circling a bit. I would like it to be as simple as the tube bothering him but I suspect it's his liver involved from what they pancreatitis group is saying.

    They have partial labs at my primary vet, Marje. I'm going to get a copy of them monday and I'll post them here or PM them to you. The spec fPL one from A&M still hasn't come back yet. That's why it's considered partial. My vet told me a bunch of stuff but it just flew over my head. I don't know about his potassium. Cain is also going into the vet on monday as well. He is not doing well with this circling and he'll probably need more fluids. Either the primary or secondary one. (Otherwise known in my posts as my vet and the other vet. :) )

    The lantis pen I have was half used. I kept it as a just in case pen. I can certainly try using it as long as it's not cloudy. I did use that savings card last year. I'm not sure if Walmart will accept it again since it's the same prescription still. But I'll certainly try.

    As to the topics brought up in the other thread:

    Karrie, so far the 60ml have some great resistance and I'm being very slow and careful with feeding him and flushing the tube. I will look into getting those 20ml you mentioned, cause the 60mls are monsters in size. lol I didn't know they could come in that size. They're easier to handle than I thought tho. :)

    Sienne, .5u? Sounds good. I'll try my pen and see if it's good (I expect not but at this point today it's that pen or no insulin.) Thanks for the suggestion about the strips. I'll try that out today. If my pen's cloudy, I'll just throw it out.

    No subq fluids. They only sent me home with the syringes, instructions, and the liver med. I asked about nausea meds from them but if he's not throwing up, they didn't want to give him any. ...shoot did I say that already here? I'm talking to two lists so if I repeat something that I already said I'm sorry.

    Okay, I'll check this when I get back. I'm going out to get something to eat. I'm going to feed Cain first though. And my mom will check in on him while I'm gone. My dad got called into work so I'll have her do it.

    Thank you all again. If I missed a question or something, just remind me and I'll answer it soon. :smile:
     
  9. Dyana

    Dyana Well-Known Member

    Joined:
    Dec 28, 2009
    Re: 3/15 Cain PMBG +11 386

    I don't know why vets think nausea equals vomiting. You can feel nauseous without the act of throwing up.
    Maybe ask the vet to please let you try Ondansetron. I don't know. I just know it helps J.D. when he acts hungry but only eats a bite of two or just sniffs it and walks away, or doesn't seem interested in eating at all.

    Good luck with the insulin.
     
  10. Karrie and Maverick

    Karrie and Maverick Well-Known Member

    Joined:
    Oct 22, 2010
    Re: 3/15 Cain PMBG +11 386

    I got an update from the pancreatitis group - they are worried about the neurological symptoms hepatic encephalopathy (especially considering the drooling before) and with the liver being compromised maybe not clearing the anesthesia and have been posting to Jennifer about this as well as the importantance of anti nausea medication. You are in good hands with this on the pancreatitis group. I will defer to these experts.

    Jennifer please keep the experts here updated on what you are doing. They need to know to manage Cain's diabetes. Also update the experts on the pancreatitis group about the diabetes side. Both groups will work together to make sure Cain gets the best advice.

    It is hard to know who to trust. Do not listen to just anybody who posts with advice. Giving too much fluids for example can be a very bad thing. So someone just posting out of the blue to give fluids should be a flag. But please do keep both groups posted. The Pancreatitis group can help with all of your tube questions.
     
  11. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    Re: 3/15 Cain PMBG +11 386

    Jennifer --

    Karrie is one of the "go to" people on these feeding issues. She's bringing up some valid concerns (like the possibility of hepatic encephalopathy) that are being raised by the pancreatitis group. Please take advantage of their input. You know the folks here will help out in any way we can.
     
  12. rhiannon and shadow (GA)

    rhiannon and shadow (GA) Well-Known Member

    Joined:
    Jul 9, 2012
    Re: 3/15 Cain PMBG +11 386

    I was just catching up on your condo....

    I ran and looked in my cabinet and I have a bottle of ondansetron with refills on it for my cat.
    If the collective wisdom from everyone is that it would be a good thing, I would gladly mail it to you on Monday. I am probably one of the closest to you so it should get
    there quickly.

    I don't understand your vet's unwillingness to give it a try.
    It's a people drug so you would be able to get it at any pharmacy.



    eta : pm me your address .
     
  13. Jennifer&Cain(GA)

    Jennifer&Cain(GA) Member

    Joined:
    Apr 1, 2013
    Re: 3/15 Cain PMBG +11 386

    Yeah I'm not sure either but I've been trying to push the buprenex more and I tried asking about the ondansetron but I'm not sure if he was just unwilling to try another anti-nausea med or what. I had to push to get Lantus too from this vet.

    Thank you, Rhiannon. I'll send you a PM. :)

    I just updated the pancreatitis group. (Sorry, my outing took longer than I thought.) If that yahoo interface was a bit faster. would be nice. There's the accidentally forgetting to add something that I told the other group of peoples. I swear at this point when I go into the vet on monday I need an outline of what's going on with Cain. I'm getting too tired and forgetting things.

    I just checked his BG and it's 404. I'm digging that Lantus pen out shortly and I hope it's not cloudy. Or frozen. It's been in there a bit. It was fine last time I checked but that was a while ago.

    Thanks, Kerrie. Was it you that was saying they had a paper I could give to my vet?

    Oh, yes, they pancreatitis group does suspect hepatic encephalopathy. Come on, liver, keep on working. You can do it. Um, for Pancreatitis how closely do I need to monitor Cain once I give insulin? I was just warned that it could make it tricky.
     
  14. Jennifer&Cain(GA)

    Jennifer&Cain(GA) Member

    Joined:
    Apr 1, 2013
    Re: 3/15 Cain PMBG +11 386

    Shoot, I'm low on strips. Thankfully they don't cost much. Depending on how closely I have to monitor him after insulin (I'm waiting for a good 12/12 so in an hour or so), I may need to go to Walmart tonight.
     
  15. Ella & Rusty & Stu(GA)

    Ella & Rusty & Stu(GA) Well-Known Member

    Joined:
    Jan 11, 2010
    Re: 3/15 Cain PMBG +11 386

    Hey Jennifer, I hope that you will get some good sleep tonight and that Cain will have a good night. When Rusty had pancreatitis I found that I had to raise his insulin dose to compensate for the food I was feeding him. I was feeding a slightly higher carb food than before because it was what he would eat, and eating was the most important thing. But since you haven't given insulin since Cain went OTJ, I guess you will just have to play it by ear with regard to dose. Julie mentioned that the dosing experts were discussing what Cain's dose should be. I hope you can get a fresh pen of Lantus. If you filled the prescription at Walmart, they probably still have it on file, since it is less than a year. If you used that Lantus discount card, you probably have lots of refills still left on it. I believe they are good for 2 years. Call their pharmacy tomorrow to check; it may be open on Sunday.

    Lots of healing vines for Cain, and a good night's rest for you,

    Ella & Rusty
     
  16. DD & Tinkerbell

    DD & Tinkerbell Well-Known Member

    Joined:
    Dec 28, 2009
    Re: 3/15 Cain PMBG +11 386

    Jennifer,

    You are doing GREAT! It can be intimidating to get the hang of feeding via the feeding tube, I remember well when Tawny first came home w/hers I was totally intimidated (which doesn't happen easily).

    Here's a couple more points I remember from Tawny's experience w/this:

    She did get Ondansatron. She was on a lot of other meds at the time but I remember that one in particular, and Denamarin (for her liver), is Cain getting this? She also got a potassium supplement which her vet was very cautious with, she tested for low potassium at the time but the vet said when her potassium #s came back up to normal range she would not need it. She also got s/thg called Actigall, I think this was for her liver too. She had ketones at the same time as she had all these other issues going on so we were in a big mess but we got thru it just fine with the help of all the people here and also from Karrie's groups. Utilizing the knowledge & expertise from these groups was instrumental in Tawny's recovery.

    If I remember correctly I may have syringed Tawny drinking water thru her tube also, tho not much, maybe 5ml every few hours, b/c as has been mentioned, the food you are tubing is a lot of liquid anyway. Whatever the pancreatitis or assist feeding groups advise, that's what I would do. I don't remember having to give Tawny SubQ fluids too many times, but I did have the whole shebang set up and did not find it difficult to do, tho I was scared to death the first time I did it. I remember watching some pretty good YouTube videos on how to do this, and together with the guidance from here and the Yahoo groups it was not hard & we did fine.

    As has also been suggested, I did not do a preflush on the feeding tube. I agree that preflushing takes up precious food space and is not necessary, so I opted not to preflush.

    I also found that those huge syringes were nearly impossible to use, my hand was simply not long enough to hold the big syringe on one end at the tube and get my thumb up high enough on the other to push the plunger down. I found that if I used the smaller ones that fit my hand better even if I had to fill them more often it gave me better control.

    I don't have any ideas for you on the circling thing, Tawny never did this that I remember.

    Jennifer, we all know that you are doing the best you can for Cain, and you are doing a phenomenal job. It's hard, believe me, I know. I really know, I went through it w/Tawny. Karrie really knows, she went through it with Maverick. Many of the others here know 1st hand too. It's incredibly hard, and I feel for you, big time. Having mastered the feeding tube is a huge milestone and you should be proud of yourself...I know I am proud of you. One step at a time, girl, that's all you can do, and we all know you are doing your very very best for Cain.

    Desi
     
  17. Tara & Buster

    Tara & Buster Well-Known Member

    Joined:
    Jul 6, 2012
    Re: 3/15 Cain PMBG +11 386

    I don't have any helpful advice but I just wanted to send some strength and healing vines your way. You are doing an amazing job! I hope Cain feels better soon.
     
  18. Jennifer&Cain(GA)

    Jennifer&Cain(GA) Member

    Joined:
    Apr 1, 2013
    Re: 3/15 Cain PMBG +11 386

    The card is good for two years? That's great. It might apply to the refill of the prescription. Though if it was only for five pens, that's what I got when I filled it last time. Well I'll find out. :)

    I hope to get a decent amount of sleep tonight. Though if I need to wake up to feed Cain middle of the night, well I'll ask the other group and see what they think.

    Thank you, Ella. :)
     
  19. mariko

    mariko Well-Known Member

    Joined:
    Jul 10, 2011
    Re: 3/15 Cain PMBG +11 386

    Hi Jennifer,
    I'm just stopping by to send your sweet Cain lots and lots of healing vines.
    Also positive thoughts and prayers that he'll recover from this.
    It's so great he's got so many knowledgeable people watching over him.

    You hide your worry and fear so well just like a cat, but I'm sure you are making yourself sick with these emotions.
    I hope you can get some decent rest, Jennifer. Hugs to you. :YMHUG:
     
  20. Jennifer&Cain(GA)

    Jennifer&Cain(GA) Member

    Joined:
    Apr 1, 2013
    Re: 3/15 Cain PMBG +11 386

    Thanks Desi and Tara and Mariko. :D

    Yup, just trying to keep up with everything but I think I have the feeding him part down. I just blenderized a can of A/D and boy that was fun to watch. :lol: Though when I warm it up after keeping it in the fridge, ugh. I don't know how cats like to eat that. I didn't do a pre-flush this time that I just fed him. I was earlier but someone on the pancreatitis list mathed out how many fluids he's getting with the A/D and frequent feedings and tube flushing and it seemed pretty impressive. Cain's still urinating when I put him in the litter box so he's having enough to do that at least. :)

    I was sent home with Ursodiol to help with his liver. The second vet was going to give me another medication but they were out so they gave me one that was just like it. Only medication I was told to dose him with.

    At 15ml so far it's easy to handle the 60ml syringe but I'm sure when I'm feeding him more it's going to get tricky. If I get time tomorrow, I'll check out the local Tractor Supply store. Or the feed store I picked up the vet wrap from. (They had sooo many colors. It was cool.) See if they have any 20ml syringes. Some pharmacies don't seem to have stock of bigger syringes.

    And I know. I think I'm complaining/venting too much. :) More sleep! Thank you all really.

    Super super grateful about all the help and vines and y'all letting me complain and vent and y'all are awesome. :YMHUG: :YMHUG: \M/ \M/

    I'm totally making a timeline tomorrow for Cain. That way I won't forget anything.
     
  21. Jennifer&Cain(GA)

    Jennifer&Cain(GA) Member

    Joined:
    Apr 1, 2013
    Re: 3/15 Cain PMPS 414

    I checked the pen of Lantus. It's clear, not frozen, and has no floaties that I can tell. I backlit it with a flashlight and saw nothing but clear Lantus. I had to look up how to shoot again. It's been long enough that I forgot. There was a sticky at some point that showed what unit markers looked like on different syringes. Is that still around? I couldn't find it. I did figure it out and remember how tiny these syringes are.

    As per Sienne in yesterday's condo, I started him on .5u. I think I'm getting older or I'm just tired. Those marks are so tiny. :lol:

    I'm just about out of test strips so I'm getting Dad to get me more. I have enough to test him at the +2.
     
  22. julie & punkin (ga)

    julie & punkin (ga) Well-Known Member

    Joined:
    Feb 17, 2011
    she posted today after we'd talked about it. i agree with the 0.5u - you may need to increase it but having him get low numbers at this stage right off the bat is probably not a great plan.

    sounds like the insulin might still be fine. fingers crossed!

    just a reminder that when you start on Lantus, you want to check amps, +3, +6, +9, pmps and +3 for the first 3 days.

    get some sleep! a written plan for tomorrow is a good idea! you're juggling a lot of things.
     
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