? 5/31 Ivy, Pmps 400, 356 +2, Gave 3 U Lantus, dropping quickly +2, post surgery yesterday

https://felinediabetes.com/FDMB/thr...this-am-how-handle-sharp-drop-if-hypo.278068/
Hi everyone, Ivy did well in her leg repair surgery yesterday and spent the night at the hospital. I picked her up late today. She was very happy to eat once she got home around 3:30 PM this afternoon.
she’s medicated and sleeping now.

She wasn’t eating well at the hospital so they gave her half of a (“3 units hospital “) dose at 1.5 units this morning at 9 AM.

I plan to give a dose at 9 PM this evening and over the next six days walk her back to normal feeding/insulin times (15 minutes per cycle early.)

**Hospital suggested I give her 3 units this evening as long as she is eating, and her numbers are not under 250 at that time.
She is around 400 now.

**The dose I had her on right before I took her to the hospital yesterday was 3.5 units and I had told them to give her no more than 3 units if they were able, if she was eating.

***What dose do I give her this evening (in about 3 hours) if she is eating /or not eating?
Any good suggestions to get her back on track safely without any risk of hypo given that she’s been through so much trauma in the past several days?
And what dose tomorrow ?? and going forward to safely raise her back up again. Trying to get back to TR but really got whacked with the broken leg.

She tends to do very deep dives and break bounces with very steep drops.

I was able to watch her BG’s on the libre sensor while she was in surgery, and it appeared She dropped very low on the libre (under 50) but they kept telling me that she was fine, and was not in that territory, that the Libre just reads very low during anesthesia so I’m not actually sure what really happened.

Thank you so much for your attention and your caring. @Bandit's Mom @Wendy&Neko @Diane Tyler's Mom @tiffmaxee @Bron and Sheba (GA)

 

Hi Staci, I'm glad to hear Ivy pulled through the procedure with flying colors! She's probably doing better at this time than you are. Cats are amazingly resilient when it comes to all of that - I think it's much worse on us!

If she's eating well and otherwise doing well, I'd be inclined to give her another half unit up tonight - however I'm sure there will be others coming along shortly who might be more familiar with you and Ivy's journey and may be better able to advise you. Typically increases are done in .25 increments, but since she's was just starting to do well on TR and you guys have been through a bit in the last few days - and her numbers are looking high - plus you have the constant checking with the Libre and if you're comfortable with that much of an increase, I'd be leaning to doing that tonight and then perhaps again in the morning - edging her closer to that 3.5 sooner than later.

I'm not sure what time you're planning on giving her the next injection of juice, but hopefully others you've tagged will be along shortly to advise you better.

In the meantime, take a deep breath and let's hope Ivy stays on the road to recovery and gets well fast! Soon she'll be thumping around on her new cast full of entertainment ideas for you! It's a lot to manage not only diabetes, but now a post-op patient - so sending you hugs and get well wishes. Try to get some rest tonight...lucky for you the Libre is providing a lot of data for you! Looks like she's already feeling more like her self again.

Hang in there!

 

She did earn a reduction down to 3.25 units yesterday with that 45 yesterday. Given how high she is now, I would test at +11 and see where she's at then. If still way over 400, you could probably shoot an hour early. That's a best case eating scenario. When did she last eat? What meds is she on? Just wondering if they will impact her appetite.

 

Hi @Wendy&Neko I fed her a meal about four hours ago. I think it was the first thing she had really eaten and she was starving. So that was good. I do think she will eat at least some thing in about an hour when I was thinking of giving her the Lantus. since she was under anesthesia when she dropped that low I’m not terribly sure what was really accurate in terms of the bg, I know the libre reads lower than a regular meter would, and they told me she didn’t drop that low while they were watching her during the procedure, so I don’t really truly know what number she went down to only what I saw on the libre, so, I’m not sure if she did earn a reduction or not, but she certainly went low during the surgery.
Does that qualify for a reduction? I was wondering if I should give her 3u tonight and then start increasing her but I’m not sure when.
She’s over 400 now at +10.5 Libre 3 says out of range.

she’s on buprenorphine 0.25 ml 3 x daily. Clindamyacin 75 mg 1 x daily. And gabapentin as needed either 50 or 100 mg.

so, what do you think I should shoot if she eats? and, if she doesn’t eat??
you do think I should shoot early????

 

Hi @Sue and Luci thank you for your thoughts and checking in with us.
She’s miserable and just sleeping right now. She’s definitely not feeling like herself. No cast either. And the leg is uncovered. She had a cone she must wear for 2 weeks so she doesn’t mess with her stitches. Ugh!

I’m due in about an hour to give her food and Lantus. I’m a bit afraid to give too much since she dropped low it seems during the surgery. I’m just not completely sure what she actually went down to. They said she was fine but the Libre 3 showed under 50. (I was able to watch from the app at home)

She’s just dragging herself to the litter box (we actually are using a rubber mat with no lip or sides with litter on it for her ease of entry and exit right now. It’s painful to watch her try to go pee. and not I noticed her front paw seems to buckle under. I don’t know if she hurt that paw also, or if maybe it’s strained from carrying the uneven weight up front.
I sure hope that’s not an additional break or injury. Praying it looks better tomorrow.

I’ll let you know how we do and thanks again for everything!

 

The reason I had though she might have really earned a reduction, or at least could have, is that it was 6 cycles after she last earned a reduction. The last time you reduced, May 27, was also after a Libre below 50, and she seems to have held the reduction, cause she saw greens 3 cycles later. Then three cycles after that was today. Also, given the circumstances, I'm thinking safety in dosing. It would be OK if you want to just give 3.0 unit tonight - though I would test for ketones when you can. She's been shorted on insulin lately.

You could shoot an hour early if over 400. And remember, she doesn't have to eat it all at once, as long as she eats some and you think she'll eat more later on in the cycle.

For the meds, Clindamycin is a really strong antibiotic. It can kill the good flora in the tummy too (speaking from personal experience, as well as Neko's). If you aren't already, I'd think about adding a probiotic into the mix - a couple hours apart from the AB. The Clindamycin may make her tummy feel off and not want to eat as much.

The front paw could have been where they had an IV in, could be some bruising.

 

Ok I will try to get the dose in a bit early. I’ll go with 3 units. I have a vetri science, probiotic that I use every day every other week per my doctor’s instructions, but you’re right I probably should add it while we’re on the antibiotic every day and see if that helps, a good thought.

**** Do you also think I should stick with three units in the next couple days and see how she does?

They did test for ketones well at the hospital and I do use the urine strips at home to keep an eye on that on a daily basis.

Good thought about the front paw, she did have all kinds of IV’s in front legs! So smart.

 

I wouldn't stick with 3.0 units. But you are just learning how she'll do at home with the cast and in her recovery, and how much she'll eat. So call tonight a test.

 

So what do you think for the morning dose then?
her appetite is less right now.
Maybe because she ate a full meal 6 hours ago. @Wendy&Neko

 

Let's see how she does tonight before guessing tomorrow.

 

Just trying to be prepared in case I can’t get anyone’s attention in the morning!

 

https://felinediabetes.com/FDMB/threads/5-31-ivydosing-surgery-update.278126/
BG suddenly dropping fast now…. Watching on Libre 3.

Ivy had surgery yesterday and dropped very low before during surgery below 50, I believe it was in the 40s as I watched on her Libre 3 during surgery.

She came home late today after getting a half dose this morning of 1.5U at 9 AM at hospital since she hadn’t eaten.
I gave her a 3.0 does Lantus this evening at 9:15 PM Eastern time. That was two hours ago and suddenly she is dropping very quickly.
She only ate half her meal.

She is medicated on sedatives (buprenorphine .25 ml and 50 mg gabapentin)
and isn’t interested in eating anything. I tried to give her a snack at +1+2 and she has no interest.
Do I break out medium carb and see if I can get her to eat that and if not, do I go for Karo syrup what do I do if I can’t get her to eat anything?

thank you.
@Bron and Sheba (GA) @Bandit's Mom @Wendy&Neko @tiffmaxee @Diane Tyler's Mom @Angela & Cleo

 

She is still quite high, so I wouldn't worry at this stage. Can you tempt her to eat anything - maybe a different food or some kind of topper/treat on the food that will get her interested?

 

She's still pretty high and I'm sure she's feeling loopy from the meds. Maybe you can dress up her usual LC with some dirty of topper or her favorite freeze dried treat

 

Looks like we cross posts

 

My concern is that once she starts to drop really fast it goes from bad to worse very quickly and that’s what I’m trying to get ahead of.
I know she’s very high bg.
She’s also taking the buprenorphine and I’m just reading that that can make glucose drop and I’m due to give her her next dose of that for her pain right now. I’m not sure what to do about all of this. she’s not a snacker or doesn’t like treats.
The only thing she likes is stinky medium carb canned food. She likes Fancy Feast grilled Turkey in gravy 13% mc, I think.
should I give her a smidge of that?
Do you think I should give the pain meds now? I’m sure she needs them @Bandit's Mom

 

She’s not a snacker @Angela & Cleo
Hard to believe but true.
wondering if I give the pain meds. I’m sure she need them. What a quandary at midnight. (so glad the rest of my household is all sleeping soundly.)

 

Will she eat LC mixed with the MC?

 

I can try.
Well, no interest in food right now. And it’s hard she has a cone around her head too. So rough.

 

She just bounced up a little. 380.
But she may drop again. she’s very bouncy after a low like she had yesterday during surgery.

 

I just wanted to say I'm so sorry that Ivy is in pain poor baby and both of you have to go through this , I feel so bad for her .Sending lots of prayers ♥

 

After 2 skipped shots and the pain from the surgery, she is likely to be high for most of the night. Take a break and get some sleep.
If MC is all she will have for now, give it to her so you can give her her pain meds.

 

I see you have help so would you please remove the 911.

 

Thank you so much

 

Done

 

She’s not eating anything.
I gave the meds and will pray she doesn’t drop too far too fast.
Aany idea what dose to shoot in the morning?

 

Thank you @Diane Tyler's Mom

 

Note, I've combined your two posts of the day into one. Due to the volume on this forum, we ask that people just do one post per day. And it gives everyone else the history of what has happened today.

Looks like she's pretty flat tonight.

 

I think you stay with 3U for now. Feed her what she will eat if she refuses to eat anything but the MC. You can always use honey/syrup to boost her numbers if she drops low.

@Bron and Sheba (GA)

 

@Staci & Ivy
How's she doing today ? I hope she's not in a lot of pain

 

Hi @Diane Tyler's Mom she’s sleeping a lot, which is good. Hates wearing her cone. (She somehow managed to get it off overnight and I found it in her litter box this morning, Oy.)
She’s on buprenorphine and gabapentin so hopefully that’s taking the edge off a bit and definitely making her sleepy.
She did try to stand up for a few minutes to eat today so that was good and we started her on Miratz yesterday for appetite, and she ate well today. Hopefully I can wean her off of that tomorrow.

I need to figure out when it’s safe to try to increase her Lantus dose again, we dropped her down to 3 units after her low BG’s during surgery and the day she broke the leg. Plus not eating well last few days.
Her numbers seem a little higher than I’d like to see, but want to be sure she’s eating steadily before I risk too much insulin than she can handle.
Do you have any idea what the protocol would be to increase her dosage again? When I go up a quarter appointment time again and over what period of time.

Thanks so much for checking in with me.
I really appreciate it. That’s so sweet of you and I hope you’re doing well!!

 

With TR, you can increase anytime to the last good dose. Pretend it was a temporary vacation reduction.

 

Hi Stacy those cones are awful . What kind is it those plastic ones?
I know they have ones that are soft and go around the neck so it makes it easier for them to eat. I the k you can just Google soft animal cones.
I know some members have used them.

I'm glad she ate good today
When it comes to giving advice on dosing, I'm not experienced when it comes to that
Hopefully you can ask Bhooma or even Wendy & Neko
I'll keep checking in on her and you ♥
Great just saw Wendy came on

 

Lol, what a “Vacation,” hardly.
Also, on Wednesday you said you thought she had possibly earned a reduction (see earlier in this thread above) based on her falling low 2 times (those very green Libre lows were when she broke the leg and then during her surgery) then she bounced of course.

*What would be the dose I return to, in your opinion, and when? She’s still on gabapentin and buprenorphine, which definitely make her sleepy. I just hope her appetite doesn’t wane again for when I kick up the dose.
I couldn’t get her to eat at all the other day and syringe fed her.
thanks @Wendy&Neko

 

Hi Diane, thanks so much for checking on us! We did get a soft cone (the plastic one they sent home was a nightmare!)
She’s definitely a little Houdini and slithered out of the one I used, somehow pulled it over her head. It closed with some major strong Velcro. (Wish we could add photos here!)

 

You can try 3.25 and see if it works, assuming that low was legit and she earned a reduction.

To add pictures, you can do a drag and drop from a desktop, or copy and paste into the text box. Love to see photos! Though preferably on a thread for today, not bumping up the old one.

 

Do you feel the 3.25 will be safe given all her trauma, sedation meds and questionable appetite?
I would like to get her back on track to better numbers, just don't need a hypo going on while I feel she’s on shaky ground (literally).

 

The lowest she's seen on this dose so far is 207, which gives you lots of room to increase. That is without the depot completely full due to the skip/half dose, so you could wait another cycle if you want. But the higher she is, the more she'll have to pee - how is that going with the cast?

 

Surprisingly she’s not peeing a lot at all.
They also said it could take up to a week to poop because of the anesthesia but luckily she pooped yesterday and it was very normal (sorry for the poop talk) very thankful for that!

And no cast, they put a plate and screws in her leg to repair it. It was actual surgery instead of the cast which they felt could be iffy.

Like I said, my only concern is if she’s not eating great, and all the medications if they would interfere with everything. Sorry for all the follow-up questions.

And if I do increases her, I would definitely wait until the morning I don’t like doing it at night if something were to happen.

 

this was her cone at 6 am this morning. Not on her head! (Her makeshift litter box)

 

Oh man… she was like… “ If you think I am using the bathroom right now with this thing on my head you got another thing coming!”

So… “And no cast, they put a plate and screws in her leg to repair it. ”

So is the plate staying in there?

Oh, and that was definitely the best solution for the litter box. I wouldn’t have room to do that personally lol but that’s definitely better than having a box …for her.

 

Wow she's a tough kitty

 

You have no idea! (But she’s a sweetheart and we love her!!)

 

Lol. I’m laughing at your comments. yes, the plate will be permanent. Hopefully no problems. They felt it was a better alternative to casting her as she’s 12 years old.
If a kitten, probably would just cast them.

The improvised “litter mat” seems to have worked (although I’m constantly sweeping, but that’s fine).
She was just dragging herself onto the mat and found a way to lie down and pee. It was so sad to watch her struggle.

 

I could cry right now reading this, poor sweet baby ♥

 

I know. It’s just so sad. She has been through so much. She’s such a cuddle bug and she can’t even climb on me for snuggles. Rips my heart out.

 

Hopefully every day things will get easier for her, she's in my prayers ♥

 

I hope so too. Thank you for your support