Advice : should I dose ?

Bruce was rushed to the vet today. He was barely moving at all and throwing up. I have been so worried. He seems to be losing his hind leg mobility but he can also barely keep his head up. The vet seemed unworried. He said he was probably just dehydrated, and if it was neuropathy- it would only be fixed by regulating his diabetes. He gave him a antibiotic shot and an under the skin hydration pack. I have to bring him back tomorrow for 8 hrs of IV drip
My question is - it’s time for his PM dose. His last reading was about 300 BG. I don’t have my chart updated yet bc the vet took that reading. He seems like he’s not going to eat dinner, so I feel like I should just skip it, right ?

 

Hi Lauren,

Your comment about Bruce not being able to hold his head up as well as having issues with hind legs made me think of a potassium imbalance. Have a look at this article to see whether there's anything that matches what you're observing:

https://icatcare.org/advice/hypokalaemia/

I'd suggest asking the vet to run blood work, including potassium and ketone levels (DKA can affect electrolyte levels). In the meantime, do you have any urine ketone test strips in the house? If yes, I'd suggest doing a ketone test ASAP as a safety precaution. If there's a pharmacy open near you I think it might be worth considering popping out for some strips if you don't have any. I'm worried about his weakness, inapppetence and earlier vomiting.

I'm in the UK and just about to sign off, but I'm going to tag Bron in Australia to keep an eye on your thread. (@Bron and Sheba (GA).

I'm not confident to suggest anything to you about insulin dose because there's so little BG information. Does your vet have an out of hours number you could call for advice? If Bruce's appetite is off I would suggest a very, very cautious approach to insulin. Choices you could consider are skipping (a risk if there are ketones, or a prior history of ketones) or give a token dose and monitor BG closely (risk of BG going too low and not being able to feed Bruce to get numbers back up into a safe range).

@Deb & Wink - If you're around, Deb, is there anything you could suggest to Lauren to help her with her dosing decision.

Lauren, if you can't check for ketones and Bruce doesn't improve, I'd suggest considering bringing him to an ER vet.


Mogs
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Helpful links:

Ketones, diabetic ketoacidosis and ketone meters

Tips for collecting urine samples


Mogs
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Another link to look at:

Ventroflexion of the neck in cats





Note: I am only throwing out ideas here based on what you described in your opening posts. Whatever is up with Bruce may be completely unrelated. I hope he feels better soon.

(((Bruce Wayne)))


Mogs
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Out of my depth here Mogs, for the vetsulin dosing.

How about pancreatitis? That could account for the lethargy and the vomiting.

I think this is a call to your vet. If not available, then an ER vet should be strongly considered.
If it's ketones or the beginning of DKA, that is very serious.
Skipping the shot could make the situation worse.

I just don't know what to tell you on the vetsulin dose Lauren.

 

@Deb & Wink -

Thanks for responding, Deb. It is a difficult situation, and I very much share your concerns.

@Bruce Wayne -

The more I think about your situation, Lauren, the more I think it would be the wisest course to put a call in to an ER if you can't get hold of your regular vet. They should hopefully be able to advise you further on how to proceed (i.e. whether Bruce might need to be seen straight away).


Mogs
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Yeah. I can’t seem to reach anyone. He’s just hiding and not really moving much. Do you think he’s in pain ? Should I pick him up and bring him where I am to console, or do you think maybe best left alone? I’m so thrown off , he never acts like this.

 

I would take Bruce to the ER or the vet now and ask for blood work to be done to check electrolytes and ketones and also ask for a fPL test for pancreatitis. The Snap fPL will tell you yes or no straight away and is done in-house , and the SpecfPL will take a day and will tell you how severe it is. I would ask for a snap fPL to start with so you know what you are dealing with.
I would not try and deal with it at home as you don’t know what it is and it could be serious and needing to be treated straight away. Don’t let the vet fob you off.

Not eating and lethargic are two red flags for me. I wouldn’t leave it.

 

The best I can suggest is getting Bruce to an ER vet, Lauren. (((Bruce)))


Mogs
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I agree.

 

Since my last post, Bruce has taken a few bits of his food and gone over to look out the window. That is more than he has done in a while. I wonder if the hydration pack under the skin he got helped a little. After those few minutes he did go back to hiding. I called the ER vet, and they said they would want to do blood work but that they would have high fees for the emergency response and that he would still need to go to his vet a 6am to get his IV treatment for the day.

My reluctance is less of the money aspect, and more of the fact that Bruce has been through so much today. We had to draw blood from both legs, with issues on both sides, he's been in some discomfort and was stuck in the vet for almost 4 hours. He had the IV pack, a B12 shot, and a antibiotic shot. I just feel like he is so traumatized, I will only make it worse to take him back out tonight. I am already worried for them to keep him tomorrow for 8 hours to hydrate him. I know his BG is really impacted by stress.

Hypothetically, if I did rush to ER and they determined he had Ketoacidosis, then what? Would he get some kind of treatment immediately? or a shot or something? would anything that you know of be handled immediately, or would it likely be something that is monitored closely and treated over time?

This is the only time as a cat- mom I have felt like all of the solutions are not the right solution. Pets with diabetes is so hard because of the complications and they can't talk so I really don't know what it is that has him acting differently.

 

If they found he had ketoacidosos he would be immediately started on treatment. It is an emergency situation. They would not just monitor him
What tests did they do with the blood they drew today? Was that the vet or the ER.?
If you don’t want to take Bruce to the ER, would it be possible for you to collect a urine specimen from him and take it to the ER and ask them to dip a test strip urine to test for ketones.?
The ketones is my main concern at the moment....does he have any?. If he doesn’t have any ketones, then waiting until the morning would probably be OK, especially if you can get him to eat some food.
The reason we are all concerned is because ketones can develop in a diabetic cat when there is not enough food being eaten, not enough insulin and if there is an infection or inflammation....well we have the recipe for DKA. Ketones can rapidly increase and develop into DKA.

 

Hi Lauren,

How are you and Bruce doing today? How did things go with the vet?




Mogs
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Hey Mogs! Thanks for checking in!

Bruce did go to the vet and he got about 5.5 hours of an IV drip. He looks much more alert now and seems to be stronger in his legs. The vet said, his blood work looked totally fine, and his BG was only 291- which is not the highest he has had at the vet. No sign of the DKA and not sign of issues in the organs. So they think it may have just been a uti that resulted in him being dehydrated and not wanting to pee or drink. I am still not sure- I have never seen him act like that.

However, I am super happy that the results were good and that he seems more alert now.

I discussed switching insulins with the vet, and he gave me some ProZinc to try instead of Vetsulin. I am going to try that this weekend at 2 units and see how he takes to that one.

 

Before you switch the insulin to Prozinc, please review the Sticky posts at the top of the Prozinc ISG forum here.