Help Sept. 2nd, 2020 Blaze and Paola.

https://www.felinediabetes.com/FDMB/threads/blaze-and-paola-amps-16-3-293-4.234444/#post-2624723

Good morning everyone,
Last night was a bit tough. Blaze does not want to eat this morning.
He went to the litter, he peed (I was actually there while he did) and when he came out he walked a little strange like he had some issues from where he pees and he licked himself right away.
This morning he is on a food strike. I tried, wet, dry, mix...nothing, he only drank water and is walking away.
AMPS is 13.0 (234)
I don't know if shooting or not. Shooting time has passed (more than 15 minutes now)

 

Am I supposed to shoot?

 

thanks Paola I just want you to have the best advice

 

Thank you so much

 

I guess right now you are stalling...sorry there wasnt anyone around in health...

 

That's ok, yes, I am stalling...with lots of anxiety.

 

Can you get him to try to eat something else, anything? Not safe to shoot if he won't eat anything.
Will Blaze eat from your hand?
Have you tried some rinsed canned tuna, sprinkling treats on his food? Anything to get him to eat?

 

yes I have tried tuna, he just walks away. I was told to leave treats only to when he is really low...gonna try again

 

@Sue and Luci @carfurby are you around?

Paola, it is quiet this time of day. I'll see if I can find someone to help.

Did you check the litterbox to see if there was any blood or anything odd? May be worth calling your vet, especially if the inappetance keeps up. He needs to eat. I think I'd be getting a vet appt.

Do you have any freeze dried treats? or some cooked chicken?

 

He is eating a little bit right now, gonna check the litter box

 

When did he last eat? Aside from needing to make sure he'll eat in order to give insulin, cats need to eat or they can develop serious health concerns. Not tryin' to scare you, just saying if he hasn't eaten in a while but he'll eat treats, give him treats.

 

Ah okay that's good. Keep track of how much he is eating.

 

He has been eating so far, just this morning...but now he is eatimg. Not sure if i should gove him the insulim now

 

@Sienne and Gabby (GA) sometimes comes on in the mornings.

 

insulin time was 7:19last night

 

If he is now eating fine and you know you'll be able to get him to eat later, then if it were Butters I would consider shooting. How do you feel about it? Do you think you'll take him to the vet?

 

I was there until 4am this morning, hence my not being around first thing.


Mogs
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I wondered about you, @Critter Mom . i know you hang out in health.
Thanks for coming. I have tried to help best I can waiting for someone.

 

No worries Mogs, he just ate maybe less than 1/4 of what was in the bowl...

 

Hi Paola,

Just playing catch-up. BRB...


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I was hoping you were sleeping in. You need to take care of you sometimes.

 

For your reference: you can get back on track moving shot times back in 15 minute increments, or by 30 minutes per day. So if you do shoot this morning, say at 8am, then tonight you could shoot at 745pm, tomorrow morning at 730am, tomorrow night at 715pm and so on.
If you end up not shooting this morning, then you can keep the PM shot to the regular time you like to shoot.

 

I don't know how long it is that you've been stalling, Paola. Please can you tell me how long past shot time you are now.

If Blaze has only just eaten, please can you do a test ASAP before the food has a chance to really influence his BG levels.


Mogs
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thanks Lyla and all

 

Ambien has a way of taking the legs out from under a person.


Mogs
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Glad Paola's helpers are here! Around this time of day it is people mainly getting ready for work or having started work. I'll leave y'all to it.

 

42 minutes past shot time. gonna go test

 

Thanks for looking after Paola and Blaze.


Mogs
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14.0 (252)

 

This is approx a reading after he ate that tiny bit of food about 20 min ago

 

Questions:

How long was that test after he had eaten?

Has he shown any signs of nausea? (Licking food then walking away, doing a sort of yawny lip licking behaviour, a bit like the face a human makes when they taste something disgusting or really salty.) Did these behaviours subside after he started to eat a little?

You know Blaze better than anyone. How confident are you he will continue to eat for the rest of the cycle? (Little and often but steadily? Largish meal in next hour and perhaps small amounts later in cycle?)


Mogs
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Ok, the food will be starting to influence numbers a little. Just having another look at the spreadsheet. BRB ...

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the test was done about 20 minutes after...he did not show any of those signs. I think he will continue to eat but I have not shot him because I was unsure and now it is 50 minutes past shot time

 

A few more questions:

- Did he get lethargic at all later in last night's cycle? (And what are his energy levels like this morning?)

- Was he finnicky about eating in the later part of last night's cycle?

- Apart from the sluggish appetite, is there anything else 'off' about Blaze this morning?

- Did Blaze poop at all since +4 of last night's cycle? If yes, was his poop normal (i.e. well-formed, not too soft)?

(Sorry for all the questions but I'm trying to get a feel for where Blaze is at after the nadir BG last night).
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1) no, he was quite happy, we played a little too, he got a little "tired" and hungry when his sugars were at the lowest point. Energy level his morning is as usual for his mornings...now he is in his bed trying to snooze

2)Yes he was, he only ate half of his dinner

3) yes, he went to the litter, peed, came out and walked a little funny as if parts were bothering him...and as soon as he came out of the litter, he licked himself there.

4) No poop found (also i have seen less pooping going on between the two cats...I have 2 litter boxes. the cats used both randomly so it is difficult to know whose poop belongs to who but I usually would find 2 poops a day, I only find 1 now)

No worries thank you for helping me

 

Looks like you're getting some suggestions from folks now.

My only comment is that Lantus has a delayed onset of about two hours. You can shoot - that's a safe number - and see if there's something he'll nibble on in a little bit...

 

OK.

The reason I've been asking this series of questions is that sometimes when a cat goes to a much lower (but safe) number that they haven't seen in a long time, it can slightly knock them off kilter in the hours immediately following.

Here are things influencing my take:

- Body may still be adjusting to Lantus.
- Lowest BG reading to date on last night's PM cycle.
- Appetite is a little off.
- Bit of a strange wobble coming out of litter box (I'm always wary of the unusual).
- VERY LITTLE DATA.

As Sue says above, the BG level is high enough to administer the dose and you would be giving a reduced dose (0.25IU). My concern is that we don't have much data for Blaze, the low last night may have left him feeling a little bit icky this morning (hence appetite being off), or it may be his body taking a little time getting used to the Lantus.

BG is at a safe level to give [ETA] insulin but numbers drop and I'm concerned about Blaze's appetite. If it were my cat, I would skip this morning's dose to see whether a little time to recover from last night's lower cycle would see the appetite settle over the course of the day, ready for tonight's PM cycle. Other members may have a different view.

You know Blaze best, Paola, and you hold the syringe. How do you feel about whether or not to give insulin this morning?


Mogs
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PS:

Another observation influencing my take was that Blaze seemed a little lethargic when he was at nadir last night.

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I know it's scary to see these numbers in the early days - but oh what a blessing!

Just take it nice and easy - looks like you may have a kitty who will be on his way to better days - sooner than later...I do hope so

 

@Sue and Luci -

Fingers and paws are well and truly crossed over here in the Shire!


Mogs
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Is everything OK, Paola?


Mogs
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Worried about you, Paola...


Mogs
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I hope everything is OK at your end, Paola. Please post an update as soon as you can. We worry...


Mogs
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For members following this thread, I've just checked Blaze's spreadsheet and, according to the 'Remarks' column, Paola has elected to skip this morning's dose.


Mogs
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I am ok, I am sorry Mogs, I realized I had my virtual staff meeting, it just ended. I almost missed it. My friends had to ask where I was and tell me to get on

 

Yes at last, I couldn't get myself to shoot. I will resume tonight. Mogs I read all your thinking and it makes completely sense. I also had a really low moment myself after the meeting and needed some crying time. I am better now. I just wish I could help him more

 

Glad you're OK, Paola, and thank you for the update. (I was half hoping you might have been grabbing forty winks: the early days of the sugar dance can be quite a roller coaster and it's exhausting at times.)

Paola, know that you are helping Blaze. You're giving him the treatment he needs and you are doing a sterling job of keeping him safe.

All is good. You're all clear till this evening. Take a breather, and go grab some breakfast if you've not yet eaten. And have some more of these:




Mogs
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LOVE YOU MOGS, thank you for everything

 

You ARE helping him more. You're here. Sometimes there are set backs . We've all had them.

 

BTW, keep an eye on the litter box today for any stools that are softer than usual.


Mogs
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What a stressful morning for you! Skipping will give you a chance to regroup. It will be interesting to see how he responds. Just get a few tests in today. Maybe at times you never tested before if there are any. It’s a little concerning that he’s having appetite issues. Maybe he just wasn’t hungry after all the dry food yesterday? Could his tummy be off from the new foods?

 

I am not sure, but it is possible that his tummy might be off due to the change in food. Last night he didnt get much dry food...just a little bit...I am puzzled but I will get some tests in today for sure to see how his levels are without the insulin shot and how much they rise.

 

As well as with diet changes, sometimes the early days of treatment with insulin can unsettle the system. Some cats experience GI upsets upon cessation of insulin treatment when they enter their remission trials. I've seen cats who have a bit of a wobble after seeing low (but safe) numbers for the first time. Also the really precipitous drops in BG typical of insulins like Caninsulin and Novolin N can make some cats feel really lousy, my own beloved girl included. (Saoirse had a miserable time on Caninsulin. )

I suggest keeping an eye on the eating side of things during the day. Perhaps feeding Blaze little and often might help settle his tum.

Just in case Blaze might be feeling a little queasy, here are some signs to look out for:

Nausea Symptom Checklist


Mogs
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Don’t go overboard on testing. Days like this it’s good for both of you to take a break.

 

That list is

that list is very useful, thank you for it. He has done slightly a couple of those things listed...I wonder if he is a little nauseus...

 

When Max was nauseous he became inappetent. For him it turned out to be pancreatitis. I’d ask your vet if you could try cerenia or get an RX for the human drug, ondansetron if it continues. I really found ondansetron helped for nausea. The stress of all he’s been through can sometimes tick off the pancreas.

 

Yes I will continue to monitor his appetite and those symptoms and I will talk to her. I hope today I get ash's blood test results. I am anxious about those too...

 

Fingers 'n' paws crossed for good test results. (((Ash)))

I echo Elise's comments about ondansetron. I have my civvie, Lúnasa, on it at the moment to help her through a food change and a protracted course of antibiotics. When it comes to feline nausea, ondansetron can be a real game changer.

There is much useful information on treatments for nausea and inappetence on the linked page above.

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@tiffmaxee -

I'm planning to try to knock myself out earlier tonight so that I'll surface earlier tomorrow. It might provide better cover for Paola and Blaze.

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Thank you I am doing my modules training right now with quizzed and the lack of sleep of the past few days is not helping...but at least I have a calmer day with Blaze

 

Hi Paola,

Just checking in to see how your day is going. I see from your spreadsheet that Blaze has stayed fairly steady thus far today. Hope you've benefitted somewhat from the lull.


Mogs
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Hi Mogs,
Yes the day today was much calmer.
I worked online all day and only finished 1 hour ago. Now both boys are sleeping and I am catching up on my pvr.
Thank you for checking in.
Yes i tested him 2 times today. He hasn't eaten that much but only a little bit.

 

I had hoped his appetite would have picked up a bit more. Can you make a note of how much he's eaten versus how much he should have eaten a little while before the next PS test is due (so we can get a feel for how Blaze is doing).


Mogs
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Appetite aside, how has Blaze been doing overall today in terms of energy/activity levels, mood, etc? In particular, did he pick up more as the day went on?


Mogs
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Today he has been low energy, he has been sleeping for most of the day. He doesn't seem to be picking up yet...i am gonna write the note for sure, i think i did but my brain is fried...gonna double check.

 

I’m thinking he must be nauseous. Is it too late to call your vet?

 

With his appetite low let’s see the PMPS number but I’m thinking you should skip again unless he gets hungry.

 

Yes I agree

 

I have a question regarding Ketone strips. I bought them, do they also measure the sugar level in the urine or that is another type of strip...

 

I have to do the PMPS in 30 minutes...I am curious to see how much it is not having eaten much and no insulin this morning

 

I’ll be back in 30. Look at the box to see. The ones I had measured both.

 

Depends on the strip. Some do both (e.g. Keto-diastix), others just do either ketones (e.g. Ketostix) or the glucose (e.g. - yes, you've guessed - Diastix).

If they do both they should have two reagent patches on the strip.

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Me three.

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PMPS is 13.4 (241.2) I am gonna call them for dinner in 10 minutes...they are both asleep, they slept a lot today.

 

He had a few licks of the FF wet, I think I should give him 0.25 because he was at 13.4 all day...?
Ash is not eating either, just a few bites...they are probably both nauseous?
They have also been drinking more than usual today...
What is going on?

 

Ordinarily I would agree. You don’t want to shoot if he’s not eating though. I know you dint want him high but what will you do if he drops low and won’t eat? It’s very stressful. I had someone in that situation last night and she was up all night.

She started in green. With the skip and lower dose it might just be fine. If he was eating I would not hesitate. What do you think?

 

Elise, could the food be a factor here, given that both cats seem to be disinclined to eat?


Mogs
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Absolutely a real possibility. Changing food often causes tummy upset. Many even get diarrhea. All the more reason to be cautious.

 

Paola, bit tired so can't remember properly, did you give the cats some new dry low carb food last night?

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She did. They both devoured it. Were starving.

 

Also, did you notice any softer than usual poops in the litter boxes?

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They had been on the wet low carb for several days without any apparent issue (thus far). The only new-ish thing in the mix I can think of right now is the dry low carb food.

Any ideas?

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What point in the cycle?

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It could be the food. Blaze wasn’t eating though which is why we tried the new dry so it’s not just that. It started before. He’s had a lot of different foods in a short amount of time.

 

Both of them have.

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It’s what made her decide she could shoot I think so 7:30.

 

I think a call to the vetty bean in the morning for nausea meds might be in order. Such a sprag! Paola's been working so hard to help Blaze and they've been doing so well. Really annoying glitch for them. Grrrrr...

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Agree. I thought she would hear from Vetty about labs on the civvie.

 

Looks to me like she decided to skip. Nothing on the ss.

 

Paola,

I'm about to sign off so I'll give you my two penn'orth now.

Given that both cats are off their grub I suggest you call the vet first thing in the morning to tell them about the symptoms you're seeing (refer to the nausea checklist as a guide). Also keep an eye out for soft or loose stools. Tell the vet about the recent food change and that you're not able to give Blaze his insulin safely. Ask about anti-nausea and appetite stimulant meds. Some vets insist that mirtazapine is a 2-in-1 anti-nausea and appetite stimulant med but any anti-nausea effect it may have is totally eclipsed by ondansetron.

If Blaze were my cat I would skip tonight. If the inappetence persists into the morning then first thing I would put a in a call to the vet requesting an emergency phone consultation in the morning with the vet, stressing that you can't give Blaze his insulin because he can't eat.

I don't know what to suggest to you for the morning because of the catch-22: it's not good for a diabetic cat to miss doses of the insulin they need, and it's not good to give a cat who can't eat their insulin (hence the reason why cats in DKA need to be treated in a hospital setting where insulin and dextrose can be administered intravenously).

I must away, with the intention of being on parade a bit earlier come morning.

Paola, when you set up a new thread in the morning, please tag me so I can find it. (I can't cope with the index on the LBL board, it completely freaks my brain out.)

Nite, all.




Mogs
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Sorry girls, I am back.
I tried to get a pee sample from him...to see if he had ketones...I dont know! I am desperate.
He has not eaten anything, he is on a food strike. I have tried to hand feed, to warm food up in microwave...you name it

 

he has not pooped, he peed though after so long I waited to get a sample.

 

MOgs, thank you I will do all that, and yes, I did not give him his insulin tonight again.

 

Do they sell Gerbers baby food where you live? Or Beechnut? Mine prefer , especially ham. . Most cats will eat it when they turn down cat food but only the ones that are 100% protein, not those with other stuff in it. It’s easy on the tummy. Lots of liquid too. Have any chicken you can bake?

 

Good you skipped. Fortunately he’s not super high so less chance of DKA. Usually we are told to gradually change food so they dint get an upset stomach. My gut tells me that’s the issue. Too quick a change and too many different foods. Especially since both are reacting.

 

we have the Gerbers ones here I think. I have no kids of my own so I am not sure...but I think I saw them on the baby area on shelves...I don't have chicken in the house right now. I can buy some Gerbers tomorrow. Will look for ham

 

I am trying to do all these things...sorry I disappeared. Between waiting for him to pee, warming foods, try to give him old dry ones...I have been following him around but no luck.

 

You want Gerbers 2nds. It’s basically cornstarch and protein. It comes in chicken, turkey, beef, and ham. I’d get a few of each. The jars are small. Depending on the protein 70-100 calories. It’s easy to finger feed or syringe.

 

I tested him and I tried to use the Alphatrak this time. It said 18.3. Is the Alphatrack higher than the Onetouch? I just wanted to make sure I know how to use both.

 

Yes I did, just little bit