High Ketone levels?? Lantus dose

Discussion in 'Lantus / Levemir / Biosimilars' started by Violet and Garland, Aug 16, 2011.

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  1. Violet and Garland

    Violet and Garland Well-Known Member

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    Garland is a DKA kitty. Shes in recovery from that and FHL. But her ketones are still high (large on the color scale strip) I asked on the other board and they said to ask you guys over here. I dont think her ketones have gone down at all since being in the ER all last week. When do they start to leave? Im so confused about all this... the vet just told me to keep tube feeding and give her insulin. He said he was more concerned with getting her past the FHL than the DKA right now? Do I change her dose?
     
  2. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

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    Violet --

    First, please get PM tests. you need at minimum, one test per cycle.

    Personally, I disagree with your vet. The HL is important to address but so is the DKA. DKA can kill and it can kill quickly. Your cat should not be throwing large amounts of ketones. That cannot be managed at home. More insulin and food are both important in keeping DKA under control. I always urge people to get their cat to the ER if ketones are above a trace amount.

    One suggestion, please test yourself to ketones to make sure the strips are working properly. And please make sure you are following the instructions.
     
  3. Sandy and Black Kitty

    Sandy and Black Kitty Well-Known Member

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    Dec 31, 2009
    Hi Violet,

    I agree with Sienne. I'm very surprised you cat was sent home with ketones.

    Please follow Siennes suggestion and test yourself to verify strips are good. If it were my cat and ketones were above trace, I would get him to the ER straight away.
     
  4. Violet and Garland

    Violet and Garland Well-Known Member

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    Aug 6, 2011
    I took her to the ER when her ketone levels showed a high level. She was there a week. They sent her home?? Told me she wasnt critical anymore and there wasnt anything they were doing that I couldnt do here (ie, her meds and tube feed) So she should still be there? They have been high since the day I took her in. They knew this when sending her home..

    I followed the directions on the box, but I will test myself to make sure they are working right

    EDIT: they are working when I tested on me
     
  5. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

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    I just took a look at the posts on Health. Who suggested a 1.0u dose of Lantus? Was this what the ER suggested?

    Also, are you able to test more frequently?
     
  6. Violet and Garland

    Violet and Garland Well-Known Member

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    Aug 6, 2011
    1u was what shes been on since her diagnosis in March. I have always thought it was too low. Shes never had a number below 250 (before the dka). When I had my vet discharge meeting, I asked about her insulin, and if I should change it. He said just keep her at her usual dose. When I did her curves in the past, they have always looked closer to a straight line. hovering around the 300 mark
     
  7. Sandy and Black Kitty

    Sandy and Black Kitty Well-Known Member

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    From the FDMB FAQ:
    Not something one can accomplish at home.

    What did Garlands regular vet have to say about the hospitalization last week?
     
  8. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

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    hi violet. we haven't met yet. sienne asked me to stop by. i have not read your other threads, but i agree with the others. it's not something you can treat at home when a kitty is measuring "large" on a ketone strip. garland should be under a vet's care tonight. they can administer IV fluids and aggressively treat with a short-acting insulin such as Humulin R.

    this will give you a better idea what you're dealing with and what needs to be done: http://petdiabetes.wikia.com/wiki/Diabetic_ketoacidosis.

    garland's dose is too low, but we can talk about that after they bring her ketone level down.
     
  9. Violet and Garland

    Violet and Garland Well-Known Member

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    I know how dangerous DKA is. I watched my cat hover on the brink of death for a week in the ER. She still not doing well. Add on the FHL and the feeding tube and I know she is very very sick. I took her to the ER and we kept her there for 7 days. They told me to take her home. I took her back on Monday because I was still worried about her. They sent her home again, telling me to keep doing what I am doing. Garland doesnt have a regular vet. We moved out here and never got one. When she lost all that weight, I took her to a vet here (one we had never seen before), they ran her blood, diagnosed her, wrote the prescription and I started home testing. Garland was doing so well after that, I wasnt worried about her. It was like she was never even diabetic until this DKA happened last week

    Here is the story

    viewtopic.php?f=28&t=49370
     
  10. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

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    yes, many of us are all too familiar with a kitty in DKA. we understand.
    i will go read the link to your story now, but please call the ER. "large" ketones cannot be treated at home successfully.
     
  11. Karrie and Maverick

    Karrie and Maverick Well-Known Member

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    So Garland needs to go to the ER for fluids until she's not showing ketones? How can she then make sure that it doesn't come back. Did it come back because Lantus was under dosed? Now that she has found Lantus Land she will have handholding to find the right dose and do her own curves. Obviously her vets haven't been hands on so far which is why so many of us found FDMB in the first place.
     
  12. Karrie and Maverick

    Karrie and Maverick Well-Known Member

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    Also maybe if you post on health (after crisis averted) on where you are maybe someone has a vet near you already.
     
  13. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

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    violet, do you have venita's phone number? you might want to call her to see if DCIN is able to help again. i have no idea if more donations came in or not.
    just a thought...
     
  14. Violet and Garland

    Violet and Garland Well-Known Member

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    I called the ER vet she stayed at. Her DR that took care of her all last week wont be in until tomorrow morning. So I told them to have him call me first thing. The tech I spoke with looked up her chart and said her ketone levels havent been checked since the 10th?? But she couldnt tell me the results bc they had been sent out for testing. Shes going to call me back with those numbers
     
  15. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

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    violet, talk to any of the doctor's there. any ER vet should know how to treat ketones and they'll know "large" ketones is not treatable at home. they're used to this kind of stuff.
     
  16. nancy and payne

    nancy and payne Well-Known Member

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    Oct 31, 2010
    Violet, you need to take her now! I didn't realize they were at large. Last time you waited too long, don't do it this time. She needs to be hooked up to regular insulin until the ketones leave and her dose of Lantus needs to go up, you need to be her advocate! you can do this, you can! We didn't steer you wrong last time ....
     
  17. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

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    i have to test alex and feed my kitties, but i'll be back.
    i hope you were able to speak to a vet about bringing garland in...
     
  18. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

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  19. julie & punkin (ga)

    julie & punkin (ga) Well-Known Member

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    just wanted to tell you i'm thinking of you and Garland . . . virtual hugs from my end of the continent.
     
  20. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

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    i'll be signing off for the night, but will check in on you tomorrow.
    goodnight...
     
  21. Venita

    Venita Well-Known Member

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    Violet, please call me this morning. We'll see what we can do.
     
  22. Angela & Blackie & 3 Others

    Angela & Blackie & 3 Others Well-Known Member

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    Hoping for a full and speedy recovery for your kitty, and I hope that the ketone issue is rectified very quickly.
     
  23. Violet and Garland

    Violet and Garland Well-Known Member

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    I talked with the vet. He said they checked her ketones on the 10th and they were at a 1 (i guess thats right above trace?) He told me that the reason DKA gets out of control is bc the cats are usually not eating or drinking and vomiting a lot. He said since Garland is getting nutrition from her tube and has a potassium supplement that the ketones should correct. And when I was asking about her dose, he (in not so many words) left that up to me. He said, you could go up to 1.5u 2x a day ,or even 2u 2x a day. Or if I wanted do 1.5u in the morning and 2u at night. etc..

    I kept pressing him about the ketones, he said if I wanted we could do a urine sample and get it sent out for testing. He would call an internalist (?) for a more expert 2nd opinion.

    Sigh.. im so worried and so confused about all this.

    Venita- Ill call you in a few minutes. Im gonna get the kids a snack to occupy them
     
  24. Marje and Gracie

    Marje and Gracie Senior Member Moderator

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    Violet:

    Just keeping sweet Garland and you in our prayers.

    I don't understand why they have to send a test for ketones to a lab??? I don't know that much about it but perhaps it is more accurate? I'm hoping Jill or Sienne will pop in to help you and this will bump you up.
     
  25. Kelly & Oscar

    Kelly & Oscar Well-Known Member

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    Feb 17, 2010
    First things first - I would personally take that dose right on up to 2u right now. She needs more insulin. Since she is getting food through the feeding tube, then it is likely a case of not enough insulin right now. Do you still have some fluids around from when Patricia visited? Is it possible to give her 50-100ml today?
     
  26. Dyana

    Dyana Well-Known Member

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    Hoping you get Garland into a vet today, and keeping her in my possitive thoughts.
     
  27. Karrie and Maverick

    Karrie and Maverick Well-Known Member

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  28. kse

    kse Well-Known Member

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    Feb 10, 2011
    Just checking in on Garland. Have you been able to get to a vet or administer any sub q fluids?

    Please don't wait....It will be much easier to treat the ketones now.
     
  29. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

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    ketone levels can change in as much as a few hours. garland's ketone levels on the 10th have nothing to do with where they are today. have you been able to get a ketone test today or better yet... is garland being treated at the ER? i/we are very, very concerned about that reading of "large" ketones last night.

    the recipe for DKA is insufficient insulin + infection + inappetance/not getting enough food.

    garland should be receiving approximately her normal amount of calories plus about half that amount within a 24 hour period. this could mean tube feeding every 3 - 4 hours 'round the clock until garland begins to eat on her own. how many calories have you been able to get in her a day? those who have been in your shoes have found it helpful to modify their spreadsheet by adding lines to record when kitty was fed and how many calories were fed at each feeding time. the food lists can be used to calculate number of calories.

    was an infection found and is garland receiving an antibiotic to rid the infection?

    is garland receiving denamarin or denosyl to support her liver?

    obviously, the dose has to be increased, but the most important thing now is to have garland treated professionally to bring down that ketone level. once she's released ketone free we can work with you on dose.

    increasing the dose, administering subq fluids at home, and making sure garland is receiving enough food may help and is definitely worth trying if hospitalization is absolutely impossible, but it's a poor substitute for remedying the problem. garland's best chance is hospitalization followed by intensive home care until she gets back on her feet.

    sending hugs and positive thoughts...
    many of us have a good idea how stressful and difficult this can be.
     
  30. Violet and Garland

    Violet and Garland Well-Known Member

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    Aug 6, 2011
    I cant take her back to the ER. She was there a week last time. We cant afford more thousands and thousands of dollars. But I have been in contact with Ventia. She is walking me through some aggressive at home treatments. I just checked her BS and it was 404, so Venita said to give her 1.5 u. I am about to feed her, then I am going to get some R insulin to use. Im hoping to be able to get another sample for another ketone test soon. but its hard to know when shes going to use the litter box...
     
  31. julie & punkin (ga)

    julie & punkin (ga) Well-Known Member

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    just remember that lantus is 12 hr intervals - i'm not sure what schedule you're on, but it will get tricky with lantus nadirs overlapping if you're not sticking pretty closely with 12/12. there are people who use R to pull down the high numbers til the lantus can "grab a hold" of the high BG.

    is that what she's helping you with? there are several people who have experience with using the R as a secondary that could be flagged to come and help you if you need it.

    :YMHUG: this has gotta be stressful - you're an angel to be doing all you can with garland.
     
  32. Violet and Garland

    Violet and Garland Well-Known Member

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    Aug 6, 2011
    I just feel so bad for her. She is so sick. I hope shes not suffering to much. Am I being selfish trying to save her?



    She got in the box and peed and of course was finished by the time I got the strip there. But I stuck it in the wet litter (which im sure probably messes up results) and it seemed much lighter. But all those pink colors are hard to decifer

    Yea, we gave her the lantus bc thats all I have right now. But Venita wants me to get some R to use to get her numbers down
     
  33. Sandy and Black Kitty

    Sandy and Black Kitty Well-Known Member

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    Dec 31, 2009
    Violet,

    Please answer the questions below -

    Was an infection found and is garland receiving an antibiotic to rid the infection?
    What is Garlands ideal wieght?
    How many calories are you managing ito get into Garland in 24 hours?

    As Jill said earlier:
    Remember - the recipe for DKA is insufficient insulin + infection + inappetance/not getting enough food. All these must be overcome in short order.
     
  34. Violet and Garland

    Violet and Garland Well-Known Member

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    Aug 6, 2011
    She did get an antibiotic while at the ER (they didnt tell me why though, not sure if something was found, or if it was just done automatically)

    Normal weight? No idea. She was always overweight for her frame her whole life (maybe 14 pounds?). Then when diagnosed she had lost a lot (down to 7 pounds) and after starting insulin she got back up to around 12 pounds. She lost a little while at the ER bc she wasnt eating, I think she is 10 pounds now

    I feed her at 7, 11, 3, 11, 7 They told me to feed her 30CC, 5 x a day and going from 12-7 during the night was fine. She gets about a can (5.8oz) of the recovery a day (Maybe a smidge more)
     
  35. Sandy and Black Kitty

    Sandy and Black Kitty Well-Known Member

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    :?: Does it indicate on the can how many calories per can or per oz.?

    :?: Is she eating anything on her own?
     
  36. Violet and Garland

    Violet and Garland Well-Known Member

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    Aug 6, 2011
    Ummm.. i cant tell on the can?? maybe 183kcal? does that sound right?

    She will not eat/drink anything on her own

    She only moves to go to the litter box or change positions.
     
  37. Libby and Lucy

    Libby and Lucy Senior Member Moderator

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    I'm looking at your spreadsheet, did you give 1u at AMPS and another 1.5u at +6?
     
  38. Violet and Garland

    Violet and Garland Well-Known Member

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    Aug 6, 2011
    Yes, Venita said to bc we needed to give her more (her numbers are sooo high) 404


    That was 1 hour 45 minutes ago. I just checked again. its 374 now
     
  39. Libby and Lucy

    Libby and Lucy Senior Member Moderator

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    How many test strips do you have? Do you have karo syrup? Do you know what carb % the food is that you're feeding? How long has it been since you gave the 1.5 units?

    Giving an extra dose at +6 is not something that we recommend. Lantus creates very long cycles and a lot of overlap. Yes, Garland's numbers need to come down, but using R would be much, much safer than giving extra doses of Lantus. Lantus can hang out in the system for a long time, so if her numbers start to drop you could find yourself testing and feeding every half hour for 16-24 hours. Please be sure you have lots of supplies. That might not happen, but you need to be prepared. I'm concerned that this might be too much of a dose increase. I'm not trying to worry you unnecessarily, sometimes overdoses turn into a non-event, but you need to be prepared. The last thing you want is to run out of test strips at 3 in the morning.

    When can you get the R? And please don't give another shot of Lantus in 6 hours, get the R instead. It is quick in, quick out so if you make a mistake with dosing you don't have to fight against it for so long. That's why they use R at the hospital. Don't misunderstand - R is a very powerful insulin and tiny, tiny amounts can have a huge effect. Don't give more than 0.1u for your first shot until you can see how it works in Garland. At the vet hospital they give larger amounts, but they also usually have the cat hooked up so they can give a glucose drip if needed.

    I don't know how many calories are in the Recovery food, but when Lucy was recovering from DKA/HL I was told to feed her every 3 hours. You want to keep a constant supply of food going. Fluids too, very important.

    I really, really think Garland needs to be in the hospital, but if you can't do that then you have to keep the food, insulin, and fluids coming (but be careful with the Lantus).
     
  40. Ann & Tess GA

    Ann & Tess GA Well-Known Member

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    Jan 7, 2010
    With shooting early you really need to check her BG frequently.

    Are you feeding her Royal Canin Recovery? That's 172 kcal per can on the list, but if the can says 183 that is probably correct. General rule of thumb is 20 kcal per pound ideal weight. If she is under weight it would be more. So 10 pounds now, times 20 is 200 kcal and you should be giving her half again that amount for the DKA as Jill said, which is 300kcal. You should be trying to get her to eat 1 1/2 to 1 3/4 cans a day.

    Hugs for you and prayers and scritches for Garland.

    ETA: If it is the Royal Canin, it is 6% carbs.
     
  41. Sandy and Black Kitty

    Sandy and Black Kitty Well-Known Member

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    Dec 31, 2009
    Like Ann said, you need to check Garlands BG frequently since you overlapped doses. You probably are at +2.5 or +3 (from the 2nd shot) about now? Good time to check.

    And how wonderful - Ann did all the math on the calories and the carbs!
    As Libby suggested, feeding around the clock is best.

    Listen to the advice given here Violet - It's from folks who have been where you are. You have probably figured out that the ER vets knowledge is limited. Here you have the many voices of experience.
     
  42. Dyana

    Dyana Well-Known Member

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    Dec 28, 2009
    When I am kind of desparate to check pee for ketones, I move the litter box to be right next to me (like next to my computer or wherever I am sitting, even in the middle of the living room). I also use a very small cup to hold under J.D.'s tail when he's peeing. Some people use something like a soup ladle. I am still following all your posts and wishing you the best.
     
  43. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

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    Dec 28, 2009
    violet, please get some varieties of high carb food to have on hand. like libby said, lantus can create long cycles and a lot of overlap. best to be prepared with plenty of test strips, karo, and high carb canned food since garland was dosed again with lantus at +6 today.

    here's a few examples of high carb canned food which can probably be picked up at any grocery store:

    Fancy Feast Grilled Beef Feast - 18%
    Fancy Feast Grilled Chicken Feast - 18%
    Fancy Feast Grilled Turkey Feast - 18%

    9-Lives Chicken & Cheese Banquet - 23%

    Special Kitty (Walmart) Chicken Hearts & Livers - 19%
     
  44. Venita

    Venita Well-Known Member

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    Dec 28, 2009
    Royal Canin Recovery. 172 calories per 5.8 oz can. Carb 6%.

    Folks have been saying that Garland's insulin dosage was too low. Violet gave 1U this morning and based on my suggestion at +6 and a BG level of 404, Violet gave another 1.5U of Lantus. Violet's husband would not be able to get home with the R for several hours after the +6 shot.

    Violet has honey. She also has high carb dry food that she can "melt down" with the Recovery and water if high carb is needed. I really doubt that we are going to see a low BG event from the insulin Violet has given Garland thus far today.

    I just spoke with ER vet, Dr. Hill. He said that on Monday, he suggested that Violet raise Garland's Lantus dose to 1.5U BID. Today, he said he suggested to Violet that she raise Garland's Lantus dose to at least 2U BID. He also agreed based on the information I gave him that it would not be a bad idea to add some R into the mix as needed. He said that when he saw Garland on Monday, he thought her breathing problem was nasal congestion. He thought Garland's hydration on Monday looked good, based on the water added to her food. He said that he wasn't really sure that SubQs were needed based on the hydration level he saw on Monday. He also said that he suggested that an outside lab perform the urinalysis because there is a chance that the bilirubin from the fatty liver is "staining" the ketone stix and making the ketone level appear higher than it is.

    Violet and her family, and DCIN's suporters, are tapped out on the $ it would take to send Garland back to the ER. More ER money is not do-able, unless we find a true sugar Momma or Daddy.

    I am willing to take phone calls from Violet whenever needed, and assist her with understanding BG numbers and Lantus and R dosages. Violet is putting her heart into Garland!! Violet has SubQ fluids and the admin line and needles that Pat left with her, but Dr. Hill doesn't think SubQs were needed, based on her hydration level on Monday.

    Violet is feeding Garland 5x/day. Violet spends an hour each time she feeds Garland.
     
  45. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

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    Dec 28, 2009
    Violet:

    Let's try to summarize what needs to be done. If you need help with trying to get this all fit into a schedule that allows you to spend time with your kids, let us help. Is there a family member or friends that can give you a hand with the kids or with other responsibilities until Garland is past this critical point? The latter is just something to think about so you don't wear yourself out.

    • Feeding times:
      7:00
      11:00
      3:00
      11:00
      7:00
    • Can you increase the amount of food to 1.5 cans per day? This would mean giving 1/3 of a can (1.5 - 2 oz or 45 - 60 cc) at each feeding time. Alternatively, is it possible for you to feed every 3 hours. This would be 8 times per day. If you feed 8 times per day, you would be feeding about 1 oz of food each time. This is pretty much what you're feeding now. (FYI - 30 cc is the equivalent of 1 oz.)
    • What is your preferred shot time? I think it might be easiest if you were to shoot at one of the times where you're feeding -- probably at 7:00 -- but we've also got to figure out what time your next shot needs to be. Most likely 12 hrs from your shot at +6 today. We will probably need to work on getting his shot times back to a point when it's convenient for you. As Libby said, DO NOT give another Lantus shot at what would be your PMPS.
    • What meds (by name) are you giving Garland and how many times a day do you need to give him his meds? We'll want to work this into the schedule, too.
    I would strongly advise you to work with Libby around getting Garland on a dose of R ("Regular" insulin). As she noted, R is very, very powerful. You only need a very tiny amount -- far less than the amount of Lantus you're giving Garland.
     
  46. Libby and Lucy

    Libby and Lucy Senior Member Moderator

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    Dec 28, 2009
    I can support 1.5u because of the ketones. I can't support 1.5u at +6, but let's work on supporting Violet and Garland now.

    Violet, here are some "recipes" for an A/D slurry that I was given in my foster training. It is intended to get as many calories into the cat as possible, understanding that it can be hard to syringe enough calories worth of regular food. I'm sure you can use the Recovery food as a base instead of A/D, if that's what you have. You might have to put it into a blender or add more water/Pedialyte to get it to go through the tube. Usually it's better to feed more small meals than a few larger ones. The added benefit of using Nutri-Cal and karo is that the extra carbs will give some room to give more insulin, helping to combat the ketones.

    A.
    1 can A/D or Max Cal food
    1 generous squirt of Nutri-Cal
    1 spoon of Karo syrup
    Rebound – stir in enough to make this a slurry that will go through a syringe

    B.
    1 can A/D or Max Cal food
    1 generous squirt of Nutri-CaL
    ½ Jar turkey baby food
    Pedialite - stir in enough to make this a slurry that will go through a syringe
     
  47. Violet and Garland

    Violet and Garland Well-Known Member

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    Aug 6, 2011
    Ive been feeding at 7, 11, 3, 7, 11

    Ive been giving her lantus at 7 and 7

    Her meds: at 7am: lantus, 2.34ml potassium gel, 1/4 tablet Famotidine, 1/2 tablet Metoclopramide

    at her 3pm feed- 1ml Petinic

    at her 7pm feed: lantus, 2.34 ml potassimium gel, 1/2 tablet metoclopramide

    I was giving her an appetite stimulant every 3 days, but didnt do her last dose based on recommendations here


    I am about to head to walmart to get more strips. What else do I need to get? Is it expensive? We do not have a lot of extra money
     
  48. Libby and Lucy

    Libby and Lucy Senior Member Moderator

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    Dec 28, 2009
    I don't know if they would have Nutri-Cal at WalMart (if so it would be in the pet section). Maybe some Pedialyte and karo to help add calories and nutrition to her food. You can buy Humulin R there at the pharmacy. I bought mine at a different pharmacy and I paid around $40, but others have gotten it cheaper at WalMart. I think someone recently said it was around $25-30.

    You might pick up a couple of jars of all-meat baby food in case she can be tempted to eat a little on her own. Make sure you get one without onions or garlic. What finally got Lucy eating on her own was store-bought reduced sodium chicken broth. I would heat it up and use it to water down her A/D. One day all of a sudden she decided it was good! She also went for rotisserie chicken heated up.
     
  49. Dyana

    Dyana Well-Known Member

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    Dec 28, 2009
    High Carb food if you don't already have a good supply.
     
  50. Dyana

    Dyana Well-Known Member

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    Dec 28, 2009
    I think the last time I checked which was only weeks ago, the R was about $28.00 at WalMart.
     
  51. Libby and Lucy

    Libby and Lucy Senior Member Moderator

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    Dec 28, 2009
    syringes with 1/2 unit markings are very helpful when dosing R. If that is not the kind of syringe you already have, WalMart's brand is around $13 for a box of 100 and you'll use them for Lantus too.
     
  52. Karrie and Maverick

    Karrie and Maverick Well-Known Member

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    Oct 22, 2010
    You have to give the metoclopromide 20 minutes before her feeding to be effective not at the same time as feeding.

    Also Pepcid shouldn't be given at the same time as other medications - give other medications one hour before or two hours after pepcid.

    Metoclopromide is not an antinausea medication for cats. But this is the least of the worries if she is keeping food down. When she turns the corner and gets over her crisis we can address this.

    Recovery has more calories than AD so stick with the recovery and follow the ways above to boost calories.
     
  53. Karrie and Maverick

    Karrie and Maverick Well-Known Member

    Joined:
    Oct 22, 2010
    The first week is difficult. I had to feed Maverick around the clock for the first week. He had a PEG tube and we could tell his stomach was empty every 2.5 hours (fed every 3 hours as recommended above). It was worth the lack of sleep for the first week. He had like ten medications to fit in at different times also.
     
  54. Ann & Tess GA

    Ann & Tess GA Well-Known Member

    Joined:
    Jan 7, 2010
    I don't want to get in the way as I don't know enough about DKA.

    But if the concern is getting more calories fed Is there a specific reason for feeding Recovery or AD? other than calories? I've been skimming the J&B list for calories: Wellness Chicken (220) and Turkey (218) for 5.5oz cans and the Kitten formula is 121 for a 3oz can. The Turkey is very soft, I make a soup of it for Tess otherwise it just mushes in her bowl.

    Blue Wilderness is even higher calorie, 132 kcal/ 3oz. can. (I checked their website.) It is more expensive, but this doesn't need to be a long term food. Wilderness is also very soft, almost a mousse, so it should be easy to thin out. You could feed the same amount and still get a lot more calories into Garland.
     
  55. Violet and Garland

    Violet and Garland Well-Known Member

    Joined:
    Aug 6, 2011
    Sorry for the delay. I had a bunch of "kid" stuff and my husband was late coming home. He just walked in. So I am (finally) headed to the store.

    list:
    R insulin
    strips (im out)
    babyfood I already have
    Recovery canned food I already have
    pedialyte I already have
    Honey I have
    Syringes w the half mark I already have

    Am I missing anything?

    What is nutri-cal??
     
  56. Violet and Garland

    Violet and Garland Well-Known Member

    Joined:
    Aug 6, 2011
    Really??? They told me to do it this way. Okay, Ill change it up. So the metoclopromide I give 20 minutes BEFORE her feed? Ive been giving it right before. If its not an anti nausea, then why am I giving it to her?

    I give the pepcid in the middle of the day all by itself apart from other meds, but with food. .is that right?
     
  57. Libby and Lucy

    Libby and Lucy Senior Member Moderator

    Joined:
    Dec 28, 2009
    it sounds like you are in pretty good shape once you get the strips. I should have known that a mom would have all the supplies handy already. ;-) We usually recommend a bunch of cans of high carb wet food (the kinds Jill suggested). Most of those are chunks and gravy, so the gravy might go into the tube ok if you leave out the chunks. I think mixing syrup with the food you are already syringing might work as well (or better) while you have a feeding tube, so if you can't get those foods that's fine. For some cats those are really tempting, though, so it might be worthwhile to get a can or two to see if you can tempt her to eat on her own.

    Do you have time to grab another test before you go? Or do you need to wait until you get strips?
     
  58. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    Nutri-cal: Nutri-Cal is a high-calorie palatable dietary supplement used for stressed or debilitated pets, pets suffering from illness, surgery or whelping, aging pets or picky eaters, who need increased caloric and nutritional intake. It's probably available at Petsmart or Petco. (You might want to call and see if it's in stock.)

    Make sure the baby food you have on hand is just the plain meat and broth kind -- no veggies, onions or garlic.
     
  59. Karrie and Maverick

    Karrie and Maverick Well-Known Member

    Joined:
    Oct 22, 2010
    I don't want you to miss the posts from the experts like Jill, Libby and Sienne. Print out the posts if its getting overwhelming.
    Pepcid works better on an empty stomach - an hour before feeding. But I had difficulty getting all the medicines in with Maverick and had to give it with food often. The DKA is the primary crisis right now so don't worry about the antinausea medication. She may not feel the best but as long as she's keeping food down thats the important thing. Metoclopromide will work for nausea caused by stomach motility. It does help some cats stop vomiting. So don't worry about that for now just keep the status quo. Once she's through her DKA crisis I can help you address nausea if she still isn't acting 100% when ketones are back to being 0.

    Remember when you give medication through the tube to disolve the meds in water first. Maverick's vet told me to predisolve meds in about 3mls of water and put that in through his tube with a syringe. But the vet didn't teach me in the beginning to do a pure water flush after the disolved meds were put in the tube. So remember when you give just medicine to also do a warm water flush after to clear the tube and push all the medicine through. I remember how overwhelmed I was so thought I'd share just in case.
     
  60. Violet and Garland

    Violet and Garland Well-Known Member

    Joined:
    Aug 6, 2011
    Thanks :) I am reading everyones posts. You guys are so nice to help me and Garland

    I just got back and tested her. It was 409. I didnt give her her usual shot at 7.

    With the pills, I am dissolving them in 3ml of water and doing them right before the feed. so the food pushes it through. Then I flush w 6 ml water. does that sound okay?

    I will have to go to petsmart tomorrow to look for the nutri-cal
     
  61. julie & punkin (ga)

    julie & punkin (ga) Well-Known Member

    Joined:
    Feb 17, 2011
    :YMHUG: you're doing great, violet!
     
  62. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    I would see what Libby thinks about the Karo she suggested. The Petinic that you're giving contains corn syrup (same as Karo) and sucrose. It also contains a bunch of vitamins. The trade off here is that the syrup/sucrose will raise BG but it also provides calories. I don't know if you need both Karo and the Petinic but I've not had experience tube feeding. Libby and Karrie and Jill are more experienced than I am in this area.
     
  63. Violet and Garland

    Violet and Garland Well-Known Member

    Joined:
    Aug 6, 2011
    What is everyones opinions on what insulin schedule I should be doing right now? I have lantus and R
     
  64. Sandy and Black Kitty

    Sandy and Black Kitty Well-Known Member

    Joined:
    Dec 31, 2009
    Sienne is correct, R is very different, very powerful. You must proceed with caution and guidance.

    I was in the same position in June 2008, with the step by step guidance from the folks her in Lantus Land, I learned how to safely use R to help my kitty recover from DKA.
     
  65. Libby and Lucy

    Libby and Lucy Senior Member Moderator

    Joined:
    Dec 28, 2009
    I would not give another Lantus shot until *at least* 10 hours after the last one, and that is only if her number is still high. How would you feel about trying the R now?

    What you would do is give 0.1 unit of R. Here is a picture of what that looks like - it's just a drop. You might want to practice first to be sure you are actually squirting out some insulin. ;-) Then test at +1, +2, and +3 after you give it to see if it is doing anything. If she is still going down at +3, then you would get a +4 to see if she is going up yet. If she is still high at +4 after the R, post for advice. Depending on what time that is, you might want to give more R or you might want to give Lantus instead (or maybe even both).

    0.1u might not do anything at all, but R is powerful so it's important to be cautious with your starting dose. Some cats are more sensitive to R than others.

    What time zone are you in?
     
  66. Violet and Garland

    Violet and Garland Well-Known Member

    Joined:
    Aug 6, 2011
    im central time. I will test every hour and put it on my spreadsheet. R makes me nervous nailbite_smile

    I will be taking Garland to the vet in the morning to get a urinalysis so we know exactly what we are battling here. But the results take 24 hours
     
  67. Libby and Lucy

    Libby and Lucy Senior Member Moderator

    Joined:
    Dec 28, 2009
    no need to be nervous. That's why we start with a tiny dose and test. That way you have complete control and can make your future decisions based on data.

    I'll watch for your next number in an hour. Breathe! You're doing great.
     
  68. Karrie and Maverick

    Karrie and Maverick Well-Known Member

    Joined:
    Oct 22, 2010
    You are in good hands.
     
  69. Violet and Garland

    Violet and Garland Well-Known Member

    Joined:
    Aug 6, 2011
    433

    Since its going up, i went ahead and gave her her Lantus. Its been 9 hours since the last dose. The doctor said she could have 2u 2x a day. So with this dose that makes 4u for the day, like what he said she needed. I really dont even think that will help too much. Her numbers are extremely high. and even after getting that dose earlier, never went down hardly anything.
     
  70. Libby and Lucy

    Libby and Lucy Senior Member Moderator

    Joined:
    Dec 28, 2009
    Please test again in an hour to see if the R has started to work.

    FYI, generally we give Lantus shots 12 hours apart. Sometimes we'll give it up to an hour earlier if the cat is very high and on the way up. Experienced users will sometimes shoot up to 2 hours early if they have data to know that is ok for their cat and if they are purposely trying to build extra overlap and bring the numbers down fast. Shooting 3 hours early is almost never done.

    Lantus has a cumulative effect, each dose building upon the previous ones. Even with a normal dose change, it can take up to 6 cycles (3 days) to see the results of a dose change. It might look like the dose is doing nothing, but then BAM! Once the dose kicks in things can change suddenly.
     
  71. Libby and Lucy

    Libby and Lucy Senior Member Moderator

    Joined:
    Dec 28, 2009
    question - on your spreadsheet it looks like you gave 0.1u of R at +9 after the second Lantus shot and then gave another 1.5u of Lantus an hour after that (which would be +10 after the previous Lantus shot). Your post says you gave the last 1.5u Lantus shot nine hours after the previous dose. Which is right?
     
  72. julie & punkin (ga)

    julie & punkin (ga) Well-Known Member

    Joined:
    Feb 17, 2011
    violet, i know it's a little weird to be trusting strangers on the internet, but Libby is one of the best. She's had years of experience with feline diabetes, 24/7 and you can trust her to guide you.

    She guided me when i was new and my vet had us using the wrong dosage of syringes - causing my cat to get 2.5x as much insulin as he was supposed to be getting. Really. You have a pro giving you advice.
     
  73. Violet and Garland

    Violet and Garland Well-Known Member

    Joined:
    Aug 6, 2011
    now its 448

    Sorry, i must not have counted the boxes right. its late...

    its 10 hours since that middle of the day extra shot she had.. So shes had 1.5 lantus and 1 drop of R tonight. Numbers 409, 433, 448
     
  74. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    hi violet. i'm sorry i won't be around to help tonight, but i wanted to post a recap so everyone understands how much and what kind of insulin has been administered when:

    8/17
    amps - 294 - (1u Lantus per vet)
    +6 Lantus - 404 - (1.5u Lantus per Venita) <----------- Lantus shot clock is reset
    +2 Lantus - 376
    +9 Lantus - 409 - (0.1u R per Libby) <----------- R shot clock starts
    +10 Lantus and +1R - 433 - (1.5u Lantus per violet?) <----------- Lantus shot clock is reset
    +1 Lantus & +2 R - 448

    hope this helps everyone because it's confusing! :D
     
  75. Libby and Lucy

    Libby and Lucy Senior Member Moderator

    Joined:
    Dec 28, 2009
    Thanks Jill!

    One more hour to see if the R kicks in...
     
  76. Violet and Garland

    Violet and Garland Well-Known Member

    Joined:
    Aug 6, 2011
    493 now..

    Im having such a hard time getting her ear to give me blood. Usually its super easy

    She looks awful tonight. Long slow breathing, not moving much... its heartbreaking :(
     
  77. Violet and Garland

    Violet and Garland Well-Known Member

    Joined:
    Aug 6, 2011
    My babies get up in 5 hours. I need to get at least a couple hours sleep to be able to take care of them in the morning. I can set an alarm and do a quick test in a couple hours....
     
  78. Libby and Lucy

    Libby and Lucy Senior Member Moderator

    Joined:
    Dec 28, 2009
    have you been adding sugary stuff to her food tonight, or just feeding the Recovery? I'm asking just to be sure I understand how food might be impacting her numbers. It might help if you can put a * on her spreadsheet in the hours where you have fed her. Sometimes it's easier to understand patterns when you can put a visual to them.

    It has been about 2 hours since the last Lantus shot, correct? If so, we can't give more R now. To give R now would mean that onsets or nadirs of the two insulins could coincide. At about +6 or +7 after the Lantus, if she is still high you can try 0.25 units of R and again test at +1, +2, +3 after the R. Please don't give another Lantus shot until at least 12 hours after the last one. I know it doesn't look possible right now, but I'm concerned that all the extra overlap could cause her numbers to bottom out if you keep giving early shots. It has happened before.

    *General* guidelines for R use, since we don't have much data on Garland's Lantus cycles yet, is to not give it between about +2 and +7. Eventually you will be able to fine-tune that, once you have learned when Garland's Lantus onset/nadir/duration are.

    Please talk to your vet again tomorrow about fluids, and try to find out from them if there is anything else you can do at home.

    I'm going to bed and won't be around until late afternoon tomorrow, but others are watching out for you too. Good job today! I remember how overwhelmed I was when Lucy came home after her DKA/HL hospitalization. I remember syringe feeding her in my closet because she wouldn't come out. She looked horrible. One day all of a sudden she decided she wanted to live. The turnaround was unbelievable from that point. Hang in there, ok?
     
  79. Libby and Lucy

    Libby and Lucy Senior Member Moderator

    Joined:
    Dec 28, 2009
    get some rest. Like I said, if you get a +7 after the Lantus shot and she is high you can try 0.25 R if you want. Wait until +12 to give more Lantus. Post if you need help. Night!
     
  80. Venita

    Venita Well-Known Member

    Joined:
    Dec 28, 2009
    Violet, while you are the vet clinic tomorrow getting the urine sample collected, please ask whether they have Clinicare.

    Hope has previously recommended it for thinning the Recovery for tube feeding. It will add nutrients and calories.
     
  81. Sandy and Black Kitty

    Sandy and Black Kitty Well-Known Member

    Joined:
    Dec 31, 2009
    Hi Violet -

    Just checking in to see how things are going. I'll be around today. Keep us posted.
     
  82. Violet and Garland

    Violet and Garland Well-Known Member

    Joined:
    Aug 6, 2011
    hi. I must have been way more tired than I thought. I slept through my alarm last night. My husband (im assuming) must have heard it after a while and turned it off...

    This morning: Im feeding her right now. i tested her before I started and it was 302. i havent given her any insulin yet. Im about to call the vet about what time they would like me to bring her in for her urine sample
     
  83. Violet and Garland

    Violet and Garland Well-Known Member

    Joined:
    Aug 6, 2011
    I havent added anything to her food yet. So shes still just getting the recovery.
     
  84. Violet and Garland

    Violet and Garland Well-Known Member

    Joined:
    Aug 6, 2011
    She will be at the vet at +12- Im dropping her off there for a few hours to get her urinalysis done. I cant wait up there bc my daughter has a speech eval I have to be at at 10. I was thinking of doing her lantus before I go. I gave her that lantus last night at 9:30pm, its 8:30am now. Would it be okay to give her the 2u in 30 minutes?
     
  85. julie & punkin (ga)

    julie & punkin (ga) Well-Known Member

    Joined:
    Feb 17, 2011
    can you check her BG and post it a few minutes before you shoot so we can look at it?

    in general you can give a shot 30 minutes early without any problems - but with the multiple lantus shots and the R shot i don't feel like i know enough to be able to say for sure. it might depend on how high she is at that point.
     
  86. Venita

    Venita Well-Known Member

    Joined:
    Dec 28, 2009
    Violet's DH will be taking Garland to the vet this morning. This is the same vet Garland has been going to. The VCA in Ft. Worth is a 24-hour facility, so it does both emergency and regular care.

    I spoke to Dr. Hill, Garland's vet and the facility's medical director. They will be doing a cystocentesis to harvest Garland's urine, and send it to Antech for a full evaluation. The dark color on the KetoStix might be bilirubin from the fatty liver, and not ketones. But the Antech lab will let us know.

    If Garland needs it, she also will be getting fluids. Dr. Hill agrees that infections figure into DKA, but Garland received a full-spectrum ABx when she was first hospitalized, and also received a Covenia shot partway through her time there so she should still be getting ABx coverage.

    I called the vet clinic back, Violet. They will be adding 3 cans of the Clinicare to Garland's take-home package.

    Violet, you are doing an awesome job caring for Garland. Truly awesome!! All of us here on the FDMB will do our best to get her through this illness--advice, financial support, emotional support, prayers and well wishes.

    Should anyone else want to help with the $ for today's vet visit, please see this page of the DCIN blog. Sorry that page isn't up to date with treatment info, but caring for Garland (and others) has been more important than writing about the care. (And thank you, Rebecca and FDMB, for your donation for Garland's care.)
     
  87. Violet and Garland

    Violet and Garland Well-Known Member

    Joined:
    Aug 6, 2011
    Thank you Venita and everyone here at FDMB. You all are truly a blessing to me and Garland
     
  88. Violet and Garland

    Violet and Garland Well-Known Member

    Joined:
    Aug 6, 2011
    Its 321 right now.
     
  89. Violet and Garland

    Violet and Garland Well-Known Member

    Joined:
    Aug 6, 2011
    Okay, I gave her the 2u. Its only 15 minutes early. I have to get going (busy day over here) Garland will be headed to the vet now and will be there for a few hours. I will let you guys know how she is when we all get back to the house!

    Thanks soo much!
     
  90. julie & punkin (ga)

    julie & punkin (ga) Well-Known Member

    Joined:
    Feb 17, 2011
    excellent. good job - crazy night for a mom with little kids and a sick cat. hang in there!
     
  91. Lisa and Do Lou (GA)

    Lisa and Do Lou (GA) Well-Known Member

    Joined:
    Jan 10, 2010
    sending lots of support your way and healing vines for Garland today :YMHUG: :YMHUG: :YMHUG:
     
  92. Ann & Tess GA

    Ann & Tess GA Well-Known Member

    Joined:
    Jan 7, 2010
    Keeping you, Garland and your family in our thoughts and prayers today. :YMHUG: :YMHUG: :YMHUG:
     
  93. Sandy and Black Kitty

    Sandy and Black Kitty Well-Known Member

    Joined:
    Dec 31, 2009
    Good job - keep us posted. I'm working today, however I am able to keep an eye out for you.
     
  94. Marje and Gracie

    Marje and Gracie Senior Member Moderator

    Joined:
    May 30, 2010
    Violet: you are amazing....you are doing phenomenal and I know Garland feels your love. We say here in LL that our prayers have special magic and we are all sending them to Garland and you.
     
  95. nancy and payne

    nancy and payne Well-Known Member

    Joined:
    Oct 31, 2010
    (((((Violet)))) our thoughts and healing prayers are with you and Garland, you will get through this!!

    My Payne almost died four times and with all the help here, she is doing great!! Cats are amazing they can come back from a lot!

    You are doing great! dancing_cat dancing_cat dancing_cat
     
  96. Sandy and Black Kitty

    Sandy and Black Kitty Well-Known Member

    Joined:
    Dec 31, 2009
    Hey there Violet,

    How about starting a fresh condo for today when you return?
     
  97. Karen & Smokey(GA)

    Karen & Smokey(GA) Well-Known Member

    Joined:
    Dec 28, 2009
    I'm still following your story and praying for Garland and you.

    What a wild ride you are having....keep hanging on; you are doing
    a great job.
     
  98. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    You are doing an incredible job.

    I'm at the airport (I've been out of town and now heading home) so I've been following from afar. Keep taking care of yourself (and Garland). Let us know if there's more we can do to help.
     
  99. Ann & Scatcats

    Ann & Scatcats Well-Known Member

    Joined:
    Dec 31, 2009
    wow although a Lantus user, I've been lured into Lantus land by Venita to see how Garland is doing.


    I hope the urine analysis comes out that it is not ketones, but the bilirubin affecting the reading.

    But I wonder, why don't the ER measure the blood b-ketones with the Abbott Precision Xceed/Xtra? My animal hospital have those and we only determine whether in ketoacidosis by that and by blood test for pH, oxygene, and electolytes.

    This is the ER parameters they use
    (I= intensive care)
    I-stat EC
    I-stat Sodium
    I-stat Potassium
    I-stat Chloride
    I-stat pH (normal 7,24-7,40)
    I-stat pCO2
    I-stat BUN
    I-stat Glucose
    I-stat Hct
    I-stat Hb
    I-stat TCO2
    I-stat HCO3
    I-stat BE
    I-stat Anion Gap
    Temperature

    When Simba came in he was hypo-sodium, hypo-chloride, hypo-potassium, hypo- I-stat HCO3, hypo I-stat Anion Gap and hyper-glucose, and the blood B-ketones (0.3-1.6) where 5.8, 5.1, 6.6, and the fPLI (for pancreatitis 2.0-6.8) was on sky high 343, and the fructosamine was at very high 700's. They were fast getting him hooked up on tube, iv and all, and 2 days later most was corrected and his blood B-ketones was down to 1.8. They gave him RC Recovery in the tube.

    But he had to stay in the hospital for little over 14 days, due to the severe pancreatitis, the pancrea was enlarged and inflammed to 1.5 cm wide size (ultrasound scan), they didn't think he would make it. But I told them to keep trying.


    Definitely need to get the blood glucose under control, if that is the only reason for it.


    Thinking of you violet and Garland.
     
  100. Violet and Garland

    Violet and Garland Well-Known Member

    Joined:
    Aug 6, 2011
    Wow Ann :) You totally lost me with the medical talk LOL I wish they had done another blood test though. But I guess a urine test was what they wanted? I have no idea. Im so new to all of this. Maybe Venita knows?

    Poor Simba.. 14 days?? Im glad he pulled through
     
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