hyperosmotic state - need dosing advice

Status
Not open for further replies.
babbie & otto

babbie & otto

Member Since 2015
4/4 amps 563 1st time ever Otto wont eat!! need advice
i hope i did that right . havent managed it yet.
Otto was breathing heavy this morning so I went to vet, fluids and diagnosed in hyperosmotic state. Vet wants me to go up to 5u tonite as he says his high glucose levels got me here in the 1st place. Yes, on my ss I have a recent dose of 3? as I gave a fur shot and didnt know how much got in but from the smell of insulin on my hands it wasnt much. So I gave him 3u. Anyway, he wasnt hungry this morning but finally ate and happy and purring now after fluids. Gotta watch closely!
 
When you typed in the "4/4 amps 563 1st time ever Otto wont eat" if you go back and "highlight" that sentence (just like if you were going to copy/paste it) and then click on the little icon that looks like a link, a little box comes up. Inside that box you put the link from yesterday's condo. To get that link just copy the address you see in the address bar (like where you'd put something like "www.google.com")

Here's your 4/4 condo for you

From what I understand, this "hyperosmotic state" is due to dehydration, not necessarily not enough insulin and the dehydration is usually caused by some kind of infection or other disease that leads to decreased fluid intake.

One thing I noticed...it looks like you thought you gave a furshot and then (because you could smell it) you decided to shoot again...and only 3 units. You don't ever want to do that because there's just no way to know how much actually got into the cat. We've seen so many times when someone was sure they gave a furshot, and later on that same cycle, their cat dropped below 50.

Since the furshot was on the PM cycle 4/2 that generally starts the 6 cycle "timer" over, so tonight you'd only be at the 3rd cycle at 4.5. One thing that can be considered is to possibly "fast track" Otto, but let's see if I can get some other opinions on that first. It would also be good to try to get some tests at different times instead of always the same times, especially on the PM cycle. You don't have to stay up all night...just get some tests in at different times. For tonight, you'd want to give the 4.5 though

Let's see if @Wendy&Neko , @julie & punkin (ga) ,@Sienne and Gabby , @Marje and Gracie @Vyktors Mum might have some ideas
 
His fluid intake has been great! I made broth and give him close to 2 cups a day. Noticed the dehydration and heavy breathing this morning. So weird as Ive been home watching him and all seemed fine then boom.
 
Some of us are discussing this but, IMHO, I would be concerned about fast tracking because Otto has gotten a couple of what we would consider blue nadirs and lots of yellow nadirs on a human meter (remember those are AT numbers). Roomp/Rand suggests the difference between the AT and human meters is 30-40% at lower numbers which leads me to think it's more at higher numbers. Even if you were to consider 35% difference (which is likely too low of a percentage), all the numbers that are pink on his SS are likely actually yellow on a human meter. But these numbers may still be too high for Otto's own body chemistry.

Hyperosmolar syndrome can be quite serious. Long lasting insulins cannot bring the BG down as fast as you probably want or need for this condition. Did the vet mention possibly using a fast acting insulin like Novolin R (aka Humulin R) combined with fluids to yank the BG down while being a bit more methodical with the Lantus dose increases? Many of us use R for different reasons but that seems to me a better scenario while increasing the Lantus dose every six cycles by either 0.25u or 0.5u. the R can get the numbers down and help the Lantus do its job a little better.

Bottom line.....you have to do what's best for Otto and what your gut tells you. If you feel you need to follow the vet's advice, then do it but just keep a really close eye on Otto with monitoring. But I would talk to the vet about using a bolus insulin in combo with the Lantus and we can definitely help you with that.
 
Last edited:
hyperosmotic
pertaining to hyperosmolarity.
hyperosmotic state
condition caused by the accumulation in the body of significant quantities of osmoticallyactive solutes, e.g. hypernatremia, hyperglycemia. See also hyperosmolality.

I had to look that one up, seems it can be caused by hyperglycaemia but obviously I don't know enough about the condition to offer advice in these circumstances. However, I do know enough about Marje to trust her judgment absolutely.

Lantus is gentle and steady it is not something to be used to bring down BG in a hurry by increasing the dose, if that is what's needed then you should look at other options.

Please heed Chris' advice about not shooting again on a fur shot. You have no way of knowing how much went in so it is a very dangerous thing to do.

Sending scritches and vines to Otto
 
As Marje noted, diabetic hyperglycemic hyperosmolar syndrome is serious.It's very similar to diabetic ketoacidosis but without the ketones. Has the vet ruled out any source of infection or inflammation?
 
I like Marje's idea of the bolus or fast acting insulin. Lantus (and Levemir) work better from lower numbers and using the bolus would nudge down those high numbers around preshot and give the Lantus something to work with. The problem with jumping up too high too fast on the Lantus is that it has a much longer lasting effect. You can get hypos that last for many hours, whereas the R is in and out.
 
He never mentioned the fast acting insulin and I didnt know to ask. Pollen is really high here so he gave him benadryl just in case thats what it is but he didnt think so - no fever and blood has been good as well as appetite until this morning. I only gave 4.5 tonite but want to bump up tomorrow to 5 like he suggests. That is in keeping with the 3 cycles TR. right?? Ill text him in the morning about the bolus. Im sure he doesnt have it on hand. (339 at pmps tonite) and starving.
 
Any human pharmacy would carry R and you don't need a prescription for it. Even on Easter there will no doubt be some pharmacies open tomorrow - perhaps a hospital pharmacy or one in a grocery store. I've used it and find it's a very good extra tool to have in your diabetic toolbox. I don't know anything about that condition, however, and think it would be a good idea for your vet to be in on a decision to use it. I'd give him a call in the morning and ask what he thinks about you continuing to use the Lantus as the basal (primary) insulin but adding on R as the bolus (secondary) insulin.

The advantage to using R is that it is in and out of a cat's body in about 4 hours. Lantus, on the other hand, forms a deposit (depot) when you inject it and and then could be thought of as time-releasing (sort of). Lantus is great at holding lower numbers flat - that's why you can see some cats (looking at the subject line on the main page for Lantus/Lev isg) with basically a flat 12 hour cycle. Not moving more than a few points in that 12 hours. R is great at pulling down the high numbers.

If you decide that trying this is right for you, we like to have an experienced person who will guide you in using it and who will stay with you when you first are trying it. So please let us know if you want to try it - don't just do it on your own.
 
babbie & otto said:
That is in keeping with the 3 cycles TR. right??
Click to expand...

No..TR has increases every 6 cycles...every 3 days. When we suggest "fast tracking", it's only in specific cases and then we might suggest increases every 4 cycles.

I'm glad to see the others offering other options for you to talk to your vet about! Hopefully between everyone here, we'll find something that works well for Otto! Using "R" is a great tool, but only to be used when you have someone who's used it before helping to teach you how to use it. It's very useful in certain circumstances, but it can also be dangerous if you don't understand how to use it.

Let us know if you want to try it and I'm sure the people who know what they're doing will be glad to help you!
 
I think we all, here, think you should give him six cycles at 4.5 and reassess but it's still your decision. We'd encourage you to talk to your vet ASAP about using R. If he knows you are a member here, you can also let him know we have a lot of experience using it. I agree with Julie that you should discuss it with him. We can make suggestions but if Otto does have hyperosmolar hyperglycemia, your vet needs to be in agreement with treatments.
 
Good morning! I'm not seeing anything on his ss since last night, but i think it's ok for you to go to 5.0u this morning if you haven't shot yet, unless he dropped significantly lower last night than he has been recently.

By the way, we just do one thread per day per cat and keep updating it throughout the day. That keeps everyone's current thread on the front page so that people don't get missed. It helps to regularly edit your subject line throughout the day with the latest information.

On the right side of your first post in a thread you'll see "thread tools". From there, you can edit the subject line and keep it current. That way you can flag a topic and/or update blood sugar tests throughout the day and people can see the info from the main page.

I hope Otto is doing well today! You can start a new thread this morning when you're ready to give an update for today. :bighug:
 
I hope Otto is doing well today. We recently started R to help bring Tess's bounces down. It's scary at first to give another insulin, but it has really helped w/ Tess. Start really low, about a drop, until you see how Otto reacts to it.

If you decide to go w/ R insulin Walmart is the best place to get it and they are open even Easter morning. Just go to the pharmacy,(no Rx required) and ask for a vial of R insulin. It is only $25 at Walmart, about $120 anywhere else. Walmart has a special deal w/ the manufacturer.
 
thank folks. What would you consider a high enough glucose level for the R dose? How do you know what a drop is? I guess I have to waste a little in the sink trying to figure it out. More fluids today just in case. Still hungry and not breathing heavy. Vet wants me at 6 and just frowned when I said i went up to4.75. He really pushed for 5u tonite.
 
Status
Not open for further replies.
Back
Top