911 JUST got him to eat. Acting very strange at night. Can I give insulin?

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ja9390

ja9390

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Please offer any advice you can. My spreadsheet is up to date but please note that the AMPS from yesterday was under the influence of a meal.

He was just switched to 1 u Novolin twice a day instead of in the mornings only. He's been on this schedule since Thursday night. Even on the second dose to keep him low throughout part of the night, he has a pattern of turning into a zombie, and drinking massive quantities of water. I have no idea why he only does this at night. It's like his body gets so exhausted from his ups and downs all day long that he just gives up. Last night he only ate a few bites of his food. Just licked the juice out of the bowl and then went to sleep again, but 2 hours prior he had scarfed a whole can of FF so I gave him his shot and just monitored him closely but his PMPS was at 495 anyway. Around 11:30 he woke up, had a huge BM--most of it solid but some was semi-loose and not as firm as I'm used to seeing but it smelled horrible which is also not what I'm used to. Color appeared normal. 5 minutes later he threw up a little bit of food. Early this morning he threw up again but it was clear. On Thursday before I took him to the vet, he had diarrhea (not liquid but pretty loose) twice and he tested neg for parasites but she prescribed Flagyl which I didn't get filled because I didn't think he needed it after just two spontaneous bouts of diarrhea. I stayed awake as long as I could with him last night but eventually went to sleep and all night long woke up because I kept hearing him drink water. He will literally sit with his face in the bowl and drink for 5 minutes. He does this all night off and on until the entire small-dog-size bowl of water has been drained within a matter of 7 hours or so and it breaks my heart. The vet and I agreed that we'll give his little body some time to adjust to this insulin but if we can't regulate him I'll be switching. In two weeks I'm supposed to take him up there so they can curve him and monitor him.

I don't know why he does this. I'm terrified I'll wake up to a dead cat one day and I hate hearing him suffer through the night. I called off work because I'm exhausted, haven't slept well in weeks and spent the whole night crying wondering what he could have or how I could fix him and it's angering and frustrating because it seems like ever since he got diagnosed and I've been treating him, he's gotten worse. Of course our vet is closed today too. This morning he only ate a couple of bites of his food and I'm wondering if I should give insulin or not. He's into the 500's..
 
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Is there an emergency vet nearby? If you can afford a visit, I think I would take him in. One of the things we worry about with inappetite, lethargy and high blood glucose levels are ketones. If you can't get him in, I would get some ketone strips at the pharmacy (just like humans use) and test his urine for ketones. If he ate a little, and you can monitor and keep pushing him to eat more, I think I'd give 0.5 units at least. You want some insulin to bring that number down.

But my gut says - go to the vet.
 
I'm in nursing school and cannot afford the $100 charge just to walk through the door much less the thousands it will take for them to keep him if he is in DKA.

I've called the teaching emergency hospital and a student should be calling me back shortly. I too think that he needs at least some insulin.
 
I agree - he needs insulin. I agree with Sue - I'd give at least .5 unit but be sure there's food in him. If he starts going too low and won't eat, you can always syringe some food into him. Ketones are a real concern right now - please DO stop by a pharmacy with diabetic supplies and pick up a bottle of 'ketone test strips'. They're not very expensive - store brands work just fine.

Do keep pushing the food as often as possible - that's half the fuel his body needs, the other half of the fuel is the insulin to create that energy. You mentioned that your treating him and he's getting worse. Stop and think - diabetes is caused by a lack of the pancreas producing INSULIN, a HORMONE the body requires to convert that food into useable energy for the body. There's a fine line to balance. He's not worse because you're treating him, he may seem worse because the things that happened prior to the diagnosis are still a bit messed up....

HUGS!
 
I called around and a clinic was able to take us on an on-call basis. We're here now. He took some blood and waiting on what it says
 
The excessive drinking is usually high BS. Same with stinky poo. I see there was a blue last night so this morning is probably a bounce and would be expected. Hope the clinic can give you some answers. It takes time and dose changes (usually increases) before improvement is noticed. It doesn't happen over night.
 
He tested his blood, gave 125ml sub-q fluids and three shots--b12, an antibiotic in case of pancreatitis and an anti nausea but said that the only thing that is high is his glucose and its imperative that his doctor puts him on a longer lasting insulin. She had wanted to wait a few weeks to see if Novolin works for him but I'm 100% done with Novolin. He recommended PZI and Lantus so I will need advice about where the cheapest place to buy either of those drugs is. I got a copy of his labs and the vet wrote in my BG notebook everything he did today along with his phone number so I can show Diego's regular vet.

I feel like I let this cat down on an astronomical level. I had expressed my concerns about Novolin on Thursday and should have demanded a new insulin that day.
 
You did not let him down. I don't think FD was explained properly to you. Like a human it is a life long condition. Even with remission "once a diabetic always a diabetic". Most people don't realize it takes longer than a few days. It's not the flu or a cold you are dealing with. It's a long term illness.

The longer acting insulin would probably be better. But remember you will need to home test and dose will probably be increased for awhile until the right dose is found no matter what insulin you use. As his dose goes up you will start to notice less drinking and less stinky poo. His numbers will start to come down however slowly. And he will feel better overall. It is not a one time fix like an antibiotic.

This is what FDMB can help you with and guide you along. Think about making this a daily stop for you. Ask questions.

I hope I made some sense for you.
 
You haven't let your kitty down, at all! Many cats do reasonably well on Novolin, and there's no way to foretell which cat will do well on which insulin. PZI and Lantus are both good choices, fingers and paws crossed that Diego's numbers start to come down!
 
Woodsywife said:
I don't think FD was explained properly to you. Like a human it is a life long condition. Even with remission "once a diabetic always a diabetic". Most people don't realize it takes longer than a few days. It's not the flu or a cold you are dealing with. It's a long term illness.
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Yes, I know what diabetes is. It's rampant in Louisiana, and also in my extended family. Additionally, I've dissected a cat, I've held it's pancreas in my hands, and I know how the endocrine/digestive system works. I had never expected him to ever achieve remission, I just want control of this disease and I want my cat back. What is frustrating to me is that I can only do so much. I'm not a doctor--I had put a lot of trust in his doctor to lead me down the quickest path to getting him regulated. I had addressed these exact symptoms with his doctor on Thursday and she said she didn't know why he was having digestive upset but prescribed him Flagyl, which I refused because Flagyl would for sure make a vomiting cat vomit even more. Then the emergency doctor says it's because his diabetes is still uncontrolled and a lot of the problem lies in the insulin, which was my initial gut feeling but I was told otherwise. This is the most frustrating thing I've ever had to do. I bought all of the right stuff, spent all this money on him and spent nights awake with him trying to get him feeling better and wondering why he still feels like crap. I don't like doing all the right things (supposedly) and getting negative results. I'm not even seeing slow improvement. I'm not seeing ANY improvement. There were a few days early this month when he acted like a kitten again and then I never saw that side of him again after that. He turned into a zombie and all I've been told to do is to wait it out.
 
Thanks, y'all. I have him home and I will wait another hour for his anti-nausea to work before I try and feed him again. He's sleeping right now. The dr said I can give him the other half of his unit once he starts to eat again. I'll take a nap with him.
 
Yeah he is eating. Will the ER vet give you a script for different insulin? Is the ER vet willing to talk with your regular vet, maybe they can convince him. Then you could start using it and then show your regular vet the results. Smokey vomited all the time for years when my parents had him. When I first got him I wasn't told that's why he vomited he was put on reglan. It took a long time to put 2 and 2 together and know that's what caused it and the fact that at my parents he was literally starving (only fed 1/3 cup dry a day). It looks months to get him to every 3 hrs feedings without vomiting. Can't seem to go any longer yet.
 
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Woodsywife said:
Yeah he is eating. Will the ER vet give you a script for different insulin? Then you could start using it and then show your regular vet the results. Smokey vomited all the time for years when my parents had him. When I first got him I wasn't told that's why he vomited he was put on reglan. It took a long time to put 2 and 2 together and know that's what caused it and the fact that at my parents he was literally starving (only fed 1/3 cup dry a day). It looks months to get him to every 3 hrs feedings without vomiting. Can't seem to go any longer yet.
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wow--thank goodness you figured that out--
I agree a different insulin sounds like a promising idea :cat:
 
Diego looks is such a cutie, hope he starts feeling like himself soon. Good luck with the insulin change.:bighug::bighug::bighug:

Just wanted to offer some encouragement, George was a sea of red/pink and black for the first month, took us that long to see a blue! I felt awfully guilty because he spent 2wks on oral meds, having read about it I didn't think it was the right move and regretted not standing my ground with the ver, during that month of red and black I felt sure that I had missed my chance to get George regulated, he got up to 3.75 units and today just over 3 months from starting on lantus he is looking pretty good his dose is now at 0.75u(saying that in a whisper, don't want him to get ideas above his station;)), don't despair, step by step you will get there.:bighug::bighug::bighug:

Can't help with the sourcing of the insulins, (I'm in europe) but I believe some buy meds from Canada because it's so much cheaper, I'm sure there is a link somewhere. Perhaps someone will come up with it soon.
 
I am puzzled as to why your vet initially told you to give insulin only once a day... Until you can get Diego started on a different insulin, I would suggest you talk to his vet about maybe increasing his dose; looking at his spreadsheet, it seems like maybe an increase might help.
 
He didn't write me a prescription for it but said to try and get him switched over. He even told me of an Albertsons down the road from his office that supposedly works with his patients to get prescriptions pretty affordably. Does anyone use Lantus pens? From what I've heard, SAMS and some other pharmacies have been known to sell just one 3ml pen at a time for $80ish instead of the box of 5 which would cost well over $275. I'm pretty sure I can get her to switch him over to at least try another insulin. Unless she wants to trade places with me and listen to him slowly deteriorate every night as his glucose rains hell on him. That would change anyone's mind. He's napping peacefully under the covers with me now for the first time in WEEKS.
 
Squalliesmom said:
I am puzzled as to why your vet initially told you to give insulin only once a day... Until you can get Diego started on a different insulin, I would suggest you talk to his vet about maybe increasing his dose; looking at his spreadsheet, it seems like maybe an increase might help.
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I was too. No human diabetic would ever be sent home on a one-a-day dose of insulin at the beginning. Also, no human diabetic would ever be sent home from the doctors office with a BG over 500 and be told "this takes time, lets just see".

She had him on one dose a day apparently because that's what all cats are started out on there. She told me to wait and come back in two weeks to have him curved but I ended up coming back with my data from testing him and she was supportive and respectful of that, and used it to increase him to twice a day, which has been our schedule now since Thursday night. Part of the reason why I'm upset to see that he's still zombie-ing out at night. I expected the increased water drinking and lack of energy at night before he was on insulin but not during.

I woke up and gave him the other 0.5u of his insulin 30 minutes ago. He stayed put in my bed while I did it and then I covered him back up and let him sleep more. Sweet baby.
 
Funny story about the dose too. Since day one she had me on 1u once a day. She told me how to draw it up into the syringe and said "its the little line under the big line" except there are two little lines under the big line. I was looking at the 0.5u little line instead of the 1.0u little line. So the entire time I've been giving him 0.5 units once a day like an idiot. I only realized this on Thursday night after she bumped him up to 1.5u twice a day. I was meticulously examining the syringe to make sure I was drawing up exactly 1.5u and low and behold that's the night I realized I've been loading the syringe wrong...so I increased his dose 0.5 like she said which would actually make it 1.0 units twice a day instead of 1.5 units. I didn't want to give him 1.5u and perhaps give him too much too quick.

Maybe it IS okay to put him on 1.5u twice a day now?
 
ja9390 said:
Funny story about the dose too. Since day one she had me on 1u once a day. She told me how to draw it up into the syringe and said "its the little line under the big line" except there are two little lines under the big line. I was looking at the 0.5u little line instead of the 1.0u little line. So the entire time I've been giving him 0.5 units once a day like an idiot. I only realized this on Thursday night after she bumped him up to 1.5u twice a day. I was meticulously examining the syringe to make sure I was drawing up exactly 1.5u and low and behold that's the night I realized I've been loading the syringe wrong...so I increased his dose 0.5 like she said which would actually make it 1.0 units twice a day instead of 1.5 units. I didn't want to give him 1.5u and perhaps give him too much too quick.

Maybe it IS okay to put him on 1.5u twice a day now?
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If she suggested 1.5U that's what I would go ahead and give him. Are you able to monitor him, to make sure he doesn't go too low? Looking at his spreadsheet, I would imagine he'll be okay, but best to monitor for safety's sake.
 
Most of us use the Lantus pens, but draw down the dose with a syringe, the pen won't let you do small adjustments to dose, you can only go up and down in whole units, usually dose changes are done in 0.25u increments/reductions (there are some exceptions) if Lantus is the route you are planning on following you would be best getting u100 syringes with i/2 unit markings. If you haven't already take a look in the stickies on the lantus forum, they are full of useful info on syringes, dosing etc,

ja9390 said:
Funny story about the dose too. Since day one she had me on 1u once a day. She told me how to draw it up into the syringe and said "its the little line under the big line" except there are two little lines under the big line. I was looking at the 0.5u little line instead of the 1.0u little line. So the entire time I've been giving him 0.5 units once a day like an idiot. I only realized this on Thursday night after she bumped him up to 1.5u twice a day. I was meticulously examining the syringe to make sure I was drawing up exactly 1.5u and low and behold that's the night I realized I've been loading the syringe wrong...so I increased his dose 0.5 like she said which would actually make it 1.0 units twice a day instead of 1.5 units. I didn't want to give him 1.5u and perhaps give him too much too quick.

Maybe it IS okay to put him on 1.5u twice a day now?
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I am not really familiar with Novolin as I have been on lantus since the start, but I probably wouldn't recomend upping his dose by 0.5u BID it seems like too much of an increase especially as you have seen some blue with the 1u last night. The high amps this morning is likely a bounce from the perceived low last night, a bounce is when the kitties body reacts to a fast drop, or a lower than usual number, essentially the liver 'panics' dumps counter regulatory hormones into the blood stream which result in sugar being dumped into the bloodstream and high BGL, the effect of the bounce can last 6 cycles.(welll it can on lantus , not sure if the same is true of novolin). If you were to increase, I think it should be a smaller increment, o.25, I am not saying that you should increase I don't really have the experience to advice if the 0.25 would be appropriate, but feel that the 0.5 is probably too much.

eta Just going to tag some experienced members to see what might be appropriate @Marje and Gracie @Sienne and Gabby (GA) @julie & punkin (ga) @Jill & Alex (GA)
 
Squalliesmom said:
If she suggested 1.5U that's what I would go ahead and give him. Are you able to monitor him, to make sure he doesn't go too low? Looking at his spreadsheet, I would imagine he'll be okay, but best to monitor for safety's sake.
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I could take him with me to my little job tonight and monitor him but the poor thing has already been through enough for one day. I will see where we are around 6pm and make a decision. On Sundays I work mornings and nights at a church nursery for a few hours at a time, and my boss suggested I take the cat with me if we feel up to it, that way I won't have to miss work to monitor him. He's been once before and just chilled in his carrier. I think that an increase is definitely in order...maybe just starting out with a 0.25 increase on both shots for a while until I feel that he won't bounce, and then move up to an increase of 0.5 twice a day.

I do have the u100 syringes already. .3 cc size, 30 gauge, 8mm. I just need the prescription for Lantus. I think Lantus is what I want to go with...if Walmart can sell me enough insulin to last 2-3 months for $87, that's perfectly doable. I need him on a long-lasting drug asap and as long as the price isn't out of this world, I'll pay whatever. For my sake. I got 3 hours of sleep when I drove him 6 miles to the emergency vet, ugly crying. Not exactly safe. He is much in need of some relief and I am in need of a glass of wine and a cat that is on his way to being well-adjusted. It's hard to see the end of the tunnel at the beginning but I will keep fighting for him.
 
BTW - I think I saw mention that Marks Marine Pharmacy may now sell single Lantus pen cartridges. Might be worth giving them a shout to see if this is the case and, if yes, how much they charge (including the shipping).
 
Critter Mom said:
BTW - I think I saw mention that Marks Marine Pharmacy may now sell single Lantus pen cartridges. Might be worth giving them a shout to see if this is the case and, if yes, how much they charge (including the shipping).
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They said that Walmart sells the single pens. I checked out Marks website and with shipping, the package of 5 pens...15 ml of Lantus is only $159. Compared to one 10 ml vial sold anywhere in America costing MINIMALLY $120. I could buy the one vial of Lantus from the canadian pharmacy for $99 and with shipping it would still be cheaper than buying it in America from the world's shadiest pharmacy.

For expiration purposes I'm glad the pens are a thing, and I can end up using more before it expires rather than having to trash half a vial.
 
If you know a lot of human diabetics, and you trust that they keep things clean and don't reuse needles, you may want to ask them to give you their left over Lantus as long as it's in a vial (not pens). Most insurance will pay for a new vial each month, and some people don't use the whole vial. Lantus expires after 1 month, but most people here keep it for much longer than that. So if you know someone you trust, it might be worth asking.
 
Meya14 said:
If you know a lot of human diabetics, and you trust that they keep things clean and don't reuse needles, you may want to ask them to give you their left over Lantus as long as it's in a vial (not pens). Most insurance will pay for a new vial each month, and some people don't use the whole vial. Lantus expires after 1 month, but most people here keep it for much longer than that. So if you know someone you trust, it might be worth asking.
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Good idea.
 
He likes my work. Walked around the entire room sniffing everything, roamed the hallways, and has been coming back every so often to rub all over my legs. Perhaps this will be a weekly thing if it gets him moving like this.
 

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Sue and Oliver (GA) said:
Is there an emergency vet nearby? If you can afford a visit, I think I would take him in. One of the things we worry about with inappetite, lethargy and high blood glucose levels are ketones. If you can't get him in, I would get some ketone strips at the pharmacy (just like humans use) and test his urine for ketones. If he ate a little, and you can monitor and keep pushing him to eat more, I think I'd give 0.5 units at least. You want some insulin to bring that number down.

But my gut says - go to the vet.
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This question was in my head but I'm just calming down and having a chance to verbalize it: how does one test a cats urine for ketones with a dipstick test. I am familiar with the tests--I would intentionally send myself into ketosis for a day or two when I was on strict low-carb/ low sugar diet to help correct a medical issue I was having. Except that I just peed directly on the stick :D how do you do that with a cat?
 
Some cats let you stick the stick in their urine stream. Some people use a ladle. Oliver would never let us watch him pee. We put aquarium gravel in a clean box and left him in a room with it. He'd have to "christen" the clean box. Then we'd swoop in and get our sample as the gravel didn't absorb it.
 
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