? 24/12: MITTENS - Novolin N, Small Ketones

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STORY SO FAR:

HUMAN METER - NOVOLIN N INSULIN - Regular Assist Feeding via Syringe

DIABETES STATUS: Dx - 19 Dec 2016; Insulin started PM 23 Dec (extremely poor vet support caused delay)

KETONE STATUS:
- Urine test: Positive SMALL (at vets c. 12:00 Noon on EST 23 Dec)

MEDS:

Anti-nausea:
- Cerenia administered at vet - c. 12:30 EST 23 Dec - (NB: NO CERENIA DISPENSED FOR HOME TREATMENT!!!)
- B12 administered at vet (same time as above)

Appetite Stimulant
- 1/8 of 7.5mg tablet mirtazapine administered at c. 02:30 EST 24 Dec (next dose due in 48-72 hrs)

Potassium Deficiency:
- Next dose potassium supplement due at 06:00 EST 24 Dec (Dose: 1 tablet every 12 hours for 2 weeks.)

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INSULIN - Novolin N (U100 Insulin) - RELION METER

PMPS - 389 - Dose: 0.5IU (20:30 EST 23 Dec) - Assist feeding via oral syringe throughout cycle.

+1.5 - 237
+2.5 - 266
+4.0 - 258
+6.0 - 234
+8.0- 290 (+7.50 - ate 7.5ml via syringe)

ETA: Click here to see Mittens' BG Spreadsheet.

(I'm updating it for now until someone can transfer ownership to Dan & Heather.)
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(Note: for those following Mittens in the UK, EST = GMT - 5 hours.)
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Food & Fluids:

- Assist feeding via oral syringe: meat/broth baby food; home cooked chicken breast and broth; Pedialite.
- Caregivers have supplies at home for giving sub-q fluids if they are required.

Hypo Kit:

- Fancy Feast Gravy Lovers; honey; Temptations treats - all available.

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Thank you for starting the new thread and compiling all that information into a list.

The last glucose test we did was pretty stressful for Mittens I think. It took several pokes before we got any blood at all. She was squirming really bad, makes me feel awful for her.

Dan fell asleep on the couch around 5:00 waiting for the scheduled 6:00 potassium feeding, I wanted to let him get some sleep so I did it myself. I mixed the crushed potassium with 10mL of food. It was very difficult, I feel even worse now that he had to do it all night without me. I was able to get her to eat about 7.5mL of it. I'm concerned because that means she only got 3/4 of the pill in her when she's supposed to have the whole thing. I hope somehow she starts eating on her own soon. The appetite stimulant didn't seem to do anything. She does seem somewhat interested in the food on the plate but never eats any more than a 2 or 3 licks still.

I have an alarm set to get up and feed her in couple of hours, I really feel like we haven't been feeding her enough. For now though I have to get a little of sleep. Thank you again for starting the new thread. We'll be back on here in just a little while
 
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Hi Heather,

Having been there myself I know just how rough it is emotionally to have to intervene like this to help our fur babies. It helps a lot to grit your teeth and 'keep your eye on the prize', not the treatment delivery. Every bit of food Mittens eats, every treatment she gets, every drop of water she drinks is filled to brimming with your love for her - and keep reminding yourself of that. Talk reassuringly to her & tell her why she needs the food and medicine; not at all easy to do when you're tired and worried out of your mind ... BUT ... it will calm all of you a little bit. Even if it feels like you're faking it, it does help!). :bighug:

Every little bit of food and fluids Mittens gets down is a little victory, helping to keep the ketones down. A step at a time you're getting there: one foot, one paw ...

Remember that you and Dan are a team: - everything you're both doing is helping Mittens. :)

:bighug:


Mogs
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* * @Dan&Heather - MOST IMPORTANT THING TO DO TODAY: * *

Move heaven and earth to get a supply of anti-nausea tablets from your %*$/@#^% vet before they close for the day.!!! ( :mad: - Pardon the vernacular but she should have prescribed them yesterday. :banghead: )

(Sending you a PM - check your INBOX at top of screen in a few minutes' time.)

Dan&Heather said:
The appetite stimulant didn't seem to do anything. She does seem somewhat interested in the food on the plate but never eats any more than a 2 or 3 licks still.
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Tell vet -

- has an appetite but still nauseated - licks at food but then can't continue. (This is a CLASSIC CLINICAL SIGN OF NAUSEA!!!)

If your vet is reluctant, try the "what's to lose by trying?" argument.

ETA - if your vet says that mirtazapine is a perfectly adequate treatment for nausea in cats, disregard this: you've got solid proof Mittens wants to eat but at the moment she's just too queasy without additional anti-nausea supportive meds (refer to the IDEXX document if needed).


Mogs


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@Chris & China, @Marje and Gracie, other members:

I've started a spreadsheet for Mittens but I don't know how to give Dan & Heather access (and some help with getting the signature done would be great if that's possible). Can someone help sort this out, please?

I've recorded last night's BG data in the sheet. Here's the link:

https://docs.google.com/spreadsheets/d/1N3b-1jXE5FAQ_7oXexRPUE1pWKCu15rjXmlQ6ez3CGE/edit?usp=sharing

(Other members following: can somebody please let me know if you access Mittens' spreadsheet OK. Ta!)


Mogs
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Echo what Mogs said. Get that cerenia 2 boxes if you can. They come 4 pills to a box. You give 1/4 pill daily. The appy stimulant will not work well if Mittens is nauseous. It's perfectly safe to give cerenia daily. It takes about 24 hrs to kick in. So right now you don't want to skip a dose. It comes in injectable form if you think you can give that.

Here is something else to consider for non eating kitties. The Liver Shake. Never had to use it myself but others had great success with it.

http://www.felinediabetes.com/FDMB/threads/the-liver-shake-for-sick-cats.30432/

I will be on and off today checking in. Make sure you both get some rest. Do shifts or tag team. Mittens needs both of you well to get him over this hump. And you will get him though, no doubt in my mind.
 
Critter Mom said:
@Chris & China, @Marje and Gracie, other members:

I've started a spreadsheet for Mittens but I don't know how to give Dan & Heather access (and some help with getting the signature done would be great if that's possible). Can someone help sort this out, please?

I've recorded last night's BG data in the sheet. Here's the link:

https://docs.google.com/spreadsheets/d/1N3b-1jXE5FAQ_7oXexRPUE1pWKCu15rjXmlQ6ez3CGE/edit?usp=sharing

(Other members following: can somebody please let me know if you access Mittens' spreadsheet OK. Ta!)


Mogs
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Click to expand...

I see it just fine. Great job Mogs. Been following you here. You are such a wealth of info. To attach to their signature. They need to have Google account set up and give you access to their account. After that I don't know.
 
Critter Mom said:
@Chris & China, @Marje and Gracie, other members:

I've started a spreadsheet for Mittens but I don't know how to give Dan & Heather access (and some help with getting the signature done would be great if that's possible). Can someone help sort this out, please?

I've recorded last night's BG data in the sheet. Here's the link:

https://docs.google.com/spreadsheets/d/1N3b-1jXE5FAQ_7oXexRPUE1pWKCu15rjXmlQ6ez3CGE/edit?usp=sharing

(Other members following: can somebody please let me know if you access Mittens' spreadsheet OK. Ta!)


Mogs
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Yes, I can access the SS, Mogs.
 
@Woodsywife - Paula, you're a star! :bighug: ETA: You too, Kris! :bighug:

Hopefully Chris or Marje will be able to sort out the sharing later on. (I'm going to add the link to the summary at the top of the thread and I'll try to keep updating the spreadsheet in the meantime when Dan and Heather post the BG tests and dose info.)

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@Dan&Heather -

As you can see I've set up a tracking spreadsheet for Mittens' BG results. We need to sort out ownership for you so later on you'll be able to update it yourselves. (I'll do my best with updates in the meantime.) Here's the link again:

Mittens' BG Spreadsheet

Members replying to your threads will also be able to see the spreadsheet and it will assist their efforts to help you both. The spreadsheet will help you to see how effectively Mittens' insulin is working.


Mogs
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Good morning Dan and Heather! You guys are doing great!!! What a group effort all around!
FDMB peeps are the best!

I don't want to clutter up this thread with any unnecessary chit chat since both of you must be exhausted beyond belief and probably feeling like you're looking at the world cross-eyed about now, but I would like to make a couple of suggestions...
Dan&Heather said:
Dan fell asleep on the couch around 5:00 waiting for the scheduled 6:00 potassium feeding, I wanted to let him get some sleep so I did it myself.
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If you're not already, get in the habit of writing everything down and then checking the list prior to administering everything and anything. It'll help prevent over doses when two caregivers are providing care.
Dan&Heather said:
I mixed the crushed potassium with 10mL of food. It was very difficult, I feel even worse now that he had to do it all night without me. I was able to get her to eat about 7.5mL of it. I'm concerned because that means she only got 3/4 of the pill in her when she's supposed to have the whole thing. I hope somehow she starts eating on her own soon.
Click to expand...
Going forward, mix the crushed pill in a smaller amount of food. You'll have a better chance of getting the entire dose into her.
Dan&Heather said:
The appetite stimulant didn't seem to do anything.
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According to Larry and Kitties (he's a vet tech): "You can give 1/8 to 1/4 of a 7 1/2 mg tab every other day." Try giving a bit bigger piece than you did last time. These are newer guidelines.


To those who have experience with N insulin: After Dan and Heather have had some rest and when they're available to dose more often, what about dosing every 8 hours in an effort to get rid of ketones? Higher carb foods can be fed to keep Mittens from bottoming out.

No matter what insulin is used, when kitty is throwing ketones it's imperative to get more insulin into the cat safely. When Alex threw ketones I would have fed her anything (including HC) to be able to get a reasonable amount of insulin into her while keeping her safe at the same time.

 
Jill & Alex (GA) said:
To those who have experience with N insulin: After Dan and Heather have had some rest and when they're available to dose more often, what about dosing every 8 hours in an effort to get rid of ketones? Higher carb foods can be fed to keep Mittens from bottoming out.
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Agreed! Every 8 hour dosing is preferable with N insulin and ketones if you can swing it. Now that your cat has insulin on board, it's OK to feed higher carb food if that's easier for her to eat on her own. Any calories you can get in her right now is the key, you can always increase the insulin dose to account for the extra carbs. This will help get rid of ketones.
 
further info on mirtazapine:
- Clinical signs began between 15minutes and 3 hours and lasted between 1 and 48 hours. Treatments were varied and included IV or SQ fluids, reversal with cyproheptadine (which antagonizes the effects of mirtazapine), decontamination with emesis or charcoal, sedatives, and others.
- Two basic steps may be taken to avoid mirtazapine toxicity. The first is to utilize an appropriate dose of 1.8-2.0mg/cat administered every 24 hours (less often for cats with kidney disease). The second is to use compounded drug at the intended dose, rather than relying on owners to correctly fraction the commercial 15mg tablets. These steps should dramatically reduce the incidence of adverse effects from this beneficial drug. (MRK)
above from:
http://www.winnfelinefoundation.org...29/mirtazapine-toxicity-in-cats-in-retrospect

- As others have said I would get from vet either Cerenia and/or ondansetron, Cerenia seems to be better for vomiting and ondansetron for nausea. Both can be given together (Cerinia once per day and ondansetron twice daily).
- N dose it depends upon how much food. Based on the 1/2 unit N does BGs, I would up it to 3/4 unit if Mitten keeps down the same or greater amount of food as when the 1/2 unit was dosed.
 
You've got lots of good help advising you, but I just wanted to add one thing in case you don't know. Saw the comment about not getting blood in spite of several pokes . . . as you poke it stimulates the growth of new capillaries. So even though it seems like it's not getting you anywhere, it is. It can take a week or two for the capillaries to grow more extensively, but after that point you will get blood every time. In the meantime, know that it's still helping and keep on persisting with the testing.

my best to you and Mittens!!! You're on the right track!
 
Critter Mom said:
@Chris & China, @Marje and Gracie, other members:

I've started a spreadsheet for Mittens but I don't know how to give Dan & Heather access (and some help with getting the signature done would be great if that's possible). Can someone help sort this out, please?

I've recorded last night's BG data in the sheet. Here's the link:

https://docs.google.com/spreadsheets/d/1N3b-1jXE5FAQ_7oXexRPUE1pWKCu15rjXmlQ6ez3CGE/edit?usp=sharing

(Other members following: can somebody please let me know if you access Mittens' spreadsheet OK. Ta!)


Mogs
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Because Mogs is the owner of the current SS, even with editing rights (which I have), I cannot change ownership to Dan and Heather or post it to their signature. I’m assuming Mogs is sleeping now (I hope) so I’ve PMd Dan and Heather and if I hear from them, I’ll create a new SS that I can get right to them and get posted immediately.

@Dan&Heather I sent you a private message requesting a bit of info I need to do the above. Can you please check your inbox ASAP (see “inbox” upper right corner of this page). It will take just a couple minutes max for you to respond with the two bits of info I need to do a SS, make you owner, and post it. Thank you!
 
Heather & Dan, Just wondering how things are going there. We fully realize how totally exhausted you are and understand you need to get some rest too but we'd really really appreciate a quick update as soon as you have the opportunity. Not trying to make more work for you but we are getting a little worried. :bighug::bighug::bighug::bighug:
 
Sorry, we both slept alot more than I thought we would. I set 5 alarms last night to make sure I woke up this morning and I don't even remember shutting them off. We are going to get a BG reading and feed her right now. I want to give her some of the fluids that I got from the vet, I know she needs them. They told me I could do them either every 24 or 48 hours depending on how much water she's drank. Yesterday she drank a tiny bit but really it was hardly any, so I really feel she needs them.

The vet was already closed by the time I actually came to. I don't think we would have been able to get the Cerenia though, we spent out last couple dollars on a few more cans of cat food last night. I know it's not ideal, but can we try to use the pepcid for the weekend? Will it help at all? We need her to start eating and I'm getting frustrated because even if I had been up in time I wouldn't have been able to get the medicine she needs. I feel like I did half of the work, got some stuff she needs but missed a very important part of it. I wish I would've asked about getting some Cerenia for at home yesterday. I need her to eat on her own, the syringe feeding is difficult and frustrating and stressful for all 3 of us.

I feel like we're losing this battle. I can't stand to think if she doesn't pull through that we made her spend her last time with us being force fed and poked constantly. A few people said we have messages, I'll answer those real quick then we're going to feed and test BG again.
 
So good to hear from you and don't beat yourself up about sleeping through the alarms. You are beyond exhausted and I quite frankly wonder how you are still so co-herent. You are doing everything you can for Mittens and Mittens trusts you and knows you are only trying to help. Remember we've all felt poorly and not been willing patients for those trying to help us despite knowing it was for our own good!

The Pepcid will keep acid down and that may help with the nausea to some degree but it may not be enough. Just wondering though, is the clinic in Appleton (quite a distance drive if I remember correctly) an ER that would be open over this weekend. (I'm sure this info is somewhere in your first thread so forgive me for not searching just now!) If needed I wonder if they would be able to give the Cerenia if needed. They did see Mittens. Something to think about if you could manage it.

Agreed that she needs the fluids. I'll let you run through the posts since early this AM and if any questions, holler. You're doing great and Mittens is going to be fine!
 
@Meya14 and all other members following -

Could someone with sub-q experience give Dan and Heather some guidance on when to give the sub-q fluids in relation to the insulin dose. (I've no experience with sub-qs.)

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I don't know about the pepcid. It's worth a try though. Give an hour before eating. Look into making this. A lot of people had success with it. http://www.felinediabetes.com/FDMB/threads/the-liver-shake-for-sick-cats.30432/

Have you tried seeing if he would eat off a spoon or your fingers?

Also bone broth if you can swing it. http://www.ibdkitties.net/bone-broth/ it has great nutrients in it. Once made freeze in ice cube tray or foam egg carton. Once frozen move them to a zip lock bag. Take one out when you need them. Smokey ate if I put a teaspoon of bone broth on his food once a day. One 'egg' gave us 3 days worth.
 
Woodsywife said:
Have you tried seeing if he would eat off a spoon or your fingers?
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Yes, I tried, she won't. She won't eat at all, leans down like she wants to but then just wont.I would like to try the liver shake, but I don't know if she will even give it a try.

I'm getting very depressed about the whole situation. I don't know why the vet didn't ask me if we wanted Cerenia for at home. It was probably metioned to me to ask her for but I didn't realize it was something she was going to need several doses of. There's so much information I feel like I miss/forget stuff far too often.
 
The subQ can dramatically and temporarily lower the BS levels due to dilution. Once the water is processed by the kidneys the BS will start to rise again. I think probably best time to give is about 1-1.5 hour prior to insulin to allow time for blood sugars to begin to rise so dose can be given safely. Also, insulin should not be given in the scruff area as it won't absorb well with fluids, you can give it in the flank (side tummy near the back leg) on days you give fluids.
 
For DKA assuming that her problems are due to the ketones and diabetes only, recovery can take about 1-2 weeks once insulin and proper support are given. Most cats recover, and cats who present with DKA as their initial diagnosis have a better recovery than cats who have been diagnosed in the past. Most cats don't seem to have many lasting effects from DKA once the acute period is over.
 
That's the nausea. Once that's addressed he should start eating better. Your vet is probably closed Monday right? Is the ER an option to get cerenia from as mentioned above?

Hang in there. You are doing everything you can and hopefully come Tuesday you can get the cerenia.
 
You are doing your very best, at a super-human level. Mittens knows that. You are giving her tons of love and cuddles amongst the pokes and the feedings, too-- focus on those times, and on the end goal of the pokes and feedings. All you want is for her to feel better.

I know you've gotten a blizzard of suggestions, but have you tried raising the food bowl up so she doesn't have to duck her head down? It helps some nauseated cats, and your description of her ducking her head then turning away made me think of it again. She's still interested in food, that's a good sign, you just have to get her over the hump on the nausea.

Hang in there, I know this is really rough on all of you right now :(.
 
Here's a pic of injection sites you can use.

injsitesforcats1.jpg


injsitesforcats2.jpg
 
Marje and Gracie said:
Are you going to dose every 8 hours and starting when?
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I'm not sure. I feel like I'm just as confused as when we started all of this. Felt for a brief time that I was catching on. We're supposed to give her more potassium in 45 minutes. She's not eating enough, she's fighting us so hard every time we try. I'm not sure when we should give her fluids or when we should give her another dose of insulin. I know we need to check her BG again, should have done it as soon as I woke up, I just feel so bad about poking her. I feel like I'm going to make her not let me pick her up at all anymore cause it seems like every time I go get her it's to do something to her that she hates and she's going to hate us for this because she doesn't understand. I guess I expected a little more cooperation from her, specially with the food cause I know she wants it, I thought she would at least open her mouth for us.
 
Did she get her potassium and insulin this morning? We always recommend testing at least before every shot of insulin.
 
Dan&Heather said:
I'm not sure. I feel like I'm just as confused as when we started all of this. Felt for a brief time that I was catching on. We're supposed to give her more potassium in 45 minutes. She's not eating enough, she's fighting us so hard every time we try. I'm not sure when we should give her fluids or when we should give her another dose of insulin. I know we need to check her BG again, should have done it as soon as I woke up, I just feel so bad about poking her. I feel like I'm going to make her not let me pick her up at all anymore cause it seems like every time I go get her it's to do something to her that she hates and she's going to hate us for this because she doesn't understand. I guess I expected a little more cooperation from her, specially with the food cause I know she wants it, I thought she would at least open her mouth for us.
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OK...I’ll leave the upper part of the SS for 12 hour dosing right now but I can easily change it whenever you are ready.

Keep in mind that shooting every 8 hours will help you get her numbers down a bit which will help. DKA is caused by not enough insulin and food/water as well as infection so if you can keep the ketones in control by keeping the BG down (which is easier to do shooting every 8 hours with N as you catch the numbers before they get too high), then you can potentially address that issue.

If the vet has prescribed fluids, you can give them at any time but I’d try to avoid giving them exactly the same time as the insulin and definitely give them in different areas. Giving subqs is more limited in location than shots so if you give the subqs in the scruff, you can shoot the insulin in the opposite side of the chest but just know that shooting the chest, side, or flank with insulin “might” increase absorption rate which is ok as long as you test (it never seemed to be a difference in my Gracie but every cat is different).

Here is a video on how to give subq fluids if you are nervous about it or haven’t done it.

It’s going to take time and persistent hands-on care to get her through this.
 
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