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

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You can do this Dan and Heather. I know it's hard. I have faith in you. I can tell how much you love your Mittens. J.D. was diabetic for 9 years and I had to learn to give insulin and test his BG. That was frustrating and hard to do, but eventually I learned to do it and J.D. learned that it was okay. Later in life when he was 19 and 20, I had to assist feed him (and I know how disheartening that can be) for a long time, and give fluids, and pills. You can do this. You are a good team.
Let us help you. Please. Believe me you do not want DKA.
 
She won't hate you. Really, really, really-- she won't. She's feeling lousy right now, and no one likes having food syringed into their mouth (even without the nausea). She's not fighting you because she's mad at you, she's mad at the world for making her feel yucky.

Honestly, the fact that she's fighting you is another good sign, in a way-- at least she still has that much energy! Her condition is very very serious, but I'd be even more worried if she were just passive and limp under all the treatments.

You've been dealt a bad hand by the unhelpfulness of your vet, but you have a lot of tools at your disposal to get her through this, and Mittens is clearly still in the fight. For a cat throwing ketones, her BG numbers really aren't that bad, and she's still drinking (a little bit), interested in food (even if she can't eat on her own), and has the energy to complain about the insults to her feline dignity. It's really rough on the caregivers to keeps subjecting her to all these treatments, but it's critical that you keep it up-- as Dyana says, you truly do not want this to progress into DKA.

We are here to help in any way we can.
 
Dan&Heather said:
I just feel so bad about poking her.
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We understand that feeling. :bighug:

I know it sounds daft but try singing when you're doing the BG test, or talking to Mittens in a sing-songy voice. It will distract you both and it can be calming.

Alternatively adopt (fake!) a very business-like approach. (Right! We need to do this to get you better and it will only take a couple of minutes!)

And praise. Lots of praise. (Can help at feeding times, too.)

Meya said that the potassium supplement will help with the nausea. When Mittens gets the fluids that should help, too.

We understand that you're so close to things right now that perhaps you can't quite see how *amazingly* well you're both doing. We can see it, and we believe in you. Don't lose heart!

:bighug:


Mogs
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Bending down for the food/water tends to exacerbate the nausea.

If you're leaving food out for her (and some of the watery chicken broth if you still have some) remember to raise the bowls up about 4-6 inches. (Try sticking some paperback books under them.) Try leaving out small bowls of different foods - a kitty smorgasbord.

Try offering well mashed-up food with a little water mixed through it from your hand or your fingers. Again keep your hand up several inches from the ground so that Mittens doesn't have to stoop to eat.

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I used a Magic Bullet to puree J.D.'s food into a slurry that wouldn't clog the syringe.
Please don't listen to what other humans say who don't get the love you feel for your cat that try to alter your perceptions. All of here, know the love of the cat, and a lot of us have been here a long time. We have seen many miracles happen. It is like a big family here. We are here to help you.
Don't worry about expenses right now, take it one day at a time. There are lots of ways to save lots of money. Right now, it is critical that she get her insulin and food, potassium, and fluids when needed. I know it's hard to do this. Eventually Mittens will understand that you are helping her. Keep on keeping on. Big hugs. We understand. Please let us know her BG test when you get it.
 
Dyana said:
Did she get her potassium and insulin this morning? We always recommend testing at least before every shot of insulin.
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I gave her the potassium this morning on time, but I wasn't sure exactly when I was supposed to give her more insulin. So the only dose of insulin she's gotten so far is the one from last night. I feel terrible about that because I know we were supposed to do it but I wasn't sure if it was supposed to be at the same time as the potassium so I was planning on asking when I got up to feed her but then I slept thru all my alarms. The potassium that she just got was slightly late, was supposed to be at 6, ended up being about 6:30 so about half an hour ago. We mixed it with 10mL of food.

I will test her BG right now and then after I hear back from you I will give her more insulin, I know that's very important. I'd like to give her some of the fluids too, I remember a post earlier that said to leave a little time in between those. Will get back to you in a few moments with the BG results.
 
Ok we just tested her again, and got a drop of blood on only the second try thankfully, her BG is 316 right now. So now should we do the fluids before we give her insulin?
 
Meya14 said:
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.
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Wow, if I would just read everything more carefully I can answer alot of my own questions
 
Oh Heather, this is a complicated situation so don't worry about asking questions again. We are quite used to it and know why you need to.
Maybe it would help if you set up a time schedule to know what to do when. For instance: today you gave potassium at 6:00am and 6:30pm. (The half hour difference is not an issue.) but you want to move that up to Noon/midnight dosing gradually (as per Dan last night).

She got insulin last night at about 8:30 pm, missed the 8:30 am. and we are recommending going to a three times daily dosing. So now you need to decide when the best time for you to do fluids would be and then the insulin schedule would flow from that. Does that make sense?
 
Dan&Heather said:
Wow, if I would just read everything more carefully I can answer alot of my own questions
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:D

You're doing great. Not many who arrive hear need to take the vertical learning curve in a single bound the way you guys are at the moment! :)

Dan&Heather said:
The potassium that she just got was slightly late, was supposed to be at 6, ended up being about 6:30
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That should be OK but you'll need to be tighter with timing for the insulin. Keeping to a regular insulin dosing schedule is key to safety.

Each insulin dose exerts an effect on BG for a certain amount of time (duration of dose). You need to make sure that dosing intervals don't overlap, hence the need to be quite diligent with insulin dose timings.

The Novolin N will have a period in each cycle where it has a stronger BG lowering effect. This is why we use the "+" numbers alongside the BG levels so we can gauge the safety of a test result as the cycle progresses. With an appropriate dose we expect numbers to be lower when the effect of the insulin dose is at its strongest. By tracking the time since the dose was given and the BG level we can determine if the kitty is in a safe range - and going to STAY in a safe range for the rest of the cycle - or whether we need to intervene with carbs to keep numbers in the safe range.

It's a lot to do for the first few days of insulin treatment because we need to learn how Mittens responds to her insulin but as you get more BG test data to see how the dose is working things will get easier.

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MrWorfMen's Mom said:
She got insulin last night at about 8:30 pm, missed the 8:30 am. and we are recommending going to a three times daily dosing. So now you need to decide when the best time for you to do fluids would be and then the insulin schedule would flow from that. Does that make sense?
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Yes that makes sense. Alot of sense, if we need to do this every 8 hours we do need to figure out what times are going to be best for our schedule, but it's already been too long and I dont want to make her wait too much longer.

I need to go to walmart soon, we have lots of test strips for the glucose meter but only a couple lancets left so I need to go get more. When I get back it will be close to 2 hours since she ate so I will feed her again. Dan just went to take a nap and I'm glad but kinda nervous, it took me forever to get the food into her this morning when I was by myself, I don't know how he managed to while I was at work last night. I'm not worried about giving her insulin and not really about checking her sugar myself, both of those weren't too difficult with her and I think I can do it alone, but I'm a little nervous about giving her the fluids if he's asleep simply because that takes a minute and it might be hard for me to get her to hold still and hold the bag up in the air at the same time.
 
Heather, for now I think it's important to get the insulin in her since she missed the morning dose. When did she last eat and how much? Let's work on the schedule over the next day or so but right now, let's deal with the insulin since you are a bit tentative about doing fluids without Dan to help, then go to Walmart and get your supplies. Question though...it's Christmas eve. is Walmart still open and if so when do they close?
 
I'll have to call Walmart and ask about the holiday hours, with all this, going on I actually didn't even realize it was Christmas Eve till you said that, I'll find out. She ate 2 hours ago and it was 10mL of food with the potassium mixed in
 
Any brand lancet should be fine [edit: if you are freehanding, but even with a device there's a lot of compatibility, it's not like the strips]-- so if Walmart isn't open, there might be a pharmacy or even a supermarket that can help you out.
 
Heather, if you need to go out after giving the insulin, Dan will need to be awake to test Mittens' BG while you're away.

Novolin N starts working very early after the injection is given. Because you've not got much BG data yet you need to monitor Mittens' BG closely.

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Mogs, Escanaba isn't that big so hopefully if Walmart is open, she wouldn't be gone too long. Of course that depends on whether they are right in the city or not.
 
I think Walmarts are open on Christmas Eve and Christmas. If you have to, you can reuse a lancet, it's just not advised as they get way duller each time you use them. If you have to I would rinse in some rubbing alcohol first and let it dry.

As far as fluids, I used a plant hook that was in my ceiling and hung a coat hanger from it and the fluids from there.
I would get everything ready first (rewatch the video, warm the fluids in warm water, then hang them, make sure I had the shot glass ready to flush the line), then go get the cat.

I think I have many boxes full of lancets that I can send you. They are the 28 gauge that are preferable to getting blood in the beginning.
 
Sorry I had to run out, Walmart didn't answer the phone and I knew the 2 grocery stores would be closing soon. Walmart shopko and both grocery stores were closed, but Walgreens was open so I was able to get lancets. I'm going to feed her right now because it's been almost 3 hours now since she ate last. After that I'd like to give her the insulin, I don't have to go anywhere for the rest of the night so I'll be able to keep an eye on her. Dan told me to wake him up in an hour but I'd like to let him sleep as long as I can so he can be alert tonight after I go to bed, so we can get on these shifts of watching her so we can each get a little more sleep.

Since we're going to start every 8 hour doses should the doses still be .5?
 
The 0.5 didn't take her down too low last night but I am still concerned about being able to get food into her if she does start heading too low so I vote stay with 0.5u for now until we get some data or she starts showing a more active cycle. I also think with 3 doses daily, we need to be conservative because it should result in lower pre-shots.
Before you give insulin Heather, I would like to hear from some other folks so we have a consensus of opinion here!
@Critter Mom @Dyana @Marje and Gracie @Meya14 can you weigh in here :)
 
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Linda, not 100% certain your tag of @Dyana went through (it's the only one that isn't highlighted blue in your list), and she's the only one I can see online right now so I'm repeating. :)
 
Ok I will wait for some more people to give their opinions before I give her the insulin. I just fed her 7.5 mL out of an attemped 10mL. I wish I was better at this but I feel better about it because I figure I'm at least getting her something.

I'm so sorry to everyone for distracting you from your holidays. I can't believe this is Christmas Eve, I feel really bad for that.
 
Don't worry about it, Heather. We just want to help Mittens and you and Dan.
Again, I don't know Novolin N, but I would tend to agree with the 0.5 dose TID for now depending upon her pre-shot test. Do we have a BG test? If you are going to do TID, would 10:00pm, 6:00am, and 2:00pm work for you Dan & Heather? If not, then I would still give the dose (depending upon what her pre-shot test is) and think about what 8 hour three times a day doses would work.
 
Actually Heather, I can't think of a better way to spend Xmas eve than to keep a little furry companion safe and his wonderful caregivers supported! No worries.
 
NB - Hang fire on the dosing suggestions for a minute. Meya posted something on the other thread - I'll try to find it.

A BG test now would be highly advisable. I know it's just after food but it is a fair while since the last test. Also for the Novolin N the guideline is to wait about 30 minutes after food before giving the dose.


BRB ...

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Meya's post from the previous thread:

Meya14 said:
My help with dosing Novolin-N would be limited to my knowledge of this insulin in humans. I've never used it in cats. I feel that starting at a negligible dose (less than 1/2 unit, or about 1/4 unit three times a day) and working up would be safe. Three times a day dosing would be preferable to prevent steep drops and to provide full day coverage with this insulin.
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Found it. Meya said " I feel that starting at a negligible dose (less than 1/2 unit, or about 1/4 unit three times a day) and working up would be safe."

So should we back up to 0.25u and see how that goes tonight.
 
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Dyana said:
would 10:00pm, 6:00am, and 2:00pm work for you
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Yes that would work well for us, I work varied shifts but those times would have me at home for two doses everyday. But I see the post above says I should wait 30 minutes from eating to give the dose, I got done feeding her 15 minutes ago, so if it's quarter after or on the half that would work fine for us too.

Dyana said:
Did you get a ketone test, today?
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No I haven't caught her in the liter box yet today, I will do one the first chace I get.

Critter Mom said:
A BG test now would be highly advisable
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I did one about 5 minutes ago it was 305
 
So I vote give her 0.25u in about 15 minutes. To keep it simple make it 10:30pm your time. Easier to track and remember. :)
@Critter Mom are you in agreement with Dyana and me.

Heather , are you Ok drawing up 0.25u? Any problem or questions about doing so, just shout!
 
MrWorfMen's Mom said:
So should we back up to 0.25u and see how that goes tonight.
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The 0.50 dose last night produced a 150 point drop by +1.5. It ran a little above this for a few hours and then dipped back to 234 at +6.

MrWorfMen's Mom said:
So I vote give her 0.25u in about 15 minutes [...] @Critter Mom are you in agreement with Dyana and me.
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If I were in this situation with my own cat the 0.25IU Novolin N is what I would give.

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I'm in poor shape here and if I need to do the UK leg again I have got to get rest now.

- Can someone start up the running log of BG info, feeding etc for the cycle? (Would probably be safer to do this in the thread tonight - esp the feeding info.)

- I recommend tests at +1.5, +2.5, +4.0 and +6.0 then AMPS at 7.5 hours after this current dose to allow 30 minutes for food to go down before giving next dose of insulin (i.e. a total of 8 hours between injection times).

- Here is some information recently posted by @Meya14 with recommendations for DKA aftercare (thread for Jo and Ozzy). It includes info on BG ranges, feeding, fluids, etc. It may be a helpful reference for members helping Dan & Heather tonight (and also useful to them when they get a bit of headspace to take in a bit more information).

CAVEAT to members assisting Dan and Heather:

NB: Ozzy is being treated with VETSULIN so dosing suggestions on linked page are not for Novolin N - general principles for target BG range may be OK to use in Mittens' situation.)

Some Pointers from Meya on DKA Aftercare




Mogs
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I'm good for a couple of hours or so but I'm not sure about the rest of the night. I'm putting the coffee on now! I'll stay as long as I possibly can. Dan & Heather must be much younger than me!
 
NB: Can members arrange cover for the beginning of the next 8-hour cycle, please? I won't be awake in time.

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Critter Mom said:
I recommend tests at +1.5, +2.5, +4.0 and +6.0 then AMPS at 7.5 hours
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I will make sure I get those tests at those times. Thank you so much for your help, really sorry to keep keeping you up like this.

Thank you everyone, I will post the test results for the +1.5 as soon as I have them.
 
Next shot will be due at 06:30 EST. If I get some sleep I can deal with that. I'll stay for the early part of this cycle and then see who is around to help if need be depending on what Mitten's numbers look like. If I need to stay up, I'll just load myself in caffeine! LOL!
 
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