New protocol for Tigger, updated SS

Status
Not open for further replies.
vbc2000

vbc2000

Member Since 2017
Hi all,​
It's been a harrowing day. S spoke to the vet today about Tiggers numbers and decreased appetite. I told her he was bordering on hypoglycemia Since switching to Friskies and Fancy Feast and she said to back him off to 4 units of insulin twice a day and continue with the Fancy Feast. She also prescribed an appetite stimulant and told me to continue him on Cerenia (I had stopped giving it to him but he's back on 1/4 of a 15mg pill per day). He is on and has been on 5 mg. Fluoxetine and when I started reading about the appetite stimulant, this article said not to give it with fluoxetine. http://www.marvistavet.com/mirtazapine.pml

Unfortunately I read that after I gave him the mirtazapine at 3:50. He had his fluoxetine at 10:30 last night. So I panicked and called the vet fearing he would have seretonin syndrome. She had a tech call back and said she doesn't know what I was reading, but she didn't find anything that indicated they can't be given at the same time. She said if it made me more comfortable, I could give him 2.5 fluoxetine for the next two days and don't give him the mirtazapine again. It's given every three days.

I don't know what to do :(
Please give me your experience if you have any with mirtazapine. Thank you in advance,
Step
 
vbc2000 said:
she said to back him off to 4 units of insulin
Click to expand...
Yes, those greens are too low. It's always wise to have a bit of a "cushion" at nadir with Vetsulin.

vbc2000 said:
I started reading about the appetite stimulant, this article said not to give it with fluoxetine.
Click to expand...
Mirtazapine can have strange effects on some kitties - restlessness, yowling, agitation, etc. It can also cause serotonin syndrome. Have a look at the list of meds in the yellow left hand column of this vet document:
http://www.cliniciansbrief.com/sites/default/files/attachments/Serotonin Syndrome.pdf
Fluoxetine (Prozac) is an SSRI and could itself cause serotonin syndrome. I think you're wise to be concerned about the two together.
 
Last edited:
Thank you Kris.
He has been vocalizing more since the mirtazapine but that seems to be common according to some posts here.

To be on the safe side, despite her suggestion of cutting the fluoxetine dose for two days, I don't think I'm going to give it to him at all until Thursday when the mirtazapine should have wore off, and I won't give him the mirtazapine again.

Also to be on the safe side because his previous meal BG was only 103, I fed him with no Vetsulin. It has raised to 126 at +3 so I gave him 2 units.

I'm not sure how crazy with me my vet is right now but I am Tigger's guardian and Mom and it's my obligation to question even if it makes me a pain or appear to be a bit crazed.
 
vbc2000 said:
Also to be on the safe side because his previous meal BG was only 103, I fed him with no Vetsulin. It has raised to 126 at +3 so I gave him 2 units.
Click to expand...
So, if I understand you correctly, his PS tonight was 103, you fed but didn't give insulin, then at +3 with a BG of 126 you gave 2 u?

He's now off schedule dose wise but you gave a much reduced dose so it *should* be OK. However, most of us wouldn't give insulin (especially Vetsulin that can hit fast and hard) on a BG of 126. If he was my cat I'd drop him back to 2 u twice a day starting tomorrow AM. The curves done at the vet clinic early on are from a stressed cat so dosing decisions were probably suspect. His present dose of 5 u BID is very high. Most cats don't exceed 2 - 3 u BID. You're testing enough to be able to keep close tabs on a dose's effects over a cycle. If, after 2 days of 2 u doses the numbers stay high, then we recommend increasing by 0.25 u increments, never whole units.

Here's the FDMB Vetsulin "user guide":
http://www.felinediabetes.com/FDMB/threads/vetsulin-caninsulin-user-guide.302/
 
Again, thank you. The vet said if it is below 100, do not give vetsulin. I took that to mean if it is over 100 it's OK to.

I am so torn. I feel like I should follow the vets instructions to drop to 4 so I can give her info off that. I'm frankly afraid to go rogue at this point. I should follow her instructions shouldn't I?

She was saying it throws off the regulating process to skip doses so try not to do it unless he's below 100. I'm so confused :nailbiting:
 
vbc2000 said:
Again, thank you. The vet said if it is below 100, do not give vetsulin. I took that to mean if it is over 100 it's OK to.

I am so torn. I feel like I should follow the vets instructions to drop to 4 so I can give her info off that. I'm frankly afraid to go rogue at this point. I should follow her instructions shouldn't I?

She was saying it throws off the regulating process to skip doses so try not to do it unless he's below 100. I'm so confused :nailbiting:
Click to expand...
I truly understand how conflicted you feel. Most of us here would not give insulin on any pre shot BG number under 150 at the lowest. The size of the dose also has to be factored in as well as the action profile of the insulin being used. Your kitty has been on a high dose of an insulin that is known for its ability to drop BG fast and low. I'm glad you reduced the dose tonight but going forward, it's your call. Have you had a look at the FDMB Vetsulin guide?
 
He's still not eating and AMPS was 415. He ate a few bites but even his old food and tuna wouldn't make him eat. You're not supposed to leave food our all day but I'm doing it. I gave him 4 units because it was so high.. I'm exhausted, discouraged and at my wits end.
 
vbc2000 said:
He's still not eating and AMPS was 415. He ate a few bites but even his old food and tuna wouldn't make him eat. You're not supposed to leave food our all day but I'm doing it. I gave him 4 units because it was so high.. I'm exhausted, discouraged and at my wits end.
Click to expand...
Will you be home to get a BG test at +2? That will show what he might do on this AM dose. Re not eating: sometimes they need antinausea meds like Cerenia along with the appetite stimulant.
 
IMPORTANT: If you are using the Advocate pet meter then your no shoot BG should be much higher than 100. We recommend 225 to 250 because it is not uncommon for the BG to drop by 100+ points early in the cycle with Vetsulin. You have had occasions where Tigger's BG has dropped over 200 points by 3 hours after his shot so you need more of a cushion to keep Tigger safe. With Vetsulin, I would suggest aiming to keep Tigger's BG no lower than 100 mid cycle.

I agree the dose is too high and needs to be reduced. I think Tigger is bouncing and giving more insulin for a higher pre-shot number is just perpetuating the bouncing making it look like he needs the higher doses. As counter intuitive as it sounds, too much insulin can look just the same as too little. I'm glad you are leaving food out all day for Tigger. There is nothing wrong with doing so and that extra food has likely helped keep him safe at the high dose.

I agree with Kris. I'd drop his dose and hold it for a few cycles barring any pre-shots too low to give insulin or extremely mid cycle readings, to see how that works for Tigger. It appears Tigger's natural defences against hypoglycemia may be tiring and less effective than they were, given the low pre-shot last night so I would recommend lowering the dose and definitely not shooting at any pre-shot under 250.
 
vbc2000 said:
He ate a few bites but even his old food and tuna wouldn't make him eat. You're not supposed to leave food our all day but I'm doing it.
Click to expand...
Many of us leave LC food out for them, just make sure to try and take it up 2 hours prior to next PS test time :). I am glad to hear Vet reduced since those lows you have been getting are close to the "take action" number of 68 on a pet meter. I also agree with bumping the Vet's recommended no shoot (NS) number of 100 up to 250 with using Vetsulin.

I know it can be very conflicting when we give different advice than your Vet but please understand we're not trying to say your Vet is wrong but to remember we all live with our own sugar baby 24/7. Our experience easily outweighs the Vet's 5 hour course in Vet school :bighug:. We always err on the side of safety! :)
 
Kris & Teasel said:
Will you be home to get a BG test at +2? That will show what he might do on this AM dose. Re not eating: sometimes they need antinausea meds like Cerenia along with the appetite stimulant.
Click to expand...
Tested +2 and he's at 173. Tried feeding him again and he wouldn't eat anything even his treats. We're going to the vet at 1:30.
 
MrWorfMen's Mom said:
IMPORTANT: If you are using the Advocate pet meter then your no shoot BG should be much higher than 100. We recommend 225 to 250 because it is not uncommon for the BG to drop by 100+ points early in the cycle with Vetsulin. You have had occasions where Tigger's BG has dropped over 200 points by 3 hours after his shot so you need more of a cushion to keep Tigger safe. With Vetsulin, I would suggest aiming to keep Tigger's BG no lower than 100 mid cycle.

I agree the dose is too high and needs to be reduced. I think Tigger is bouncing and giving more insulin for a higher pre-shot number is just perpetuating the bouncing making it look like he needs the higher doses. As counter intuitive as it sounds, too much insulin can look just the same as too little. I'm glad you are leaving food out all day for Tigger. There is nothing wrong with doing so and that extra food has likely helped keep him safe at the high dose.

I agree with Kris. I'd drop his dose and hold it for a few cycles barring any pre-shots too low to give insulin or extremely mid cycle readings, to see how that works for Tigger. It appears Tigger's natural defences against hypoglycemia may be tiring and less effective than they were, given the low pre-shot last night so I would recommend lowering the dose and definitely not shooting at any pre-shot under 250.
Click to expand...
Hi, I have not been leaving food out for him. We are going to the vet at 1:30.
 
Yong said:
Many of us leave LC food out for them, just make sure to try and take it up 2 hours prior to next PS test time :). I am glad to hear Vet reduced since those lows you have been getting are close to the "take action" number of 68 on a pet meter. I also agree with bumping the Vet's recommended no shoot (NS) number of 100 up to 250 with using Vetsulin.

I know it can be very conflicting when we give different advice than your Vet but please understand we're not trying to say your Vet is wrong but to remember we all live with our own sugar baby 24/7. Our experience easily outweighs the Vet's 5 hour course in Vet school :bighug:. We always err on the side of safety! :)
Click to expand...
I SO much appreciate all your input...I'm just very confused. It's starting to really make me depressed and discouraged. We are going to the vet at 1:30 today. I know you have nothing but my Tigger's safety at the heart of your advice, that's why I appreciate it so much.
 
Well the news was not so good at the vet. There is a bunch of bad stuff in his abdomen. They did an xray and it show a lot of gas, what we think is impacted fecal material, his liver doesn't look normal and neither does his stomach and he had "stacked" intestines. She said it almost looked like he'd been eating a foreign object but I have no sign of that at home. His belly was tender and he Belcher when she was feeling around it. She and I am very concerned and she mentioned lymphoma. We are going for an ultrasound at a specialist tomorrow. He was given fluids and they did blood work that will be back tomorrow as well. Please send us kitty prayers if you pray and good kitty vibes if you don't. This kind of thing never ends well so I have a sinking feeling. He has eaten a few bites since we got home, but the vet said if he doesn't eat at least a few tablespoons, skip the Vetsulin. He was at 225 when we had him there. I tested when we were there and got 255 so it's good to know the Advocate meter is pretty accurate. That's where we're at.
 
Kris & Teasel said:
I'm sorry you've received such worrying news. Sending positive energy your way ... :bighug::bighug:
Click to expand...
Thank you :) The word lymphoma came up but maybe it's just IBD or something less deadly. My sweet Jasper had it for years but it did turn to lymphoma in the end. I'll post when I know more.
 
I think that 4 units is still too high... He's dropping far too fast. Cut that back. I would try 2, 3 tops. It's too hard on their systems to drop 60% and more.
 
JanetNJ said:
I think that 4 units is still too high... He's dropping far too fast. Cut that back. I would try 2, 3 tops. It's too hard on their systems to drop 60% and more.
Click to expand...
The vet wants to make a decision based on what happens tomorrow. He ate a little since we got home and his BG was 305 so I gave him 2 units.
 
Status
Not open for further replies.
Back
Top