Chloe 19

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srk4cats

srk4cats

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@Djamila @StephG
Hello. I hope you're having a good weekend. Chloe's been in the yellow for a few cycles, so I'm going to try 1.5u tonight and do a curve tomorrow.
th0ughts?
 
I'm sure I sound like a broken record, but there is no way to know how the dose is working without the mid-cycle tests. You have no way of knowing if she needs an increase or not when all you're looking at is the pre-shot number.
 
It can mean that she went low in a previous cycle. After a low, many cats will have several flat cycles. Or it can me insufficient insulin. The only way to know is to continue getting mid-cycle tests more than once/week. Since you work during the day, that means getting mid-cycle tests at night.
 
@Djamila @StephG Poor Chloe is bouncing all over the place. When I increased the dose from 1.5 to 1.75, she went way up in the black, so I came back down to 1.5 again. Today at mid-cycle, she only went down to the yellows. How much should I give her to get her back in the blues and greens?
 
Yes to what Kris said. It's great that you got a test today, but we need more than one day to know what's happening. Post after you get a test tonight and do a curve tomorrow and we'll be able to have a better sense of what's going on.
 
Djamila said:
Yes to what Kris said. It's great that you got a test today, but we need more than one day to know what's happening. Post after you get a test tonight and do a curve tomorrow and we'll be able to have a better sense of what's going on.
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This is odd. I took a reading at +11 and she hadn't changed much. At dinner time, she wasn't yowling for food, so I didn't give her any and didn't give her a shot. Now, 3 hours later, she's at 134. Any idea what's going on?
 
S
Djamila said:
That doesn't make sense to me. Why didn't you give her a shot?
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She's still not eating and lethargic. She attacked Fuzma last night because she was in her spot on the bed, and peed all over the bed. I had just changed the sheets that day. Then, after I calmed her and put her on the other side of the bed, she vomited, but it was clear. She's not feeling well today.
 
Skipping a shot after a DKA episode can be dangerous. She was high enough that you should have given her the shot anyway and then given her small amounts of food at a time to get her to eat, using treats, chicken, tuna, parmesan cheese - whatever you could entice her with. If she's still lethargic and not eating, a vet visit will be in order again as she may be going back into DKA again.
 
I agree with Djamila. You should have given a shot and fed small amounts to her. ProZinc isn't a fast onset insulin so there's no need to have a full meal on board before a dose. Chloe has had DKA twice and that makes her highly vulnerable to more episodes. You have to be extremely vigilant about testing, dosing, feeding and so on. There's no margin for error or inattention in her case.

I wouldn't delay a vet visit if she doesn't perk up today.
 
If she won't eat a little before a shot - which absolutely CAN'T be skipped - puree a bit of her low carb food with a little water and give her a syringe feeding. Even a tablespoon of food prepared this way and syringed into her will be enough to give her a full dose. If necessary give her another syringe feeding a bit later. You're trying to prevent another DKA episode. If ketones start to build they can make them nauseous and lethargic. I wouldn't dither in this case.
 
I gave her 1 unit at 7:30 am and at 9:45 am, her BG hasn't changed a bit. And she still hasn't eaten. It's looking like another vet visit. What could change her ketones so quickly? Could it have been the fight she had with Fuzma last night? It only lasted a few seconds, but when I turned on the light, I saw a couple drops of blood on the sheet.
 
srk4cats said:
at 9:45 am, her BG hasn't changed a bit.
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No dose last night and a reduced dose this AM. Also, the ProZinc onset might not happen until closer to +3.

srk4cats said:
What could change her ketones so quickly?
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They can go from zero to high ketones very quickly, in hours. She's had two NSs recently and you don't have enough data either from daytime or evenings to really know how the 1.5 u dose has been working. Did you do an immediate retest on 09 Feb when she had that 51 in the AM? We always recommend a retest when an out of the ordinary number pops up. It might have been a dud test and you might have been able to dose.

srk4cats said:
Could it have been the fight she had with Fuzma last night?
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It might be part of the perfect storm. Ketones build when they aren't eating enough, haven't received enough insulin, are dehydrated and there's another stressor of some sort, usually infection or inflammation. A cat fight is a stressor too.

srk4cats said:
And she still hasn't eaten.
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You absolutely need to start syringe feeding now. You also have to haunt her in the litter box to get at least one urine ketone test today.
 
srk4cats said:
What is syringe feeding. Is it putting food in her mouth?
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Go to any pharmacy and buy a plastic syringe in the 20-30mL range, no needle just plunger/barrel assembly. Mix a little low carb wet food with enough water that when it's well blended it'll be able to be sucked into the syringe. Feed small amounts of that at a time to Chloe. Go online and Google videos of how to syringe feed a cat. There are lots out there.
 
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Kris & Teasel said:
Go to any pharmacy and buy a plastic syringe in the 20-30mL range, no needle just plunger/barrel assembly. Mix a little low carb wet food with enough water than when it's well blended it'll be able to be sucked into the syringe. Feed small amounts of that at a time to Chloe. Go online and Google videos of how to syringe feed a cat. There are lots out there.
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Thank you. I had a few of those from when Chango and Cheddar were sick. I used it to get some watery food down her throat. Her BG is down finally.
 
I want to add that the curve they are suggesting and extra tests are very important.
If you give her a dose that is too much, she will go down low enough to cause a bounce. Those high numbers from the bounce are just as bad as high numbers from food. They can last longer too. So, you need to find out how the dose is working to see if you need to feed her more food or adjust the dose to keep her in a good range. Feeding more food is probably the best idea because she NEEDS the insulin to keep ketones at bay.
For now, syringe feeding her is a must and giving her the insulin.
I hope she's not going into DKA but the quicker it's caught, Chloe's chances are better.
 
StephG said:
I want to add that the curve they are suggesting and extra tests are very important.
If you give her a dose that is too much, she will go down low enough to cause a bounce. Those high numbers from the bounce are just as bad as high numbers from food. They can last longer too. So, you need to find out how the dose is working to see if you need to feed her more food or adjust the dose to keep her in a good range. Feeding more food is probably the best idea because she NEEDS the insulin to keep ketones at bay.
For now, syringe feeding her is a must and giving her the insulin.
I hope she's not going into DKA but the quicker it's caught, Chloe's chances are better.
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She's been under the bed the last few hours. I got her out and she drank a lot of water and took of BG reading of 225. I'm going to force feed her now. She's very weak.
 
If you can't get a ketone test in, it might be easier to take her to the vet.
She sounds like she's in very bad shape.
 
Chloe is back in the hospital with another DKA. This time, they're going to do an abdominal ultrasound. Every time she goes to hospital, it costs me a month's wages. I will make an appointment with my regular vet for next week to find out if I should switch insulins.
 
I'm very sorry that Chloe is having another bout of DKA, Roberta. She's obviously very vulnerable to that. You might have better luck flattening her numbers with an insulin like Lantus or Levemir but as we've said before, they require a more intensive monitoring approach. There are fairly strict rules about keeping to an exact 12/12 dosing schedule, when to change dose, etc. I know you've posted on that forum before asking for input. I suggest you read more about how these insulins work:
http://www.felinediabetes.com/FDMB/threads/lantus-levemir-what-is-the-insulin-depot.150/
http://www.felinediabetes.com/FDMB/threads/lantus-levemir-start-low-go-slow-method-slgs.129446/
http://www.felinediabetes.com/FDMB/threads/lantus-levemir-tight-regulation-protocol-tr.1581/

They're likely looking for inflammation or other issue with the ultrasound. That can be part of the DKA picture. Unfortunately, a lot of the rest of it will be on you to watch her like a hawk, have a strict testing routine, syringe feed if needed, etc. It's worth it, though, if you can prevent more of these episodes, spare Chloe the negative health effects and spare yourself the astronomical expense of treating them.
 
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srk4cats said:
Chloe is back in the hospital with another DKA. This time, they're going to do an abdominal ultrasound. Every time she goes to hospital, it costs me a month's wages. I will make an appointment with my regular vet for next week to find out if I should switch insulins.
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I'm sorry to hear Chloe is having another episode of DKA. I know you don't want to keep going on this merry-go-round and neither does she.

I would try really hard to get a solid routine down (giving insulin & food & testing for ketones) for the sake of Chloe, your sanity & bank account.

I don't want to keep repeating what these ladies said. Hoping Miss Chloe is feeing better today though.
 
Teenuh said:
I'm sorry to hear Chloe is having another episode of DKA. I know you don't want to keep going on this merry-go-round and neither does she.

I would try really hard to get a solid routine down (giving insulin & food & testing for ketones) for the sake of Chloe, your sanity & bank account.

I don't want to keep repeating what these ladies said. Hoping Miss Chloe is feeing better today though.
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The vet said that the abdominal scan showed pancreatitis, but Chloe started eating right afterwards. The vet also said that this time she will make a decision about which insulin to use and how much. I've been staying on a routine for the most part. Should I give her the shot within a certain time from when she starts eating? She eats for a long time. Is there medication to help get rid of pancreatitus?
 
A cat with Pancreatitis doesn't mean they don't ever eat. They have "flare ups". Pancreatitis isn't like a UTI. Antibiotics doesn't cure it. I'm speaking from a medical perspective on humans though. @Djamila please correct me if I am wrong for felines.
You learn to manage the symptoms with "lifestyle" changes (diet specifically), or you remove the gallbladder and sometimes-usually are forced to make dietary restrictions. Treatment options vary by person and whether the person is acute or chronic. I imagine it is similar to felines.

It does cause pain. Did the vet offer Tx options, or medication?

I mean routine as in: Test, Eat, Shoot. Don't go off that path, or try not too. Like @Kris & Teasel said even just a little bit of food is better than nothing and syringe feed is needed. I give Gracie her shot as she is eating. I just need to see that she is going to eat something.

With the new Dx it will be extra important for you to pay close(er) attention to Chloe.
 
srk4cats said:
the abdominal scan showed pancreatitis,
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This is in addition to her DKA state, correct? The pancreatitis could be the inflammatory event that, along with not enough insulin, not eating , etc. brought about the DKA. Your vet should be able to explain all that to you.

srk4cats said:
Should I give her the shot within a certain time from when she starts eating? She eats for a long time.
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With ProZinc or Lantus (if you go to that) she only needs to eat a little in order to get the shot. So let her eat a tablespoon or so, give her dose and then let her take as long as she wants to eat the rest.

srk4cats said:
Is there medication to help get rid of pancreatitus?
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Your vet should advise. Treatment is aimed at symptoms and can include pain meds, antinausea meds, appetite stimulant and sometimes subQ fluids. Ask a ton of questions of your vet and make notes. I seems you'll be dealing with two issues, the pancreatitis and the DKA - related but separate.
 
Kris & Teasel said:
This is in addition to her DKA state, correct? The pancreatitis could be the inflammatory event that, along with not enough insulin, not eating , etc. brought about the DKA. Your vet should be able to explain all that to you.


With ProZinc or Lantus (if you go to that) she only needs to eat a little in order to get the shot. So let her eat a tablespoon or so, give her dose and then let her take as long as she wants to eat the rest.


Your vet should advise. Treatment is aimed at symptoms and can include pain meds, antinausea meds, appetite stimulant and sometimes subQ fluids. Ask a ton of questions of your vet and make notes. I seems you'll be dealing with two issues, the pancreatitis and the DKA - related but separate.
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I agree with Kris. Taking notes is super helpful. It allows you to go back and reference. If you have trouble taking notes or would just rather focus on what he/she is saying --ask the vet to write it down for you. I'm sure he/she would be more than happy to.
 
Teenuh said:
Abbott Precision Xtra meter is a meter that tests for Ketones & BG. Supplies are probably expensive like the AT, but maybe something to consider if you can't test her urine.
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Yes! I agree 100%
They are expensive strips and I believe you need to get them from the pharmacy.
You could test once or twice a week to keep costs down. I'm certain it is much cheaper than treating DKA at the hospital.
I used to let Chuck eat for 5 minutes, long enough for me to put his food down then go draw up the insulin, then give his shot while eating. I still do this on lantus.
I'm sorry Chloe has DKA again. Her symptoms seem to be the same each time so you know what to look for now.
I agree with Kris that the testing and protocols on lantus are more strict and are pretty clearly written on what they expect. I don't want to scare you away from lantus or levemir. Just trying to say you should be prepared to focus more on Chloe than you normally would have to on prozinc.
Once she is regulated on a dose and you have tested long enough to see that patterns the testing can become less often but rarely only preshot tests. It took us about 6 months before I could relax my testing schedule. BUT I STILL get curve balls thrown at me from Chuck. So it's important to test even after you know how she reacts... Even almost a year down the road!
I hope Chloe recovers quickly. There's a lot of kitties on here with pancreatitis. I'm sure you could get a lot of tips and info from others if you post on the main health forum asking for advice on ketone prone cat with pancreatitis. Food, supplements to ask your vet about.
 
Teenuh said:
How is Chloe right now? Is she still at the vet, or did they release her?
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I just came back from visiting her. She was back to her perky, purry self. The doctor wasn't there, but the tech mentioned something about potassium. What's that about?
 
srk4cats said:
I just came back from visiting her. She was back to her perky, purry self. The doctor wasn't there, but the tech mentioned something about potassium. What's that about?
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Next time you are confused on something--don't be afraid to ask them for clarification. Remember you don't speak vet language. Even if the vet isn't there--you should request they call you, so ask your questions. Any sensible vet would have no problem doing this.

Glad to know Miss Chloe appears to be perky and and full of purrs. I'm sure that is a relief. :)

I would take this time while she is at the vet to get things in order at home in terms of routine. If you haven't already-- figure out how you will test for ketones. If you need to buy a testing kit I would order it SAP to avoid any delay.
 
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I really think a meter that tests for Ketones is necessary for Chloe. It can save you so much money and keep Chloe from getting so sick.
I've actually been thinking about getting one for Chuck. He's become a pro at digging up the plastic wrap I put in his box to get a sample. He's a snob. :joyful:
 
StephG said:
I really think a meter that tests for Ketones is necessary for Chloe. It can save you so much money and keep Chloe from getting so sick.
I've actually been thinking about getting one for Chuck. He's become a pro at digging up the plastic wrap I put in his box to get a sample. He's a snob. :joyful:
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I'm thinking of keeping Chloe locked in my bedroom for awhile with food and water, at least when I'm not home. When I keep an empty litter box in there, she pees in it and it's easy to get a ketone test. Ketones seem to pop up very quickly. I had gotten a ketone test less than a week before she got sick and it was negative.
 
I guess that could work, but I personally don't see that as a good solution. Maybe very short term. Is this only until you get a ketone meter?

Ketone meter will avoid the havoc of keeping her secluded. You wouldn't have to do anything different. It would just be a new meter.

Is cost a concern of the new meter? I know you've spent a lot on Miss Chloe lately.


I don't know about Chloe, but if I keep a door shut in my apartment Gracie goes nuts and finds a way to get it open.

Any update of when she will be released, or if you are switching insulin?
 
I agree about investing in a blood ketone meter. I also like the earlier advice about getting all your organizational ducks in a row before Chloe comes home.
 
StephG said:
I really think a meter that tests for Ketones is necessary for Chloe. It can save you so much money and keep Chloe from getting so sick.
I've actually been thinking about getting one for Chuck. He's become a pro at digging up the plastic wrap I put in his box to get a sample. He's a snob. :joyful:
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Who are we kidding. Our felines own us. Hahaha
Oh, you don't want that food? Let me open another 4 cans . . . :rolleyes:
 
Chloe's coming home tonight!!!!! I think when I'm at work, the cats just sleep, so I don't think she'll mind being isolated. She might like the break from the boisterous boys. I had Fuzma shut in her room today while I was at work. The boys harrass her, too. I know that Chloe hates it when I shut her in the room while I'm home and not in her room with her, because she yowls. Did you know that cats only vocalize to their humans? They don't talk to each other, except maybe to hiss. How much does a ketone meter cost? I have a ton of ketone strips and know how to get a sample easily.
 
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