A lot of thoughts going on in my head

Crista & Ming

Crista & Ming

Very Active Member
I think I need a talking down from all you lovely people. I'm trying to make sense of everything that's happening with Ming. And of course, I'm freaking out here. My work week is over and I have TOO much time to think and it's probably why I'm feeling this way.

Mostly, I have moments of calm and then I have moments where I'm just thinking, wow, everything I've learned here in the past month is being thrown out the window LOL

Okay, for those of you who don't know: Ming's in the hospital right now. I'm a vet assistant and I'm working the night shift so that will explain why I know exactly what's going on some days and some days I don't lol. He's been seen by 3 vets but Vet A is the one in charge and who I trust more and takes bigger risks with treatment. Unfortunately, Vet A was not present when Ming first was hospitalized and so what happened in the first 3-4 days were not good in my opinion.

He had another pancreatitis flare up. He was on fluids, bupe, cerenia, and ampicillin for 2.5 days. I got an okay to bring him home to see if he'll eat on his own. He did not and I KNEW, deep in my stupid heart, that he was NOT okay. He had ketones and I brought him back to the vet. (Many of the assistants told me to speak up if I KNOW my pet is not okay because only I know what he's really like.)

The vets got a wake up call. He got on fast acting IM insulin (humilin) whenever his BG was over 14 mmols (252) which was all the time honestly lol.

Ultrasound: micro abscesses on the pancreas. He gets put on a stronger antibiotic, zenquin. Vet asked if I wanted to try steroids/pred. I said okay.

During all of that, they started him on 2 units of PZI (with the humilin). Last night, 4 units. This morning, 6 units. And tonight: 8 units.

We. Are. Going. FAST. Now. The vet even said this and knows. And stressed this is not a simple case and there's no time to wait and see like usual. Which was so different from the beginning of the week when the other vet wanted him on 2 units for a week!!! TWO UNITS!

When he was on 4 units in hospital, his BGs were 25 or 450 plus the WHOLE night, every hour. He had ketones in the middle of the night. In the morning, his ketones were trace, thank god.

On 6 units, the lowest he dropped was 17 or 306.

Tonight, he'll be on 8 units.

I guess, what I'm asking is what is everyone here on the forum thinking?

I'm afraid. His BGs are high. He got ketones, AGAIN. He's going on pred. And the assistant who has 20+ years of experience with diabetic cats is pretty sure Ming will be on at least 10 units.

I mean, just last month, I reduced him from 6 units to 4 units with some success and now, 4 units doesn't even budge.

I know. His pancreas is a WRECK. But what do you all think? What are your concerns? Is there anything I need to think about to ask my vet?

I still think what's happening is crazy when I position what I've learned at this forum with the treatment he's getting. Even when I increased his dose up 0.2 u, he would flirt with hypo. And here we are, increasing him up 4 units within 24 hours.

If anyone wants the play by play with more details, you can check out my other thread: http://www.felinediabetes.com/FDMB/threads/gave-insulin-even-though-ming-wont-eat.204763/

I think I used up all my calm juice and now I'm finally freaking out hahah
 
But to put some ease into my spasm of crazy strew, he's eating now. Wet and dry food. He's still painful but that bupe is doing the trick. He meows and purrs and trills when I walk by his kennel while I'm working. He's not a mope-y non-eating mess anymore.
 
I’m certainly not a vet but there seems to be something driving these high numbers. The likely culprit is his pancreas but he might well be insulin resistant after so many days in high numbers. It causes glucose toxicity which impairs his ability to respond to insulin. The way through that is with dose increases but those are huge increases taken very close together. Has there been any discussion of trying a depot insulin like Lantus to see if he responds better to it?
 
Kris & Teasel said:
I’m certainly not a vet but there seems to be something driving these high numbers. The likely culprit is his pancreas but he might well be insulin resistant after so many days in high numbers. It causes glucose toxicity which impairs his ability to respond to insulin. The way through that is with dose increases but those are huge increases taken very close together. Has there been any discussion of trying a depot insulin like Lantus to see if he responds better to it?
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Ah I see. No discussions on that. I just read the sticky abojt depot insulin. I’ll ask that today. I can see how it’s helpful but also another thing to do guesswork with. But again, I’m not 100% familiar with that type of insulin. I’ll read up more on it though :)
 
I have nothing to contribute from a scientific standpoint but I do want to say I understand the anxiety and just know you are a great mom and I will be praying for Ming.
 
JanetNJ said:
Jumping two units at a time doesn't sound like a good idea. One unit tops.
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We’re doing 10 units today loool. At this rate, it just seems like what Kris said: glucose toxicity.

What are the fears of jumping two units too fast? Missing that nice dose?
 
Lisa and little said:
I have nothing to contribute from a scientific standpoint but I do want to say I understand the anxiety and just know you are a great mom and I will be praying for Ming.
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Thank you :) Your understanding and kind words mean a lot and it’s definitely a great contribution :bighug:
 
What your vet is doing with the increases is very typical for vets. They will eventually get a good cycle and think that they've found "the dose" and then he'll come home, he'll relax(lower stress), the pancreatitis will abate (panc causes inflated numbers in many cats) the insulin will have had a few cycles and his body will adjust and he'll go hypo. The good news is that you know how to test once you get him home and you know what to do when he goes hypo, so as long as you're around you'll be able to keep him safe.
 
Djamila said:
What your vet is doing with the increases is very typical for vets. They will eventually get a good cycle and think that they've found "the dose" and then he'll come home, he'll relax(lower stress), the pancreatitis will abate (panc causes inflated numbers in many cats) the insulin will have had a few cycles and his body will adjust and he'll go hypo. The good news is that you know how to test once you get him home and you know what to do when he goes hypo, so as long as you're around you'll be able to keep him safe.
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Ok yeah that’s what I thought might happen. And I’m definitely ready to do that. I’m curious what the specialist will say to do though.

I don’t get the impression that my vet is trying to find that the dose. I think she’s just trying to break the high BG levels but yeah, 10 units sounds insane.
 
Finally!! We got a 6.5 mmols reading! No ketones when I went in and he peed.

Vet stopped the pred for now until I see the specialist on Monday.

The steroids for diabetic cats specialist emailed back and my vet said she said the pred dose can be even more and my vet is not comfortable with that lol She also said something else but I forgot. I’ll look in his files at a later date.
 
Crista & Ming said:
Finally!! We got a 6.5 mmols reading! No ketones when I went in and he peed.

Vet stopped the pred for now until I see the specialist on Monday.
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When did they stop the pred?

Since the vet fast-tracked him to 8-10u of insulin, please be very careful to monitor his BG. Steroids are notorious for jacking up BG values and a cat's insulin needs can plummet pretty quickly when they come off. I realize Ming is a complicated case and is hospitalized, so he should be in good hands, but I had a steroid-indicted diabetic and have been down the path of erratic insulin needs and having to pivot quickly when steroids were removed (and yes, my guy surprised the docs at the hospital a few times with some pretty low BG values).
 
JL and Chip said:
When did they stop the pred?

Since the vet fast-tracked him to 8-10u of insulin, please be very careful to monitor his BG. Steroids are notorious for jacking up BG values and a cat's insulin needs can plummet pretty quickly when they come off. I realize Ming is a complicated case and is hospitalized, so he should be in good hands, but I had a steroid-indicted diabetic and have been down the path of erratic insulin needs and having to pivot quickly when steroids were removed (and yes, my guy surprised the docs at the hospital a few times with some pretty low BG values).
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He got pred twice and I think it was half of a 2.5 mg tab. They gave him one today and so tomorrow, he won’t have one.

Before pred, he was still super high but yes, they’re monitoring his BG almost hourly. The official plan is to check BG every 2 hours and give humilin if his BG is over 18. And give dextrose/honey in his IV if it falls under 4 mmols.

How quickly did you have to adjust your guy’s insulin? Within a cycle? I just want to prepare myself in case the first cycle off pred will be the dangerous one.
 
The night nurse told me Ming stayed in the 20s and was st 33.3 at one point. I asked if this is a bounce cycle and she says probably not and it’s probably because the PZI isn’t lasting long enough. I mentioned that Kris suggested Lantus and she said she uses Lantus herself with her cats and had success getting them into remission except for one.

So blah. Vet B is in charge today because Vet A is off now. She said Ming is staying around 20 but anymore and he’ll get humilin support again.

I’m going to ask about Lantus with the specialist. Completely forgot to ask yesterday about it haha

No ketones!! And eating like a trucker.
 
13.6 mmols or 245 when I went in. It was +4 when I came in. He ate probably 3 oz of food when I got there and he peed THREE times in half an hour and took a tiny poop. Ketones negative.

He's eating the FF with gusto and we're starting to give him his freeze dried raw as well.
 
Oh right and I read the e-mail from the diabetic cat specialist. She suggested trying chlorambucil and/or melaxiam/robenacoxib instead of prednisolone. As of this moment, before I start googling, all of that looks like mumble jumble to me. My vet mentioned that they're NSAIDs. Again, mumble jumble. Off to google land!
 
Did you mean meloxicam? which is a NSAID - it's used for pain. It is an alternative to the bupe, although I think most folks around here prefer bupe. Chlorambucil is, I believe, used for leukemia and lymphoma. Glad to hear he's eating well. :cat:
 
So glad to hear Ming is eating well! I have no experience with any of those meds. NSAIDS are non-steroidal anti-inflammatory meds. I'm not really sure if they'll work better than steroids or not...but then I'm also hesitant to use steroids. Don't get me wrong, if I needed to, I would, but if there are other options I prefer to explore those.
 
Djamila said:
Did you mean meloxicam?
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Maybe she mistyped. I typed out what she wrote to my vet haha

And thank you @Djamila and @Rachel! He's SO much brighter and more himself. I do wonder what the internal medicine specialist will say tomorrow. I wrote out a 3 page document detailing Ming's history and a list of my questions and concerns lol!!! I heard she is very thorough so I hope she appreciates the long document I'm going to give her tomorrow.
 
Oh and here’s a pic of Ming peeing. I think it’s hilarious

0163E58C-0484-4A63-9346-8D547A874D60.jpeg
 
I spoke to the specialist for a good hour and everyone, everything we’re doing here on this site is GOOD and CORRECT. Not that we weren’t but it was just nice to hear validation. Especially while I was with my mom because she was sorta against it and kind of blaming me sometimes for his pancreatitis flare ups. The specialist said nothing I did caused it.

I’m still out but I thought I’d give an update. We’re going to try Lantus. She originally was okay with PZI but I asked about it and she had mentioned it by another name throughout the session. And continue with pred but larger amount. Instead of 2.5 mg daily it’ll be like 3.75 mg. And cerenia as a supportive thing for Ming almost every other day.

He’ll be in hospital for another 2-3 days to try out the Lantus.
 
I think trying out Lantus will be good for Ming. Prozinc is a great insulin for cats, but the L insulins give you flatter cycles which sometimes can help those bouncy kitties. And with Lantus you can shoot lower numbers, which can be critical for ketone prone kitties.

I'd go ahead and post on the Lantus forum (if you haven't). Introduce yourself, give some history on Ming, and let them know you'll be around when he comes back from the hospital. They're a great bunch over there and several of them have used Prozinc before (Sharon and Bobbie are two I can think of off hand) so they have experience in switching. And feel free to come by and say hi over here! I try to keep an eye on kitties who go to that forum, but it's a lot busier, so I often miss those updates.
 
I'm glad the specialist agreed with what we do here. You'll feel better about it. :) She probably called Lantus by its other name, glargine. Lantus is a brand name.
 
Yes she called it glargine!

Thanks everyone!!!! I’m sure I’ll still post here to give updates :) it’s only really been a month and more of me being here and talking to you all but I’ve learned SO MUCH. I don’t think Ming would be at this point without any of you. I think Ming might still have been just getting supportive care instead of treatment for his pancreatitis and asthma and everything.

I hope it’s not too forward or odd to say but I love you all and can’t thank you enough for everything :bighug::cat::D
 
Hi everyone. I know it's late for most of you but I'm just feeling bad and need a place to just talk. I heard about Ming's diet plan for the night and I guess the following days. We did talk about his diet with the specialist and she recommended giving dry food throughout the day and I did say I don't like that because it's too many carbs. At one point in the conversation, I did agree to try it (the plan: raw food twice a day with dry food left out) but the more I thought about it, the more it goes against everything I've learned and what we're trying to achieve. I also instantly thought, you might WANT to give him some dry, but I'm not going to give him any at home.

Sure, Ming doesn't eat all his food at once but someone is usually at home and can feed him a small meal of wet. If no one is home, I understand WHY we'd give dry food but there's so many different ways to make sure he has meals in between like with a meal timer thingy or leaving out dehydrated freeze dried food instead of the actual dry food.

So that's where I'm at. I heard from the night nurse that the plan for tonight is 1/2 can of DM + 2 primal freeze dried nuggets twice a day (which is weird on its own because I made it really clear I DON'T want to feed canned DM) and then 1 tbsp of DM dry four times a day.

And here I am going... WHAT?! The night nurse is pissed too.

I kind of have a suspicion the specialist didn't make up that specific plan because my coworker was texting me about how many nuggets I feed Ming which was odd in itself.

I spoke to my mom about my concerns and of course, I'm all worked up about it which in turn, worked her up. And she's telling me I'm always not listening to the doctor and that I can't just go around changing doctor's orders. She already has multiple times blamed me for causing Ming's pancreatitis because I didn't want to put him on DM and would feed him other food like raw or FF. And she didn't like that I was changing his doses.

I got super upset. Then my dad came home and made a stupid comment that the reason Ming is sick is because we have a hamster which has NOTHING TO DO WITH ANYTHING also it's not even MY hamster. It's my sister's!

I went to my room and cried. My sister didn't provide much comfort to me when I talked to her. She was busy gaming but told me to forget about what my parents said and that they're "butt holes" (censored to keep this place PG lol)

So yep... I'm definitely having another freak out. I just want my cat home. I hate all of this right now. I was feeling fine about everything up until now and it's such a small thing too when compared to all the other issues going on. He's been eating some dry all week anyway but I don't know. I think just having my parents indirectly blame me for Ming's illnesses didn't help.

Edit: I just don't understand why, in the face of facts or logic, my mom is more upset that I'm questioning the doctor. She made a point that the doctor has had years of schooling and I don't. I know I don't. But you can't deny that 1+1=2. Just like how you can't deny that carb loaded food is going to raise blood sugar levels. And now I'm more upset about being blamed for Ming's illnesses when I'm just concerned since he's starting Lantus and the dry food ISN'T going to help if his BG is going to be so high anyway.

They also didn't give him anything this AM and his BG at PM was 23mmols or 414 because his AMPS reading was 8 or 144 which isn't shootable but at least give SOMETHING. Sigh. Vet A is off and I think if she was there, she would have said to give something.

But maybe he'll do amazing tonight. Maybe my freak out is over nothing. I hope my freak out is over nothing and he does beautifully tonight. Sigh.
 
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Aw Crista! Sounds like you had a tough night. My guess is your mom is worried about Ming and she is still in the mindset of "vet knows best" that most people come here in. I get it. I had a HARD time coming in here and taking the word of a ton of "crazy cat ladies" instead of my vet whose JOB was to treat animals! It took me time to realize that these "crazy cat ladies" had way more experience since they'd been doing this for so long, and that vets simply can't know EVERYTHING about every disease in every animal type. No one could expect that! Have you told your mom that (nicely of course)? I wonder if she'd be willing to come on here and talk to us or at least read some of what we all say?

Let me assure you that you are NOT responsible for Ming's illnesses! Pancreatitis, as far as I know, just HAPPENS. It sucks and it's no fun, but it does. I think it's more helpful to focus on what you ARE doing...you are taking care of Ming! A lot of people just put diabetic kitties down, but you are taking care of him. You're giving him shots, checking his BG, researching the food, getting him vet care...you're doing EVERYTHING you should be doing. Sure Ming is having a tough go of it right now, but vets aren't magicians and neither are we...it takes time to get kitties feeling better and we can only do what we can do.

It sounds to me like maybe your vets have some miscommunication going on. I wonder if they'd be willing to call you if they are not going to give a shot at all so you can ask them to do something at least?

I'm so sorry all this is hitting you at once, Crista! It happens to us all where one day some tiny thing sets us going and we just lose it! I've done it plenty of times and the folks here talked me down and kept me going. I wish we could all come over and give you a giant hug to help you feel better! Just know that WE know that you are doing a great job and that Ming is super lucky to have you!

Sending tons of healing vines his way and lots of peaceful vines your way! :bighug::bighug::bighug::bighug:
 
Great post from Rachel! If Ming is getting DM pate at the vet clinic, it's only 6% carbs so I wouldn't worry about that. Avoiding all dry is more important. If you want to get him on a raw diet I'd wait until he's home. There could possibly be IBD in the picture but a definitive diagnosis requires open surgery biopsy. Many people avoid that due to cost and the major impact on the kitty and treat with diet changes, maybe meds, etc. Some kitties do well with limited ingredient wet food, some do better on wet food that has no carageenan or other thickening gums in it, some do better with added supplements. It's complicated and requires a lot of experimenting.

We all understand the reluctance to go against the vet's advice. I lurked here for many months after Teasel's diagnosis while I did what my vet recommended. I finally tried things the FDMB way 8 months later after Teasel showed poor response to the insulin dosing. Over a very long time and three different insulins (all overseen by myself!) I've learned how Teasel responds (erratically) and how to dose him optimally (no sudden moves!). Unfortunately he went off the rails into DKA a second time in early June (possibly from a pancreatitis attack) but he recovered after a very expensive couple of spells in hospital. I had an IM vet consult too. One med she mentioned for IBD was Atopica (cyclosporine) instead of steroids. Did your IM vet mention it? Teasel had an ultrasound done and it showed some thickening of the small intestine so probably some IBD. I won't put him through the biopsy process.

I've also switched Teasel to carageenan free low carb wet food (Wellness brand) and give him a digestive enzymes/probiotic supplement. Not saying this is exactly what Ming needs, just giving you an example of how a kitty's treatment can get customized over time. The new food and enzyme supplement seems to really agree with Teasel. His meals are more like soup because I add 3-4 Tbsp of warm water to every meal (1/3 of a 5.5 ox can per meal - four meals a day).

What does my vet think? First, she's a great vet and likes to work collaboratively with her patients. She knows I do my own thing and acknowledges that I know a lot more about FD than she does at this point. ;):)
 
Thanks everyone.

I did send a text to the IM specialist but she didn't reply. I called the hospital and she did talk to the doctors there and upped his insulin dose from 5 units to 7 units and reduced his dry food intake (1 tsp instead of 4 tbsp four times a day).... which... is not.. what I asked for. He's been in the high 25s or 450s but no ketones.

(I should probably post all this in the Lantus forum too haha)

I'm going in for my night shift tonight and I'm really tempted to not feed any dry food tonight. Actually, I probably won't even. There's no reason. It's a weird position I'm in. Being an employee but also a client lol. What a headache.

I do feel better. The night nurse also decided NOT to feed dry food for the last half of the night so that made me feel better too. I talked to Vet C and I think she sort of agrees with me that feeding dry doesn't make sense if he's readily eating his wet food. I don't think she wanted to outright say it but she said, "That's her plan and well.." and kind of trailed off.

I feel like I made a mistake now. He was doing well and had really good BGs for a day on 10 units of PZI. Maybe it would've been better to try Lantus later rather than now.

Kris & Teasel said:
One med she mentioned for IBD was Atopica (cyclosporine) instead of steroids. Did your IM vet mention it?
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She did mention that but if I recall correctly, she decided against that because of his asthma. Better to treat both, I think.

Kris & Teasel said:
I've also switched Teasel to carageenan free low carb wet food (Wellness brand) and give him a digestive enzymes/probiotic supplement
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I was very adamant about staying away from carageenan before Ming's diabetes. Less so now because his diabetes took over. What supplement are you using?
 
Rachel said:
Aw Crista! Sounds like you had a tough night. My guess is your mom is worried about Ming and she is still in the mindset of "vet knows best" that most people come here in. I get it. I had a HARD time coming in here and taking the word of a ton of "crazy cat ladies" instead of my vet whose JOB was to treat animals! It took me time to realize that these "crazy cat ladies" had way more experience since they'd been doing this for so long, and that vets simply can't know EVERYTHING about every disease in every animal type. No one could expect that! Have you told your mom that (nicely of course)? I wonder if she'd be willing to come on here and talk to us or at least read some of what we all say?

Let me assure you that you are NOT responsible for Ming's illnesses! Pancreatitis, as far as I know, just HAPPENS. It sucks and it's no fun, but it does. I think it's more helpful to focus on what you ARE doing...you are taking care of Ming! A lot of people just put diabetic kitties down, but you are taking care of him. You're giving him shots, checking his BG, researching the food, getting him vet care...you're doing EVERYTHING you should be doing. Sure Ming is having a tough go of it right now, but vets aren't magicians and neither are we...it takes time to get kitties feeling better and we can only do what we can do.

It sounds to me like maybe your vets have some miscommunication going on. I wonder if they'd be willing to call you if they are not going to give a shot at all so you can ask them to do something at least?

I'm so sorry all this is hitting you at once, Crista! It happens to us all where one day some tiny thing sets us going and we just lose it! I've done it plenty of times and the folks here talked me down and kept me going. I wish we could all come over and give you a giant hug to help you feel better! Just know that WE know that you are doing a great job and that Ming is super lucky to have you!

Sending tons of healing vines his way and lots of peaceful vines your way! :bighug::bighug::bighug::bighug:
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Thank you, Rachel :)

I'm trying to find that nice balance between vets and us crazy cat ladies (I like to think that I'm part of the team). I would have loved to have brought Ming home yesterday after such a great day of BGs and feedings. But I also feel like I need to do something MORE and that just sounds like the route of steroids.

Perhaps it would be better once Ming is home. Even though there's no one there to watch him like a hawk, at least I'm there to make the decisions. Sure, there's people watching him at the vet, but it feels like too many people in charge and not in charge at the same time and then we get into this stalemate where Ming doesn't get a shot or is being fed weird things.

Ugh.

But yes, I need to remind myself of what you said: that it takes time to get kitties feeling better. He's been through a lot. I spoke to my mom again last night after I calmed down and told her that I understand where she's coming from but that if it's possible, if she could give me support rather than a lecture. And that I know I can be difficult to talk to when I'm all worked up but thanked her for trying and putting up with me. I said I'll try too to be less crazy and calm down and trust.

I don't think she would be interested or have the head space to read through everything that's here lol. But I'll give her the option to come here and send her the links if she does feel up to it.

After our talk, my mom echoed that Ming has been through a lot and he's still kicking. So a little dry food and another darn night of high BGs might be super rough but he'll pull through. Especially if he's much brighter and actually eating. That provides SOME comfort to me but y'know, all of this seems just sort of easily fixed rather than hard to fix. It's such a small thing to just NOT give him dry food that I don't think it will either make it worse or make it exponentially better. It's an easy fix and I just wish it would've been fixed without resistance or complication.

I think he's off fluids now too. Something about his potassium being too high. If he does well without fluids flushing out his ketones tonight, then I'm ready to bring him home ASAP.
 
Oh goodie! They have it in Canada too. A lot pricier but at least it’s available :) I’ll look into it.

My mom actually bought something similar a couple years ago. I think I’ll compare the ingredients and see if it’s similar or the same.
 
Crista & Ming said:
Oh goodie! They have it in Canada too. A lot pricier but at least it’s available :) I’ll look into it.

My mom actually bought something similar a couple years ago. I think I’ll compare the ingredients and see if it’s similar or the same.
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I'm in Canada, Crista - Ottawa to be exact. If you're in Ontario you can order it from Well.ca. That's where I got it. They might ship out of province too. Amazon.ca likely has it too.
 
Oh riiight haha! Yeah I saw it on Amazon.ca for $38. The American amazon had it for much less plus shipping. I’ll check out well.ca
 
Crista, I'm sorry things have been so hard lately. As Rachel and Kris have said, it will get better. And I think you're right that once Ming can come home and rest, and once you aren't dealing with the extra stress of being both a client and an employee, things will ease a bit for you both.
 
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