Very New - Need Guidance (from HI to hypo to HI)

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Bandit's Mom said:
I know nothing about Prozinc, but I wondered whether Patty should give it one more day for the bounce to clear? Or do you think Cookie is not bouncing from that 25 two days back, because she's seeing those blues in the AM cycle?
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I think this bounce is caused by the blues, but I have a feeling she's bouncing so darn high because of that 25. We have a lot of wiggle room with that nadir even on a bounce break, so 1.5U should be ok.

With the DKA I'd rather see nadirs closer to 120 ish (or lower bounces) before letting her "settle into" a dose for a few cycles. Hopefully this 1.5U does the trick.
 
pstanfield said:
Yes, I will be looking into the human meter soon, and then I can maybe add the AlphaTrak to my Hypo kit as backup. Thank you all for being here! I am working on getting her original labs inputed as well.
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Hi Patty I'm glad everyone is helping you
If you plan on switching to a human meter whenever
If you have a Walmart where you live most of us use
The Relion Prime. It's 9 dollars
17.88 for 100 test strips
I'm sure you are spending a fortune on those Alpha Trak strips
At least you can run to Walmart if you need more
I have even ordered them on line from Walmart and got them within 2-3 days
Best of luck :bighug::cat:
 
Diane Tyler's Mom said:
Hi Patty I'm glad everyone is helping you
If you plan on switching to a human meter whenever
If you have a Walmart where you live most of us use
The Relion Prime. It's 9 dollars
17.88 for 100 test strips
I'm sure you are spending a fortune on those Alpha Trak strips
At least you can run to Walmart if you need more
I have even ordered them on line from Walmart and got them within 2-3 days
Best of luck :bighug::cat:
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Thank you, I will look into that. I appreciate it! The Alpha testing strips are nothing compared to the ER visits, though! :nailbiting:
 
Her appetite is really poor this morning, she has been nibbling on her food, then became completely disinterested. I had 4 doses of the Cerenia from her first round of DKA and gave one dose to her this morning around 7 am (+1), I don't see a huge improvement, and she is really going after that water. I tried some canned chicken breast, and she was really interested in the juice/broth from that ((chicken breast meat, rib meat, water, and less than 2% of sea salt, modified food starch, sodium phosphates, and chicken flavor). The can says 45 mg cholesterol and 410 mg sodium for a 3 oz serving. Is it ok to just give her the broth? She took a couple of nibbles of the chicken but turned away. Trying whatever I can to get her eating. Also mixed the broth with the FF Classic, but she did not want that either.

She had some straining with a bowel movement this morning, and couldn't go at first, then tried and went about 20 minutes later, (poop was on the harder side), and then I left to pick up my boys from practice, and she had pooped again, this time a larger amount, but soft, not quite diarrhea, but not formed either.

Tested her ketones and it looks a little closer to trace, so thinking I should call the vet. Any tips, thoughts, advice?
 
pstanfield said:
Her appetite is really poor this morning, she has been nibbling on her food, then became completely disinterested. I had 4 doses of the Cerenia from her first round of DKA and gave one dose to her this morning around 7 am (+1), I don't see a huge improvement, and she is really going after that water. I tried some canned chicken breast, and she was really interested in the juice/broth from that ((chicken breast meat, rib meat, water, and less than 2% of sea salt, modified food starch, sodium phosphates, and chicken flavor). The can says 45 mg cholesterol and 410 mg sodium for a 3 oz serving. Is it ok to just give her the broth? She took a couple of nibbles of the chicken but turned away. Trying whatever I can to get her eating. Also mixed the broth with the FF Classic, but she did not want that either.

She had some straining with a bowel movement this morning, and couldn't go at first, then tried and went about 20 minutes later, (poop was on the harder side), and then I left to pick up my boys from practice, and she had pooped again, this time a larger amount, but soft, not quite diarrhea, but not formed either.

Tested her ketones and it looks a little closer to trace, so thinking I should call the vet. Any tips, thoughts, advice?
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I would call the vet before they close, regular vet cheaper than ER! She probably needs fluids. In the meantime, try diluting the broth. So just a little bit in a bigger bowl of water.
 
You may also want to consider syringe/assist feeding if you can.

If you take her in, it may be worth running a SnapfPL to check for pancreatitis, these are also symptoms of that. Treatment is generally fluids, anti-nausea, appetite stimulant, and pain meds. No need for her to stay overnight if it's that unless she's in dire straits, all they'll do is give fluids and pain meds which you can do at home if comfortable (and if they'll send you home with meds). It's possible underlying pancreatitis may have contributed to the DKA (and still can cause it)
 
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Just be careful because after DKA cats can be more sensitive to insulin. Ceres is for home and an RX for ondansetron/zofran for nausea is a must.
 
Bandit's Mom said:
Hi Patty, I see Cookie's numbers are coming down at a good speed. Did she eat anything?
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I've been syringe feeding her a little at a time, she has had about 12ml of food, I blended a 3 oz can of FF with 1 TBS of water, it is a good consistency, she is tolerating it. I don't know how slow to go, I am giving it to her 1ml at time. She did start licking the blended food out of the measuring cup that it is in, but only did that for a few laps and then went back to her water. Waiting for her to pee to test ketones again.

I did speak to the ER internist specialist who treated Cookie in the hospital. She suggested with her numbers that perhaps Prozinc isn't the best for her, but it may still be too early to tell. She suggested that I consider Lantus or Levemir, but still wants to see how she does on the Prozinc. She also suggested a continuous glucose monitor if I stuck with the Prozinc to monitor her for 2 weeks. We discussed her bouncy numbers and she agreed that Cookie hasn't been on a steady diet and the diet combined with incorrect dosing could certainly be the issue. She also suggested mirtazapine for appetite stimulant if she continues to show disinterest in food.
 
pstanfield said:
I've been syringe feeding her a little at a time, she has had about 12ml of food, I blended a 3 oz can of FF with 1 TBS of water, it is a good consistency, she is tolerating it. I don't know how slow to go, I am giving it to her 1ml at time. She did start licking the blended food out of the measuring cup that it is in, but only did that for a few laps and then went back to her water. Waiting for her to pee to test ketones again.

I did speak to the ER internist specialist who treated Cookie in the hospital. She suggested with her numbers that perhaps Prozinc isn't the best for her, but it may still be too early to tell. She suggested that I consider Lantus or Levemir, but still wants to see how she does on the Prozinc. She also suggested a continuous glucose monitor if I stuck with the Prozinc to monitor her for 2 weeks. We discussed her bouncy numbers and she agreed that Cookie hasn't been on a steady diet and the diet combined with incorrect dosing could certainly be the issue. She also suggested mirtazapine for appetite stimulant if she continues to show disinterest in food.
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So, I'll put this bluntly because I'm worried about Cookie - I wholly disagree with almost everything she said and her overall lack of concern. And since the ER caused most of this problem to begin with, she's in no position to be saying any of this.

You need to be pushy on this one. Get a SnapfPL test. If it's pancreatitis, it's easily treatable, but also she's at a serious risk of DKA right now. DKA is not enough insulin + inappetence + underlying stress/inflammation/infection.

If it's pancreatitis, you need:
Anti nausea meds - Cerenia and ondansetron are ideal because you can give them both at same time

Appetite stimulant - sometimes they need a nudge to eat. But this is pointless if the cat is nauseous, those nausea meds need to be working first.

Pain meds - most here use gabapentin or buprenorphine. Pancreatitis is very painful, so even if they're not nauseous the pain may be too much to want to eat

SubQ fluids - very important if dehydrated, also important to help flush ketones.

You don't need a continuous monitor if you can test like you have been, but a lot of people like them. They do tend to fall off though.

ProZinc may or may not be a good insulin; Lantus and Levemir are generally better, but no sense wasting a whole ProZinc vial just yet. There's too much going on for ProZinc to have a chance to really work yet.
 
pstanfield said:
I've been syringe feeding her a little at a time, she has had about 12ml of food, I blended a 3 oz can of FF with 1 TBS of water, it is a good consistency, she is tolerating it. I don't know how slow to go, I am giving it to her 1ml at time.
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How much of the 3oz can has she had so far? Would she be interested in any other food? The carb% doesn't matter right now. She needs to eat.
 
She's had about 2/3 of the can now, so about 2 oz., plus she's eaten a little of the amount from earlier. I also just tested (+5), and she her BG is at 196.
 
Yikes, you have been through a lot very quickly. I have huge sympathies with the ER situation, I've had similar situations and Minnie gets ketones very quickly - we've had 3 (or 4? I forget) DKA. You're getting lots of excellent advice here so I'll only add a few things from my own experience. (assuming you are in the US)

You don't mention if getting blood is an issue, I had real struggles at the start so the smaller blood sample the better. AlphaTrak takes the smallest, 0.3microliter.

Ketone meter: The Novamax meter measures both Ketones and Blood Glucose, you buy different strips. It only needs 0.3 microliter blood for the glucose (more for ketones). The glucose strips are some of the cheapest you can find (on Amazon). Ketone strips are more expensive but as you say, cheaper than the ER. I got the meter as a kit on adw diabetes I think - you can get it with starter ketone & glucose strips. The meter catches ketone readings much earlier than the urine strips. For reference, Minnie's 'normal' blood ketone reading on Novamax is 0.3 but I think that's on the high side compared to other kitties - nonetheless it shows up as negative on a urine strip.

The Freestyle Lite is a human BG meter that has strips almost identical to the AT strips (but you can't mix/match strips & meters) with the little tabs on the side for drawing blood. I picked it for that similarity. Strips are not that cheap but much cheaper than AT strips.

I'll echo advice on mixing water with food and giving several small meals. On the plus side, she is drinking water too. I had bowls everywhere but Minnie doesn't drink much now.

Food - There are a few other prescription foods which are in range. The DM pate is LC 5%. DM Selects is just MC ~11%. AD (for sick kitties) is MC - I only started that after she came out of hospital last time. I don't think it's ideal long term but at the moment she is being super picky and won't eat most of what she used to like, but the AD is a win. I smear a little on top of normal food to entice her. You'll probably get better advice on food from others who've been around longer and generally prescription food isn't preferred but I have huge sympathies on a sick finicky kitty. If she only wants prescription food, that's what she'll get (while she's sick at least) My kitchen counter right now has 5 different open cans!!
 
FrostD said:
So, I'll put this bluntly because I'm worried about Cookie - I wholly disagree with almost everything she said and her overall lack of concern. And since the ER caused most of this problem to begin with, she's in no position to be saying any of this.

You need to be pushy on this one. Get a SnapfPL test. If it's pancreatitis, it's easily treatable, but also she's at a serious risk of DKA right now. DKA is not enough insulin + inappetence + underlying stress/inflammation/infection.

If it's pancreatitis, you need:
Anti nausea meds - Cerenia and ondansetron are ideal because you can give them both at same time

Appetite stimulant - sometimes they need a nudge to eat. But this is pointless if the cat is nauseous, those nausea meds need to be working first.

Pain meds - most here use gabapentin or buprenorphine. Pancreatitis is very painful, so even if they're not nauseous the pain may be too much to want to eat

SubQ fluids - very important if dehydrated, also important to help flush ketones.

You don't need a continuous monitor if you can test like you have been, but a lot of people like them. They do tend to fall off though.

ProZinc may or may not be a good insulin; Lantus and Levemir are generally better, but no sense wasting a whole ProZinc vial just yet. There's too much going on for ProZinc to have a chance to really work yet.
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I'm waiting on a call-back from the vet, and will address those with them. I am bringing my spreadsheet as well as notes, etc. Thank you, I agree with you on that. I just tested her ketones and it is negative, she actually sat in the litter box and her pee went out of the litter box, practically right in the cup. Her urine does not look diluted, it is yellow.
 
May I ask what dose of Cerenia you are giving Cookie? Most vets under dose it, and then it's not very effective. My cat weighs about 11 lbs and gets 12 mg of Cerenia. It comes to 1 mg/lb. That's the only way it works well for Ruby.
 
PerfumedCatMom said:
May I ask what dose of Cerenia you are giving Cookie? Most vets under dose it, and then it's not very effective. My cat weighs about 11 lbs and gets 12 mg of Cerenia. It comes to 1 mg/lb. That's the only way it works well for Ruby.
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She weighs about 4.3 pounds (probably slightly less now), and gets 4 mg, once a day.
 
pstanfield said:
She weighs about 4.3 pounds (probably slightly less now), and gets 4 mg, once a day.
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Good. Adding ondansetron (brand name: Zofran) as Melissa suggested would be good. It's another anti-nausea medication that works on different nausea receptors in the brain than Cerenia so it can be given together. The only issue with ondansetron is it might have negative interaction with mirtazapine, the appetite stimulant that her vet recommended. If you wind up giving ondansetron, I would ask for cyproheptadine (an anti-histamine that works well to stimulate kitty appetites) instead of mirtazapine. There are fewer side effects with cyproheptadine than mirtazapine. Ondansetron can be given every 6 hours, and with the cerenia once a day and cyproheptadine twice a day, it creates a really effective anti-nausea cocktail.
 
Liz & Minnie said:
Yikes, you have been through a lot very quickly. I have huge sympathies with the ER situation, I've had similar situations and Minnie gets ketones very quickly - we've had 3 (or 4? I forget) DKA. You're getting lots of excellent advice here so I'll only add a few things from my own experience. (assuming you are in the US)

You don't mention if getting blood is an issue, I had real struggles at the start so the smaller blood sample the better. AlphaTrak takes the smallest, 0.3microliter.

Ketone meter: The Novamax meter measures both Ketones and Blood Glucose, you buy different strips. It only needs 0.3 microliter blood for the glucose (more for ketones). The glucose strips are some of the cheapest you can find (on Amazon). Ketone strips are more expensive but as you say, cheaper than the ER. I got the meter as a kit on adw diabetes I think - you can get it with starter ketone & glucose strips. The meter catches ketone readings much earlier than the urine strips. For reference, Minnie's 'normal' blood ketone reading on Novamax is 0.3 but I think that's on the high side compared to other kitties - nonetheless it shows up as negative on a urine strip.

The Freestyle Lite is a human BG meter that has strips almost identical to the AT strips (but you can't mix/match strips & meters) with the little tabs on the side for drawing blood. I picked it for that similarity. Strips are not that cheap but much cheaper than AT strips.

I'll echo advice on mixing water with food and giving several small meals. On the plus side, she is drinking water too. I had bowls everywhere but Minnie doesn't drink much now.

Food - There are a few other prescription foods which are in range. The DM pate is LC 5%. DM Selects is just MC ~11%. AD (for sick kitties) is MC - I only started that after she came out of hospital last time. I don't think it's ideal long term but at the moment she is being super picky and won't eat most of what she used to like, but the AD is a win. I smear a little on top of normal food to entice her. You'll probably get better advice on food from others who've been around longer and generally prescription food isn't preferred but I have huge sympathies on a sick finicky kitty. If she only wants prescription food, that's what she'll get (while she's sick at least) My kitchen counter right now has 5 different open cans!!
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Thanks for the advice! I will definitely look into those as my AT strips run low. Getting blood is not an issue, but I am grateful that the AT is able to read some of the smaller samples I've had. The pictures of where those capillaries are (from one of the stickies on this board) have really helped!!!
 
So I heard back from the vet, and I have a couple of options. They can see her today, but it would be a drop off and see her when they have a chance (they are open until 6), or bring her in tomorrow at 8:30 am. I am torn because having a set appointment is better since I can work feedings in, and it isn't a long time away from here, but it is another day delayed from seeing if anything is going on, and another day of possible dehydration. Plus she just had another bowel movement and it is definitely very soft/mushy. Not formed at all. That concerns me, although could be from the Clavamox? If I drop her off, she won't be eating until after she comes home. She WOULD be home in time for her next insulin shot though. And she would get fluid and hopefully meds sooner.
 
So I decided it was better to take her in, and she is still there and I haven't heard anything yet. It is time for her insulin dose. When she does come home, if they haven't given her a dose, should I give the 1.5u? And since it is now after hours, I could only leave a message to check on her status. So hoping for some news soon and some additional advice. Also, with her current weight at about 4#, could that be why she doesn't seem to want to eat more than 6 oz a day?
 
Unregulated diabetic cats are usually starving for food. So no her current low weight would not be the reason for her inappetence. The reason would be something else such as pancreatitis.
 
Deb & Wink said:
Unregulated diabetic cats are usually starving for food. So no her current low weight would not be the reason for her inappetence. The reason would be something else such as pancreatitis.
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That makes sense. Ugh. Poor kitty. :( Is it also possible that the Clavamox is what is causing the soft stools and the inappetence? I wouldn't think it would decrease her appetite for a full day though. I would think it would wear off by the evening/next dose.
 
pstanfield said:
So I decided it was better to take her in, and she is still there and I haven't heard anything yet. It is time for her insulin dose. When she does come home, if they haven't given her a dose, should I give the 1.5u? And since it is now after hours, I could only leave a message to check on her status. So hoping for some news soon and some additional advice. Also, with her current weight at about 4#, could that be why she doesn't seem to want to eat more than 6 oz a day?
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I would still give a dose to keep DKA at bay...but be doubly sure they didn't give a shot, miscommunications can and do happen, especially if there's a shift change in there.

You'll be off schedule with the shots because they need to be 12 hours apart, but we can help you get back on track
 
pstanfield said:
That makes sense. Ugh. Poor kitty. :( Is it also possible that the Clavamox is what is causing the soft stools and the inappetence? I wouldn't think it would decrease her appetite for a full day though. I would think it would wear off by the evening/next dose.
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Clavamox can cause diarrhea/ loose stools. Not sure if it could be the cause of Cookie not eating well. Don’t think so, but ask your vet.
 
I hope the vet visit goes well. It is very frustrating you can’t talk one in one with the vet. Yes she will need her insulin but do double check with the vet that it hasn’t been given by them.
With the food… at this point ANY food is ok for her to eat. It doesn’t matter if it is a suitable diabetic cat food or a high carb dry food. Just eating anything trumps everything. I would ask for some Hills a/d canned food from the vet as it can be syringed if she is still not eating.
 
Returned from the vet, they did not give insulin, they didn't want to risk overdosing, so she is about 2 hours and 40 min later than her usually. I was advised I can give her next injection between 10-12 hours later, so I am thinking I give at 6:40am, and then 6:00pm, to get back to my 6:00-6:00 schedule. Is that ok to do?

She was given fluids with Vitamin B to help with appetite, and they were able to get her to eat some FF Classic salmon with churu on it. The vet is treating her for triaditis (inflammation of pancreas, intestines and liver/gallbladder). I also need to get a fresh stool sample to check for heliobacter. She advised I start giving Cookie pepcid. We are going to decide on the combo of anti-nausea and appetite stimulant tomorrow after we see how Cookie does tonight after her fluids and Vit. B. She went over the pros and cons of all of them, which were the ones suggested here, the only thing with the Cyproheptadine is that you need to be cautious of the liver, since Cookie had elevated liver enzymes at one of her prior vet/ER visits. I am going to see if I can get them a stool sample and bring that in tomorrow, as well as bring Cookie back for additional SQ fluids, which they said they would teach me how to do at home.

So as far as testing her tonight, should I just let her rest, or should I be testing her BG? I will be honest, I am feeling exhausted. I don't think I can do every 2 hours tonight and still be functional tomorrow. Spent most of today feeling sick, worried, anxious, and had a splitting headache. I need to do some better self-care.
 
I just looked at the SS and I see you gave the insulin 2 hours 40 mins past usual time.
I know you are really tired but I would set the alarm and get up and test at least once just to check she is OK and the BG has not dropped too much..it is unlikely to, but if she is feeling better it could drop lower than it has, so better to be safe.
 
Can you do a test at +3.5 and +5.5? If both of those are high (I expect they will be) then take the rest of the night off.

Vet seems very thorough, great! I hope she eats for you.

As for schedule, I would actually just test at your normal time tomorrow. If she's in the red or black, I'd shoot at your normal time. If pink or lower, ask for help here and be sure to let us know how she's eating/drinking.
 
I am not a Prozinc user but I think you have more leeway with Prozinc than with the depot insulins, so I would think that as long as the BG is high enough, shooting 1 hour earlier should be OK but I’ll tag @Panic and @Deb & Wink as they are Prozinc users and I am not.
I’m not sure I would use the Pepcid over cerenia or ondansetron. I’ll tag @tiffmaxee to see what she thinks as I think she has used it. I didn’t have much success with pepcid as far as nausea went.
@FrostD
I’m not sure I would shoot 2 hours 40 mins earlier than normal tomorrow morning without getting specific advice from a Prozinc user. She is going back to the vet tomorrow and the BG may not be able to be monitored as she would at home.
It’s great they will teach you to do the sub Q fluids Patty.
When you get up to test during the night, I would offer some food to Cookie
 
Bron and Sheba (GA) said:
I am not a Prozinc user but I think you have more leeway with Prozinc than with the depot insulins, so I would think that as long as the BG is high enough, shooting 1 hour earlier should be OK but I’ll tag @Panic and @Deb & Wink as they are Prozinc users and I am not.
I’m not sure I would use the Pepcid over cerenia or ondansetron. I’ll tag @tiffmaxee to see what she thinks as I think she has used it. I didn’t have much success with pepcid as far as nausea went.
@FrostD
I’m not sure I would shoot 2 hours 40 mins earlier than normal tomorrow morning without getting specific advice from a Prozinc user. She is going back to the vet tomorrow and the BG may not be able to be monitored as she would at home.
It’s great they will teach you to do the sub Q fluids Patty.
When you get up to test during the night, I would offer some food to Cookie
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Definitely will work on getting her some food when I test. I will wait on additional advice for when to shoot tomorrow, but I do know that there is more leeway with the Prozinc. The pepcid is more for the possibility of heliobactor as well as for nausea, so it is dual purpose, but vet still recommended the others for anti-nausea.
 
pstanfield said:
Definitely will work on getting her some food when I test. I will wait on additional advice for when to shoot tomorrow, but I do know that there is more leeway with the Prozinc. The pepcid is more for the possibility of heliobactor as well as for nausea, so it is dual purpose, but vet still recommended the others for anti-nausea.
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I’m glad the vet recommended the cerenia and ondansetron the nausea. Often ondansetron will work if the cerenia doesn’t. They work on different pathways so can be given together, if necessary. Oncandsetron can be given 8 hourly if needed. Did they give her anything for pain?

I see in post 60 that the ER vet suggested considering swapping to Lantus or Levemir. They are both great insulins for cats but at the moment, with the recent history of DKA, you are better to stick with Prozinc which is an in and out insulin and is better to use as you will get the full effect each dose. If you swapped to one of the depot insulins(Lantus or Levemir) it would take up to 5 days for the depot to fill and the full effect of the dose to be felt. Once the DKA is in the distance you can safely swap to Lantus or Levemir if you wanted to.

You are doing a really great job looking after Cookie and I can imagine how tired and stressed you are feeling. Try and get some sleep:bighug:
 
tiffmaxee said:
@Bron and Sheba (GA) I agree. Pepcid is not good for nausea. It’s not even used much for ckd any more. You need cerebra or my preferred ondansetron.
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The vet agreed, she liked ondansetron best for nausea, and likes to stop cerenia after 5 days so it doesn't build up.

So I did my first test of the night, and at +3.5 we are at 232. Going to test at +5.5, or should I test sooner since she is going down?

She is eating some, and seems interested in food, although she isn't eating a huge amount. Going to see if I can keep her interested.

Thanks again for all the help and support, it honestly has been helping me feel less helpless.
 
I've used ProZinc before. The shooting early is more a concern with the extra duration you sometimes see with ProZinc, but what I was saying is with bounces to red or black I'm not worried about that.

What is the timing with the vet visit? Are you allowed in with her? Can you bring meter with you? I would try to time it so the vet is after +6, but that may be unavoidable. The +3 to +6 window is where she drops the most (for now) and needs the most monitoring.

She doesn't seem to be bouncing as high which is good!
 
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