Benny post DKA at home being tube fed

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I'm waiting for him to pee now. I haven't managed to see him go today. I will give him 40ml of fluids down the tube and make sure I get a ketones one tonight. He is eating and drinking well though. I am beginning to think I messed up his shot this morning as I don't get the high levels.

Update : Ketone -ive
 
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"What do you mean by you think you messed up his shot?"
Maybe a fur shot? I usually let the pinch go wait a few seconds and then retract , but this morning I think I retracted quite quickly.

I have just cleared the house of all kibble. He had quite a bit of it yesterday and this morning. So perhaps he is really carb sensitive? His numbers have got worse as he has started eating himself ( reduced tube feeds he had none today). The Vet said let him have kibble as eating is more important but he likes the FF Pate, roast chicken and Prawns, so I think I will offer that before resorting to kibble.
 
Your vet is correct. Eating is more important than what the carbs are at the moment. If he needs to eat the dry a bit longer we can just increase the dose of insulin. That’s not a problem He doesn’t need to be really carb sensitive for his BG to be high when eating dry. It raises all cats BG.
Its great he’s starting to eat well again on his own but make sure he’s getting enough. Keep supplementing with the dry if you need to. It’s still more important he eats well than what he eats at this stage.
you probably didn’t mess the shot up this morning. The high BGs would be from the dry food.
It’s so good to hear he’s back eating himself.
 
Kindagot said:
Update: Spoke to Vet and upping insulin to 2units am and pm.
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Hi Fiona. Yes I noticed you had increased the dose. Make sure you are monitoring closely with the increase and the reduction of the dry food.
Would be good if you could keep updating the SS as I keep an eye on it…;) thanks:)
 
I will update SS . Just got back from Vet with Billy who has poor appetite. Constipation! I was desperate to get back and give Benny his +4. He's ok. I'm doing 50/50 wet dry . I thought about what you said and left dry out for night and will encourage wet in the day( and prawns!) He's seems good even though high BG. Will get ketones fine this arvo too
 
When you have time, would you mind putting in the remarks column what food he has each day. Will give us an idea of how he’s going with the food verses the insulin dose. Make sense?
 
Just looked at Bennys SS. He’s responding to the increase in dose. Nice to see the green BGs.
Looks like he is bouncing from the green BG.
That’s normal so don’t be concerned and don’t be tempted to increase the dose.
Any luck in increasing low carb food and decreasing the dry yet? How is Bennys appetite? Good luck at the vet today. Let us know how it all goes.
 
Bron and Sheba (GA) said:
Just looked at Bennys SS. He’s responding to the increase in dose. Nice to see the green BGs.
Looks like he is bouncing from the green BG.
That’s normal so don’t be concerned and don’t be tempted to increase the dose.
Any luck in increasing low carb food and decreasing the dry yet? How is Bennys appetite? Good luck at the vet today. Let us know how it all goes.
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Yes! Thanks for keeping eye out. I was going to ask you what you thought about his numbers last night, but it was so late! Also. I think the diet changes as well have had an effect. Saw Vet today. She can see improvement in him, decided to keep O tube in place for 2 more weeks while stabilising the BG. I had to give him a bit of dextrose solution last night to bring him up from 3.3 ( of course he may well have been ok as the Libre is +/- 25%) .
He is eating FF, Chicken and Prawns ok during the day and I will leave his Kidney Kibble ( 1 Portion) for night time. Billy is doing ok as well. He has lactulose twice a day and a buccal inflammatory twice a day. I feel like a full time Vet nurse!
 
I’m glad the vet is leaving the feeding tube in longer and she thinks he is improving. Great news.
3.3 (60) is still a safe number. You could have just fed some low carb food or even given a bit of a/d to try and bring the BG up a bit higher. But those greens are normal numbers.
Under 2.8 (50) is when you get the high carb or glucose/ honey out. You can always tag @Bandit's Mom during the night as she is in India and will be online if you ever get stuck.
If you think he will keep wanting dry at night fir a while, you might be better getting some hills m/d as it is lower than the one you are currently using. M/d is around 17% which is still high carb but not as high as the kidney one.
Are you practicing using a hand held glucose meter yet? Might be an idea to start as using the libre is expensive. It’s also good to have to double check the lower numbers on the hand held meter.
I’m glad Billy is ok.
 
Ah! So I panicked! I did give him some food when he was starting to drop but then it went down to 3.3 and I thought I would do a little glucose. The reason being it was past midnight and he had settled for the night, no way of telling whether he is lethargic or not. I will tag @Bandit's Mom in if anything happens again in the middle of the night. Isn't it wonderful to have this global community?
I tried his ear at the weekend. It did not go down well. I tried it on myself today . The sensors are $85 ( vet charges more to install) . I'm happy to use them until he is stable.
 
Kindagot said:
tried his ear at the weekend. It did not go down well. I tried it on myself today . The sensors are $85 ( vet charges more to install) . I'm happy to use them until he is stable.
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Even when he is ‘stable” you will need to test, so I would keep trying the meter. Try rubbing his ear and giving him a small treat to get him used to it. Always test in the same spot. Always give a treat, even when you are unsuccessful. He will get used to it. When I used to go into the testing box, Sheba would come running from wherever she was in the house as she knew she would get a treat. I used to let her eat the treat as I was testing.


Kindagot said:
Ah! So I panicked! I did give him some food when he was starting to drop but then it went down to 3.3 and I thought I would do a little glucose. T
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Don’t worry….the first time Sheba dropped close to 3 ( this was pre forum days) it was the middle of the night and she kept dropping….I hadn’t learnt properly how to manage it at that point. My daughter had parked her car behind mine and I was at the point where I thought I was having to go to the emergency vet so I basically woke the whole household. At that point I had given Sheba so much honey and dry food that the BG stopped dropping so everyone but me went back to bed. Sheba was feeling very seedy the next day from so much honey and dry food in her system.
 
Bron and Sheba (GA) said:
How are things going Fiona? I see the SS is not up to date. Would you mind updating it when you get a chance please?
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Going slowly. Benny is pretty much averaging 24/25 a day over the past fortnight. Although of course that could be 25% lower. He is ok in himself. Still tired. Likes a cuddle and a play. Eating well. Drinking a fair bit. Ketones negative though. I think the Vet wants to take it slow with any increases. He grazes or has 6 small meals a day of 40 calories so I think that is why his numbers do not form a curve so much.
 
Glad ketones are negative. Are you still reducing the dry food? And increasing the wet?
Because of the 3.3 a couple of days ago, I would not increase the dose yet either. I would like to see if he is bouncing from that 3.3 or if he is just in high numbers from the dry food.
Did you think about swapping the renal dry to Hills m/d dry?
It’s still higher carb but much lower than the renal dry, if you are having trouble getting him off the dry.
It’s not good leaving him in those higher numbers and I’m sure the renal dry is contributing to it al lot, because we can see the 2 units can bring him down to 3.3.
He will keep drinking lots until he gets down into better numbers
Any chance of another progress photo?:)
 
Ideally I would like to get him off all dry food. He has CKD so it will be a balancing act between the DM and CKD. Poor kitty. Both of them detest any Hills food apart from the A/D. So I guess I am looking for a DM friendly low phosphorus wet food. They are really into the FF savory center food. It's not on the list of foods but seems to have a low carb content based in addition of the ingredients.
His numbers are high. It worries me. I suspect he will be going up a smidge on the insulin soon. He has 12 days until his check up. Hopefully the Vet who is monitoring from the cloud will suggest it next week. She is reluctant to go fast with Benny as he does weird things.
 
How advanced is Bennys CKD? I thought from memory it was early stage.
If so you can just feed ordinary food but look for low phosphorus foods. There is no need for the CKD foods until it is very advanced.
He needs a high protein, low carb and low phosphorus diet.
Sheba was early stage CKD and I managed that with low phosphorus, low carb and high protein diet and her path results remained stable.
Putting CKD cats onto a low protein diet is old thinking and not what is recommended now. Low protein gives muscle wastage and high protein promotes muscle building which is what is needed in older cats.
 
benny 3.12.21.jpg
 

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I did a fur shot! I changed from flanks to neck and as I pushed shot I saw the needle had gone through the other side of the tent! I cannot redo the shot even though I am 99.99% he didn't get dose. There was a tiny drop of wet that instantly evaporated and smelt of insulin. @Bron and Sheba (GA) I feel terrible!!
 
You are right that you can’t give another shot. If all you felt was a drop I am sure some got in. Just make sure he eats and drinks enough. :bighug:
 
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Kindagot said:
I did a fur shot! I changed from flanks to neck and as I pushed shot I saw the needle had gone through the other side of the tent! I cannot redo the shot even though I am 99.99% he didn't get dose. There was a tiny drop of wet that instantly evaporated and smelt of insulin. @Bron and Sheba (GA) I feel terrible!!
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We have all done a fur shot. It is very frustrating.but never give the dose again. He could well have got some of the dose. You would be surprised how often cats do.
As Elise said just make sure he eats and drinks plenty and do an extra ketone test if you get the opportunity….but don’t stress about it.
 
Hey Fiona.. how are things today? how was the BG after the possible fur shot yesterday?
I notice in the US SS you have entered a world BG which is lime green instead of red.
How is Bennys eating going?. And ketones?
And how is Billy managing with all of this happening around him ?
 
BG remained High all night. Was definitely a fur shot. Today he is 23ish and eating wet food that is 11 carbs. Lots of urine and drinking still. Negative ketones. Billy and he had half hour mutual groom yesterday. So pretty much best buddies again. I'm hoping to move them on to a lower carb wet food now. I thought Fancy feast pate was low but this one has a savory centre ( tiny bit of gravy) they love it! Obviously wity Benny's numbers I need to go low carb but CKD is an issue. I think we will need to go up a tad on the insulin.
 
Would you mind filling in the SS so it’s up to date so I can see the last days numbers please?
Without seeing the BGs I can’t comment on a dose increase.;)
That’s great they are best buddies again!
 
Thanks for updating the SS.
Yes I think I would increase the dose to 2.25 units but make sure you monitor closely as he dropped to 3.3 on 2 units 5 days ago. However if you are swapping to lower carb food in the next day or two, i would hold off on the increase to see if the lower carbs make a difference. It’s best not to do two changes at the same time.
 
Benny is having his O tube pulled today. He has been eating cat grass and it has been coming out of the insertion site. I thought I was going mad when I found a piece of grass in his collar on Thursday. Yesterday I pulled a 10cm strand through the hole in his neck! Today a smaller piece. I gave him some antibiotics as I could not get through to the vet last night. His numbers seem to be getting better on the wet food but I think I will have to watch carefully while the ABX take care of any infection. Hey ho! Poor Benny Booboo.
 
Poor Benny. Do you think he’s eating grass because he’s nauseous? What is he getting for nausea? :bighug:
 
No. He just likes grass. Always has done. Helps with hairballs. He's eating and drinking well on his own so I have dropped the Mirtazapine and antiemetic. I guess the ABX might make him nauseous so I will give him some for a few days.
I can't work out how grass could work it's way out of his esophagus and out of the insertion site! He had been itching the collar . Now I know why.
 
Kindagot said:
Benny is having his O tube pulled today. He has been eating cat grass and it has been coming out of the insertion site. I thought I was going mad when I found a piece of grass in his collar on Thursday. Yesterday I pulled a 10cm strand through the hole in his neck! Today a smaller piece. I gave him some antibiotics as I could not get through to the vet last night. His numbers seem to be getting better on the wet food but I think I will have to watch carefully while the ABX take care of any infection. Hey ho! Poor Benny Booboo.
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Poor guy <3
 
How exciting he is having the tube removed today. That’s progress! Your vets have been really good through this process. .
Why are you giving him an antibiotic again? Can’t quite work out why?
Is he having any dry food at all now?
Any ketone urine tests for the last couple of days.?
 
Bron and Sheba (GA) said:
How exciting he is having the tube removed today. That’s progress! Your vets have been really good through this process. .
Why are you giving him an antibiotic again? Can’t quite work out why?
Is he having any dry food at all now?
Any ketone urine tests for the last couple of days.?
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The grass he has been eating orally has some how found its way out of the tube insertion site. Not through the tube itself. I guess the tube stopped the grass going down and then the strand would poke through the hole in his skin. So it is all a bit yucky, hence the ABX. I pulled out 10cm grass strand when cleaning his insertion site last night!
While I was waiting for Vet to call me this morning, yet another piece. He was hacking a bit yesterday.

So back from Vets now. no tube. Voracious appetite. (must have been bothering him yesterday as he was not eating a lot at a time, more little and often ). ABX orally (Benny is a dream cat to nurse) Resting now with BG of 8.5 mmol at +6 !!!

Ketones are negative I will update SS.
 
Great to see the 8.3 (149). Don’t increase the dose with a new blue BG in the picture.
I’m sure he will feel better with the tube out. Great to hear he has such a good appetite.
Great progress in the last three weeks! Great home nursing!
 
Bron and Sheba (GA) said:
Great to see the 8.3 (149). Don’t increase the dose with a new blue BG in the picture.
I’m sure he will feel better with the tube out. Great to hear he has such a good appetite.
Great progress in the last three weeks! Great home nursing!
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Thank you! I agree re the dose , I think the swap to wet food is now taking effect. Full time Vet nurse me! He is much better with tube out and lower numbers seem to have made him perky. He smelled the butter on my sandwich from upstairs for the first time in weeks he came running!
 
Hi Fiona, if you don’t get some blue BGs in tomorrows cycles, I would increase the dose to 2.25 units the following morning..
We don’t want him to stay in those high BGs too long as glucose toxicity can set in and it’s harder to get them into better BGs.
 
Bron and Sheba (GA) said:
Hi Fiona, if you don’t get some blue BGs in tomorrows cycles, I would increase the dose to 2.25 units the following morning..
We don’t want him to stay in those high BGs too long as glucose toxicity can set in and it’s harder to get them into better BGs.
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I was going to ask you what you thought today. I was going to ask the Vet about an increase. She is meant to be monitoring the BG results. I think I will have to source some needles with 1/2 unit markings as I found it really difficult to do the 1.75. He seems to have a nadir around 15-18. He seems ok in himself. Still not 100%.
 
Kindagot said:
I was going to ask you what you thought today. I was going to ask the Vet about an increase. She is meant to be monitoring the BG results. I think I will have to source some needles with 1/2 unit markings as I found it really difficult to do the 1.75. He seems to have a nadir around 15-18. He seems ok in himself. Still not 100%.
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I doubt you will find any syringes with 1/2 unit markings in NZ as we don’t have any here in Australia. And I can remember someone else who lived in NZ had to get them from the UK as well.
You can buy them online from the UK from a reliable source and they should be there within a fortnight at most. I used a magnifying glass always to draw up the doses as I rarely used 1/2 unit syringes. If you do go ahead and buy them, keep them for the 1/4 and 3/4 unit doses as they are more expensive than locally bought ones…that’s what I did….just used them if I was drawing up the 1/4 and 3/4 unit doses. we need to get his nadirs into the green BGs in the not too distant future.
Here is the information from the Aussie info link about the syringes.
Buying ½ unit syringes. We do not have ½ unit marked syringes available here in Australia. However, they can be ordered through a company in the UK which will deliver to you in about a week. The company website is Hyperdrug.co.uk. Here is the direct link to the page to order the 1/2 unit (Demi) U100 0.3ml syringes: https://www.hyperdrug.co.uk/BD-Micr...03ml-pack-of-100/productinfo/BDMICROFINE03ML/.
 
Kindagot said:
Thank you @Bron and Sheba (GA) I will order them. Might be delays with Christmas etc. So do you think I should go for 2.25 in the morning?
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I see you added another days data into the SS since I wrote post 95, so I think you could increase in the morning to 2.25 units. Just monitor closely ….I’m sure you will.
Might be an idea to start a new thread tomorrow too as this one is getting pretty long.
I’m so glad Benny is doing well.
 
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