Taz it's hopefully coming home today, but I'm scared!

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SaraMV

SaraMV

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Taz was diagnosed on Sunday, and has been in the ER clinic since Monday, with Pancreatitis. They say he is doing well and that hopefully he'll be able to come home today. They have been monitoring his blood sugar and are trying to find the magic number of units to give (Lantus), but they've also been keeping him a little sedated to help him not be so scared in there.

Once he comes home, I have to go off of blind faith and a prayer. The ER isn't allowing people into the office to talk one on one, due to covid and their covid protocols right now. So our discussions are via phone and the office is so short staffed that the calls are cut too short to answer all of my questions. I won't be able to get into our regular vet until next week (hopefully). I have a few questions but I can't seem to find the answers anywhere.

From what I've found, I need to do a curve. With lantus, would it be a 12 hour curve or a 24 hour curve? My Alphatrak2 arrives tomorrow.

I've also been told that I need to take a pre shot reading. Taz will be fed twice a day. How soon before eating should this reading be done?

What is the time frame after eating, that insulin should be given? Immediately? Within 30-60 minutes?

How do I know the number range where a full insulin dose should be given, versus a smaller dose (or no dose at all)? I can't find a chart anywhere. For example, if he is at 150 or less before feeding, would that be a full dose or a half dose? Is there a chart somewhere that can guide me?

I plan to feed him at 7:30am and pm. I imagine his numbers will be lowest right before a meal (12 hours later)? What range should I look for him to be in, at a +6 reading to know if he'll go too low as he approaches his feeding?

If I'm not home exactly at the time he should eat (running late), and he gets insulin an hour late, what do I do about his next dose? Can I still give it at 7:30 the next feeding?

Sorry there's so many questions. I hope they all make sense. I'm terrified that once the pancreatitis is gone and he's back home, his numbers will come down from what the vet says it is. I don't want to overdose him.
 
Hi Sara,

I can answer your questions shortly. I need to get a cup of tea down my throat first.

Can you tell me what insulin Taz has been prescribed?
 
Taz coming home should be a happy time with nothing to be terrified about. You won't overdose him with some common sense.
-Start posting in the Lantus forum for dosing advice. More common health questions go in this forum.
-Your profile is blank. Learn how to post his numbers so that other members can help. List previous medical conditions, the food he eats, anything that might affect his health.
-Diabetes doesn't kill cats, owners who don't care do. You obviously care about and love Taz so know you're in the right place here.
-Feel safe here. There's no such thing as a stupid question, no one will shame you. We all started somewhere, me too.
 
Good morning. This will be a long post with lots of links. Take your time. Re-read. Ask more questions.

SaraMV said:
Pancreatitis.
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Ask that Taz be sent home with drugs and fluids for treatment of pancreatitis. It is a long drive for you to the vet. Taz may not be completely over the attack and also since pancreatitis can recur, it would be good to have these drugs on hand.
Fluids
Buprenorphine for pain relief – the vet may give you a hard time with this one (it's a narcotic)
Zofran for nausea
Cerenia for vomiting (can be given with Zofran)

Here is the link for the Pancreatitis Primer
SaraMV said:
From what I've found, I need to do a curve. With lantus, would it be a 12 hour curve or a 24 hour curve? My Alphatrak2 arrives tomorrow.
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After a week, yes, do a curve. Test every 2 hours from one preshot to the next.

btw: strips for an AlphaTrak are expensive. You may want to switch to a human meter at some point.

SaraMV said:
I've also been told that I need to take a pre shot reading. Taz will be fed twice a day. How soon before eating should this reading be done?
Click to expand...

Yes, you need to take a pre shot reading. No food for the 2 hours before the shot so that the test number is not food influenced. So pick up any food 10 hours after the previous shot.

1. Test – to make sure the blood glucose number is high enough to shoot.
2. Feed – to make sure the cat will eat
3. Shoot

Feeding twice a day is old school. I honestly don't know why vets still say only twice a day. :banghead: Insulin works best if you feed a meal at shot time and then snacks throughout the cycle, especially the first half.

Along with a preshot, you should try to get a couple of tests during each cycle. This will tell you how the cycle is panning out and over time, you will begin to see a pattern. Two 2 hours after the shot is a good time to test, then somewhere between 4 and 6 hours after the shot. Also do some random tests. The more information you have, the more you will understand Taz's diabetes and the better we can help you. The first place anyone will look is your signature and spreadsheet.

Here are the links for a signature and a spreadsheet. If you need help setting them up, ask. There are people here who can do it in minutes.



SaraMV said:
How do I know the number range where a full insulin dose should be given, versus a smaller dose (or no dose at all)? I can't find a chart anywhere. For example, if he is at 150 or less before feeding, would that be a full dose or a half dose? Is there a chart somewhere that can guide me?
Click to expand...


Post and ask for help if you get a number below 200. The general rules are:

Q4.4. My cat's pre-shot level was way below the usual value. Should I give the injection?

A4.4. There's no hard and fast rule, but if you don't have data on how your cat responds to insulin, here are some general guidelines. Below 150 mg/dl (8.3 mmol/L), don't give insulin. Between 150 and 200 (8.3-11.1 mmol/L), you have three options: a.) give nothing; b.) give a token dose (10-25% of the usual dose); c.) feed as usual, test in a couple of hours, and make a decision based on that value. Above 200 (11.1 mmol/L) but below the cat's normal pre-shot value, a reduced dose might be wise. In all cases, if you are reducing or eliminating insulin, it's wise to check for ketones in the urine. Above the normal pre-shot value, give the usual dose, but if the pre-shot value is consistently elevated, it's a good idea to schedule a full glucose curve to see whether a change in dose or insulin is appropriate. In most cases, the target "peak" value should not be below 100 mg/dl (5.6 mmol/L), and for some cats it might be higher. Keep in mind that these are general guidelines, and they should be personalized to your own cat's reactions to insulin. If your experience is that your cat does not became hypoglycemic with a dose which is close to her usual, then your experience should be your guide.​



SaraMV said:
If I'm not home exactly at the time he should eat (running late), and he gets insulin an hour late, what do I do about his next dose? Can I still give it at 7:30 the next feeding?
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KNOW THY CAT. Shooting early or late is a practice best reserved for those who have a full understanding of the insulin used and it's effects on their kitty. Because of the cumulative nature of glargine and detemir be aware:​
      • Shooting an hour or two early *could* act like a slight dose increase.
      • Shooting an hour or two late *could* act like a slight dose reduction.
      • How your cat will react has a lot to do with what kitty is doing that day. For instance, if a bounce is breaking shooting early probably isn't the best idea because you'll have a little extra action on the dose from both the early shot and the bounce breaking simultaneously.
      • The next shot is due 12 hours after the time of the early or late shot if you're shooting twice a day. Oftentimes the effects of an early or late shot will not be seen until the next cycle. Please monitor carefully when shooting early. Ask for guidance if you're unsure.
If you are late giving a shot, you cannot shot at the next scheduled time. To get back to your scheduled times, you can shoot 15 minutes earlier each shot until you are on schedule again. For example:

8:30pm (late shot)
8:15am (15 minutes early)
8:00pm
7:45am
7:30pm

Some links to where I found all of this information:
FAQs
The Basics: New to the Group? Start here!
Sticky Dosing Methods: Start Low, Go Slow (SLGS) & Tight Regulation (TR)


But most importantly:

Symptoms of & how to treat HYPOGLYCEMIA - what to do if your kitty experiences hypoglycemia
Jojo's Hypo Tool box - be prepared, what to have on hand in case of an emergency
Don't Panic! or How to Handle Low Numbers

Feline diabetes is a steep learning curve but I promise – it becomes second nature very quickly. And the people on the forum can help you every step of the way.

Breathe – it does get easier. :bighug:
 
The only other things I'd add for the pancreatitis are:
  • Appetite stimulant like Mirataz. You give this once the nausea meds have had time to kick in. Many times it helps get them over the hump and eating on their own again
  • Syringes for assist feeding. I usually grab the really cheap 10-20mL ones.
  • Food for assist feeding. I use the Gerber meats baby foods, some people like the Hills A/D food. Basically any food that is low carb, safe for cats, and very smooth (you'd be surprised how much regular pate gets stuck in syringes).
I always keep a spare set of meds and stuff on hand because the pancreatitis usually does recur. And it's much better to have extra meds, fluids, food, syringes, etc to manage at home - because it inevitably flares up on a holiday weekend Saturday at midnight
 
Thank you everyone. I greatly greatly appreciate the help! I updated my signature, I hope that helps.

My normal vet is fitting us in tomorrow afternoon and I believe they have a diabetic course that they'll have us take. If there's any important questions I need to ask, I would really appreciate if you could help me put together a list.

The ER vet called and said that Taz is alert and not showing any signs of discomfort. He's eating well for them, but they're still having problems with his dosing (which she said is normal in the beginning). He has been getting 3 units twice a day. She said that his BG dropped down to 86 mid day yesterday, and today he's 300-400. He has another reading at 4 and then at 7. She didn't sound confident that coming home might be best for him if his numbers are still wonky. She also said that testing BG often at home is a bad idea because it makes cats resent their owners. :(

They are also feeding him and giving him insulin at 10:00. I can't keep this schedule as I'll be at work and sleeping during those times. I don't know how to safely get him to the 7:30 feedings that I need. Would I need to skip a dose?
 
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SaraMV said:
She also said that testing BG often at home is a bad idea because it makes cats resent their owners
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Along with feeding twice a day this is another silly idea. I've even heard it "breaks the bond of trust" between cat and owner, that's absurd. I've been pilling, injecting, force feeding and poking holes in cats for 45 years. They may not enjoy it but they really do know it's for the best and you're not doing it to harm them. My first diabetic was a dream come true, I'd thump the kitchen table and he'd leap up for his shot. Trust comes with intelligence, so much for the idea of cats being stupid compared to dogs. I was deathly afraid of all this at first with visions of the cat hiding behind the furnace and hating me forever, it just isn't true.
Sara, you've come this far without some of the hysterics we see from some new members, you've educated yourself and want what's best for both of you. Diabetes will not ruin your social life or scar either of you emotionally. Eventually it will just become an inconvenience and you'll be a better human being for having done it.
I once had a dental receptionist who after hearing my story told me "Oh sweety, that's when it's time to let them go". I switched dentists.
And never ever be fearful of doubting a vet's advice, they don't all finish at the top of their class.
 
Noah & me (GA) said:
Along with feeding twice a day this is another silly idea. I've even heard it "breaks the bond of trust" between cat and owner, that's absurd. I've been pilling, injecting, force feeding and poking holes in cats for 45 years. They may not enjoy it but they really do know it's for the best and you're not doing it to harm them. My first diabetic was a dream come true, I'd thump the kitchen table and he'd leap up for his shot. Trust comes with intelligence, so much for the idea of cats being stupid compared to dogs. I was deathly afraid of all this at first with visions of the cat hiding behind the furnace and hating me forever, it just isn't true.
Sara, you've come this far without some of the hysterics we see from some new members, you've educated yourself and want what's best for both of you. Diabetes will not ruin your social life or scar either of you emotionally. Eventually it will just become an inconvenience and you'll be a better human being for having done it.
I once had a dental receptionist who after hearing my story told me "Oh sweety, that's when it's time to let them go". I switched dentists.
And never ever be fearful of doubting a vet's advice, they don't all finish at the top of their class.
Click to expand...
I just want to echo everything you said. Look at my spreadsheet - it's a LOT of tests. And I'm not even a testaholic by any means . But guess who still comes running to sit nicely for me when he sees the meter come out? It's overwhelming and there's a learning curve, sure, but eventually everyone settles into the routine and it's no big deal.

I also believe the ER vet knows next to nothing about Lantus. You cannot change the dose willy nilly like that, it's a depot insulin and it takes time (days) for a dose to stabilize and truly see if it's a good dose of not. Nor can you achieve regulation in a span of a few days.

My advice: take him home, tell them you will manage it at home. There's nothing they're doing that you can't do at home, and save some money and stress on your cat (and you). He's already low carb. Get the BG data from the vet, and well help you figure out the dose and how to get back on schedule
 
We just picked Taz up and are on our way home. It's a 90 minute drive for us. He acts tired and is resting in his carrier. I can only imagine how stressful the last four days have been for him. I think I'm going to miss work tomorrow, so that I can monitor him through the night. I'm a helicopter parent when I know the fur kids don't feel well, so I have to remind myself to not bug him too much. He's due for more insulin at 10pm, but I can't tell if he's not feeling well or if he's just resting. I'm terrified the pancreatitis is going to flare back up.

I'm pretty upset with the ER vet's office right now. I asked about sub fluids but the vet said he's well hydrated and giving liquids like that would stress him out more than he already is. I had to badger 3 different employees to get a printout of his records. They kept trying to email it to me. They also didn't give us the discharge records, so I had to go back and request them. I know they gave us cerenia and an antibiotic, but I'm not sure what the third medication is (maybe pain?). It's currently in the front seat (I'm in back with Taz). When they handed me his records, they said they also emailed them to me. I went to the email and it came through really glitchy, so it's a good thing I waited there and had them print them out for me. To make everything even worse, when we dropped Taz off on Monday, we tried to give them his insulin. They told us to take it home. On Tuesday when I talked to them and they said they were going to start him on Lantus, I asked if I should bring his bottle down to them (90 miles away). The lady said it would probably be only about $100 worth. So I didn't. We just got the bill and for the 9 units that they gave him, they charged us $460. I already spent $300 on the bottle I was going to leave there for him on Monday. :banghead:

So $5500 later, I pray that he's on his way to recovery, and that we can avoid the ER! I'll try to get the records posted tonight or tomorrow. I'm not going to give him insulin tonight.
 
SaraMV said:
We just picked Taz up and are on our way home. It's a 90 minute drive for us. He acts tired and is resting in his carrier. I can only imagine how stressful the last four days have been for him. I think I'm going to miss work tomorrow, so that I can monitor him through the night. I'm a helicopter parent when I know the fur kids don't feel well, so I have to remind myself to not bug him too much. He's due for more insulin at 10pm, but I can't tell if he's not feeling well or if he's just resting. I'm terrified the pancreatitis is going to flare back up.

I'm pretty upset with the ER vet's office right now. I asked about sub fluids but the vet said he's well hydrated and giving liquids like that would stress him out more than he already is. I had to badger 3 different employees to get a printout of his records. They kept trying to email it to me. They also didn't give us the discharge records, so I had to go back and request them. I know they gave us cerenia and an antibiotic, but I'm not sure what the third medication is (maybe pain?). It's currently in the front seat (I'm in back with Taz). When they handed me his records, they said they also emailed them to me. I went to the email and it came through really glitchy, so it's a good thing I waited there and had them print them out for me. To make everything even worse, when we dropped Taz off on Monday, we tried to give them his insulin. They told us to take it home. On Tuesday when I talked to them and they said they were going to start him on Lantus, I asked if I should bring his bottle down to them (90 miles away). The lady said it would probably be only about $100 worth. So I didn't. We just got the bill and for the 9 units that they gave him, they charged us $460. I already spent $300 on the bottle I was going to leave there for him on Monday. :banghead:

So $5500 later, I pray that he's on his way to recovery, and that we can avoid the ER! I'll try to get the records posted tonight or tomorrow. I'm not going to give him insulin tonight.
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Hi sarah! FrostD gave a lot of great advice! She chimed in to help my guy Lando with his Pancreatitis battle. Sending lots of encouragement and well wishes Taz and your way. Im happy to share what worked for Lando ( but the more experienced members know the score)!! BTW Lando responded wellto cerenia but i had to put the half pills in a size 5 empty gel cap since the taste made his mouth foam and drool). Maybe the pain med is Buprinex? That worked well for Lando.
Well wishes
 
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