05/08 Bubba (skipped AM dose); +23/PMPS 171 (PM 1/2 dose); +2.5 169; +4.5 157; +8 142

bubbasmom (GA)

bubbasmom (GA)

Member Since 2022
Yesterday

Bubba is 3.6 / 65 this morning. Last night before bed he was 4.1 / 74 at +7 - he didn’t want to eat a snack last night either.

This morning he’s still disinterested in food.
Since he is 3.6 / 65 and I have to work today (parents will be home to monitor though), @Wendy&Neko I guess I will give Bubba 3.25U instead of his newly reduced dose of 6.5U?
Does that sound reasonable…?
 
Bandit's Mom said:
You could also skip to drain the depot if monitoring is an issue. He will recover.
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thanks Bhooma. He’s so “low” that I also wouldn’t be too worried if he didn’t get his AM dose. My focus right now is to get this boy to eat! Waiting a follow up email with his vet to get a bupe Rx. He had a follow up appt this Thursday anyways.

I think he’s just really sore from his OA. He was walking pretty low on his hocks last night .. complete 180 from Friday and Saturday
 
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I skipped Bubba's dose this morning...

I was debating to give half a dose of 3.25U considering his low AMPS and lack of appetite (he ate via spoon feeding by my mom at first, then eventually nibbled some breakfast from his bowl on his own a short while later). If Bubba ate at his usual rate/amount, I would have given the 3.25U.
 
Even without insulin this morning, Bubba is still holding his sugars / numbers pretty well.
He ate some steamed salmon. Didn’t finish his breakfast/raw though.
I sent his vet a video of Bubba walking last night and she said he definitely has diabetic neuropathy :( :( He’s been walking lower than usual. I was hoping it was his osteoarthritis maybe, but I guess his sugars were so high for so long (about 3 months before I started lantus) and then slowly increasing his dose to get better numbers. Thankfully he stopped seeing lots of reds and pinks in late Feb but I suppose the damage was already done. He’s been on vitamin B12 / methylcobalamin shortly after his Dx last September. Trying not to feel like I’m failing my boy. What an insidious disease. :(:arghh:
 
Skip is fine, given how he is. Better be rid of larger depot. How is his hydration? Pancreatitis treatment means anti nausea, pain meds, and fluids if needed. I am assuming p’titis, even if the vet doesn’t. One other possibility is heart. What is his RR (resting respiration rate)? Better check that before fluids.
 
Wendy&Neko said:
Skip is fine, given how he is. Better be rid of larger depot. How is his hydration? Pancreatitis treatment means anti nausea, pain meds, and fluids if needed. I am assuming p’titis, even if the vet doesn’t. One other possibility is heart. What is his RR (resting respiration rate)? Better check that before fluids.
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Thanks Wendy I’m glad I skip this morning since his sugars were at 3.6 and are still within the three range a few hours later. His hydration is pretty good. It’s definitely decreased since his sugars have gotten better the past couple of weeks he doesn’t drink as often, but when he does drink, he usually chugs his water lol. I haven’t counted his resp rate recently, but he doesn’t seem to be breathing faster. I’ll check it tonight.
 
Wendy&Neko said:
Also, what was his most recent potassium number? And how long ago. Another contributor to wobbly walk.
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In February his potassium was low at 3.1 then he was on Thera K for about two months. In March it was 3.9 and in April it was 4.0. In April, His vet decided to discontinue the Thera K since his potassium levels were within range we’re going to do more bloodwork on Thursday, so at that time we will obviously recheck with the levels are and if he needs to be reinstated on Thera K
 
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Wendy&Neko said:
Skip is fine, given how he is. Better be rid of larger depot. How is his hydration? Pancreatitis treatment means anti nausea, pain meds, and fluids if needed. I am assuming p’titis, even if the vet doesn’t. One other possibility is heart. What is his RR (resting respiration rate)? Better check that before fluids.
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in September when bubba was diagnosed with diabetes The vet said his heart was a little bit larger I think from an x-ray, but there is no heart murmur detected. Initially they thought there’s something going on with his heart and if he had congestive heart failure because at the time he was peeing everywhere and we weren’t sure what was going on but then he was diagnosed with diabetes and we found out his sugars were 25 MMOL. I can follow up with his vet this Thursday regarding his heart. If she thinks there could be any issues, especially since his hypertension was still quite high even on a half tablet of amlodipine, which I think was 0.625 mg now he’s on 1.5. I have to double check when I get home.
 
@Wendy&Neko @Bandit's Mom or anyone else?

any advice on providing comfort / supportive care for diabetic neuropathy?
Bubba is on 5000mcg methylcobalamin
I did have him on 50mg of gaba twice a day (mixed with food) for a short while in February - but as soon as we started it, he started having pp accidents so I discontinued it and the issues stopped. Perhaps I should restart? perhaps at 25mg (I will consult with vet as well).
 
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Bubba still holding pretty steady today with his sugars.
He's been resting, unfortunately still not as hungry today.
 
I just got home from work... and Bubba still hasn't eaten much food today. He last ate around 6hrs ago and that was steamed fish. Just now I tried to spoon feed him some slurry (raw + MC + supplements) and he kept turning his head away :(

@Wendy&Neko @Bandit's Mom ... Bubba's dose would be due in approx 30-45minutes. Since he hasn't eaten, but his sugars are 9.5mmol / 171 - should I give his full dose (6.5U) or half dose (3.25U)? I'm thinking perhaps the latter simply due to his continued inappetence and since his sugars have been pretty good today considering he hasn't had any insulin in nearly 24 hours. If anyone else has any suggestions or recommendations, I am all ears. Thank you!

I got some more Cerenia from his vet and gave a tablet about 20 minutes ago.
Tomorrow I am going to the compound pharmacy and will drop off his Rx for bupe.
 
I just finished syringe feeding Bubba some raw + MC + supplements + gaba 25mg (going to retry gaba to help with neuropathic pain).
 
Ok so I gave Bubba 3.25U - half of what would be his current dose of 6.5U. I feel comfortable giving him that since his depot from 24hours ago has probably drained, his sugars were 9.5mmol / 171 and I syringe fed him some dinner (so he at least has some food in his system and medium carb at that).
 
Sorry I wasn't around earlier. Just got online.

bubbasmom said:
any advice on providing comfort / supportive care for diabetic neuropathy?
Bubba is on 5000mcg methylcobalamin
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It's just methyl-B12 and BG regulation. Neuropathy can take some time to resolve. Bandit's took almost 6 months. Glad you are getting labs done so we know if there is anything else causing the neuropathy. Even high levels of phosphorus can affect gait.


bubbasmom said:
I got some more Cerenia from his vet and gave a tablet about 20 minutes ago.
Tomorrow I am going to the compound pharmacy and will drop off his Rx for bupe.
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Did the vet not want to prescribe Ondansetron? If he is nauseous, he might not want to eat and Ondansetron sometimes works better for nausea. The bupe should help with any pain :bighug:
 
Those larger depots can influence 4-6 cycles after a reduction, more with the larger dose. A smaller dose today was OK, he will get back on track. And you might get some sleep tonight.

I second Bhooma on the ondansetron. I find it way better than Cerenia on helping with nausea. Gaba dose might need to go up, but hopefully this will at least help, and the bupe even more so.

To test hydration, lift his scruff and see if it snaps back into place quickly (good) or slowly. And you can check his gums to see if they are slick (good) or tacky.

Any luck with the RR?

Neko never had neuropathy, just bad arthrisis, so she wasn't down on her hocks. So I can't say anymore than what Bhooma did already.
 
Bandit's Mom said:
Sorry I wasn't around earlier. Just got online.


It's just methyl-B12 and BG regulation. Neuropathy can take some time to resolve. Bandit's took almost 6 months. Glad you are getting labs done so we know if there is anything else causing the neuropathy. Even high levels of phosphorus can affect gait.



Did the vet not want to prescribe Ondansetron? If he is nauseous, he might not want to eat and Ondansetron sometimes works better for nausea. The bupe should help with any pain :bighug:
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That's okay! Thanks for replying back to me.

I'm just surprised that since Bubba has been having good BG numbers lately, that all of a sudden his back legs got worse :( A short time ago, when he stepped down from his sleeping platform (its less than 6 inches off the floor), he stepped down with his front paws, then I guess his back legs were so weak that he stumbled on the floor :( I just missed seeing it, but my dad did. Then Bubba just laid on the floor till I picked him up right after it happened - I took him to his box to have a pp. He was able to walk a little bit afterwards, but still quite low down and step back onto the platform on his own. He's currently napping on his platform on my heating pad.

My vet said she found cerenia to work better - based on Bubba's presentation. Should Cerenia not help the next two days, I will bring up ondansetron again on Thursday at the follow-up appt as another option.
 
Wendy&Neko said:
Those larger depots can influence 4-6 cycles after a reduction, more with the larger dose. A smaller dose today was OK, he will get back on track. And you might get some sleep tonight.

I second Bhooma on the ondansetron. I find it way better than Cerenia on helping with nausea. Gaba dose might need to go up, but hopefully this will at least help, and the bupe even more so.

To test hydration, lift his scruff and see if it snaps back into place quickly (good) or slowly. And you can check his gums to see if they are slick (good) or tacky.

Any luck with the RR?

Neko never had neuropathy, just bad arthrisis, so she wasn't down on her hocks. So I can't say anymore than what Bhooma did already.
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Thanks Wendy. Yeah, I've got 50mg capsules of gaba that I sprinkle into Bubba's food. I can re-start with 50mg tmrw morning.
Bubba's resps were 21 resps over 1 minute - average from 3 tests.
 
Also @Wendy&Neko .... can the current dose a cat is on suddenly become "too much"? and reductions either happen more frequently (say if for example, a cat continues to experience limes at every new reduced dose) or the reductions are larger (ie. more than 0.5U at a time)?

If that makes sense?
 
I think the 25mg of gabapentin I gave Bubba approx 3 hours ago is making him fly to the moon... poor thing looks spaced out and ready to launch lol
Thankfully Bubba ate a tid bit of MC via spoon, plus licked on a freeze dried nugget (about a 1/4 of it) Haha!
 
A lot of vets like Cerenia better. It is better for vomiting. For nausea without vomit, ondansetron is better, in my experience. Also, there are a lot of vets not as familiar with ondansetron in cats.

bubbasmom said:
can the current dose a cat is on suddenly become "too much"? and reductions either happen more frequently (say if for example, a cat continues to experience limes at every new reduced dose) or the reductions are larger (ie. more than 0.5U at a time)?
Click to expand...
ECID - every cat is different. The answer depends on many things. One being, what caused the diabetes and is that a condition that has reversed itself, or has been treated. There is also glucose toxicity. Once cats break through the toxicity, there is typically a period of time where the dose falls quickly for some time. There are also medical reasons kitty may not need as much insulin, too many to list.

For example, I've seen some cats with acromegaly, with successful treatments that caused a huge and fast drop in dose needed. For example, Mr. Kitty started cabergoline to treat his acromegaly on July 1, 2021 on 13 units of Levemir. His last dose was July 11, 2021. See SS here. That's an extreme example, I know of another similar, Marvin, first kitty here on cabergoline. In those two cases, the cats went into remission quickly and both more frequent reductions and larger ones. I've also seen kitties transition away from dry food (known or unknown access) have dramatic insulin needs reduced. There isn't really a one size fits all answer. I've also seen cats scream down the dosing ladder for a while, then stall out and have to go back up. It really is ECID.
 
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