? Raven 12/22 AMPS 361 +2 355 +3 335 +4 333 +6 337 +7 327 +10 290 +12 348 - should I shoot?

SophieFRA

SophieFRA

Member
Hi all,

my foster cat Raven has had a high spell of BG numbers recently due to a skin infection he was fighting (which externally looks pretty cleared up) and medication he’s been taking in response since Dec 10.

I just walked into his room and there were 4 different puddles of puke. I suspect something was off wit h the raw rabbit food I fed him. It smelled a little stronger (different brand since my normal delivery didn’t make it in time). He has a very sensitive stomach and occasionally throws up if his food doesn’t agree with him (he has IBD). This morning he is very weak and won’t eat. I got him to drink a little water mixed with fortiflora.

I have not given him his antibiotics which should be given with food, nor his shot since he’s not eating. However his AMPS is very high. For reference when I first got him from a shelter almost 2 years ago his BG was over 500 and he was acting fine. No seizures etc. Since then I’ve gotten him down on green numbers only with occasional blues on a stable dose of 2.25. In response to his recent high numbers I have increased dose to 2.75.

My instinct is to skip his morning insulin (or at least defer until I get him to eat). He has IBD and is on novel protein diet so options to feed him broths etc are limited.

I do have some old Cerenia and Mirtazapine from my foster org. I’ve had it in my drawer fir at least a year, probably longer. So not sure if it would be worth trying that. Doesn’t have expiration date since it’s just a couple of pills they gave me.

Thanks for your help.
https://docs.google.com/spreadsheets/d/1pw2gozDXz_UhGSs897ptj3iAeUPqD-dGnxrcCwXgfWg/edit

The oral meds he’s taking are Clavicillin and APoquel twice daily as well as topical Animax once a day.
 
Bandit's Mom said:
Has he eaten since? Does he have a history of DKA? Can you syringe feed him?

Link to previous post:
https://www.felinediabetes.com/FDMB...mps-315-numbers-high-due-to-infection.296711/
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Thanks for your response. He hasn’t eaten or drunk anything since. No history of DKA. Just retook BG reading and unchanged (361). I just used my ketone meter (which I got back from someone I loaned it to) and detected 0.6. I know they’re not very reliable/applicable to cats, but previously I always got 0.2 when I tried it. I will try using a ketone test strip if he pees - though he is probably quite dehydrated. I could try syringe feeding. Have never had to do that and struggling to think what I could fit into a syringe. I’m coming up on two hours past usual shot time at 9:15 EST so not sure if it is too late to give insulin even of I get him to eat now?
 
SophieFRA said:
Thanks for your response. He hasn’t eaten or drunk anything since. No history of DKA. Just retook BG reading and unchanged (361). I just used my ketone meter (which I got back from someone I loaned it to) and detected 0.6. I know they’re not very reliable/applicable to cats, but previously I always got 0.2 when I tried it. I will try using a ketone test strip if he pees - though he is probably quite dehydrated. I could try syringe feeding. Have never had to do that and struggling to think what I could fit into a syringe. I’m coming up on two hours past usual shot time at 9:15 EST so not sure if it is too late to give insulin even of I get him to eat now?
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Update: I’m getting him to eat a little of his MC food (instinct Liminted Ingredient rabbit). Realize that MC is not what the doctor ordered but he wouldn’t touch any of his low carb food. Should I give him shot and just move evening shot back?
 
Update: I gave him his shot after I got him to eat a little MC food. I also just gave him a little inaba churu (which is nit usually on his diet due to IBD) and he loved that. And I gave him his antibiotic and chased it with Churu. I give him a little on occasion and haven’t noticed any bad side effects. So I’m hoping he’ll keep it down. I’ve noticed in the past that after he throws up he doesn’t like eating his usual diet because he associates it with being sick.
 
Bandit's Mom said:
You could try giving him the Cerenia. I guess you don't have any Ondansetron or Famotidine?
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I just gave him the cerenia. I found a package that was not expired in my hypo toolbox. Forgot I put it in there and not with my other meds. And I gave him a quarter pill of Pepcid. He now hates me and is still not eating food. Hoping this will help settle his stomach and allow him to eat.

I remeasured blood glucose (now 355) and ketones (now 0.5) with meters
 
Just wanted to provide an update. Someone from my foster org just came by and administered some subq fluids since Raven seemed quite dehydrated. I have not been able to get him to eat anything other than a few licks of Inaba churu and a few licks of canned rabbit food. But his Bg has remained high and stable. I have also measured his ketones throughout the day (via meter since he hasn’t peed) and they’ve gone down from 0.6 initially to 0.4. I did syringe feed him a little water and I am considering syringe feeding him food this evening if he doesn’t eat soon.

what are your recommendations for giving insulin tonight @Bandit's Mom and others? I will probably skip his antibiotics since they’re tough on the stomach, he threw them up this morning and he’s taken them for 11 days (was prescribed 14). His skin infection has healed as far as visible.

Thanks so much!
 
Any chance you could get him some probiotics? Not Fortiflora, but something more along the human line like Renew Ultimate with L. acidophilus in it. Just a thought for what you can get quickly. For IBD kitties (which I have), Visbiome is a good product. Give the probiotic a couple hours apart from the antibiotic. Start with a low dose and work your way up.

The downside of antibiotics is that it does kill the good flora too.

I'm a little worried that with the infection going away (which could have meant he needed more insulin), and no mid cycle testing, that his dose is too high. He should only have been increased to 2.5 units.
 
Wendy&Neko said:
Any chance you could get him some probiotics? Not Fortiflora, but something more along the human line like Renew Ultimate with L. acidophilus in it. Just a thought for what you can get quickly. For IBD kitties (which I have), Visbiome is a good product. Give the probiotic a couple hours apart from the antibiotic. Start with a low dose and work your way up.

The downside of antibiotics is that it does kill the good flora too.

I'm a little worried that with the infection going away (which could have meant he needed more insulin), and no mid cycle testing, that his dose is too high. He should only have been increased to 2.5 units.
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I have been testing all day. The numbers are in his spreadsheet. The lowest he’s dropped to is 290 - despite not eating food. That does not seem to track with too high a dose, does it?

I just syringe fed him 8 ml of his MC food mixed with water an hour ago and another syringe just now. It’s barely any food (around 1.5 teaspoons), but he kept the first syringe down and fingers crossed for the second. It’s time for his insulin. Should I administer it? He’s at 348 PMPS.

I can mix a probiotic into the next syringe meal but I really don’t want to give him the antibiotic. His skin infection seems healed. I have Proviable. Not sure if that would fit the bill.
 
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Are you familiar with the concept of bouncing? Here is the definition:
Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).

Basically, you can't tell how low the dose is taking a cat by looking at just one cycle. It's possible he went lower at another cycle and what you are seeing is numbers from a bounce.

The probiotic should help him. If you think you can monitor and keep giving him some syringes of food, you can shoot.
 
Wendy&Neko said:
Are you familiar with the concept of bouncing? Here is the definition:
Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).

Basically, you can't tell how low the dose is taking a cat by looking at just one cycle. It's possible he went lower at another cycle and what you are seeing is numbers from a bounce.

The probiotic should help him. If you think you can monitor and keep giving him some syringes of food, you can shoot.
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Ok. Thank you! I will adjust dose to 2.5 then.

And how often would you suggest syringe feeding him food? Thank you!
 
First question, how many calories per day should he get? And how much does he get per feeding? I'd do syringe sessions couple hours apart.

I see he's coming down, but slowly. That's good.
 
Yes, unfortunately during our last syringe feeding session he ended up peeing on the bed while we were holding him to feed.

I’m going to go to bed now to sleep 1.5 hours. Then I’ll feed again unless he’s eating on his own. I set him up in my bedroom with me and he just started drinking from the fountain on his own. I think that’s a good sign. He has been doing nothing but lying down and looking miserable today. So anything he does out of his own volition seems like a great improvement.

Well he’s 18lbs and overweight. I usually feed him every 3 hours (1.5 teaspoon of raw meat). I need to lower his food intake generally. He’s not getting as many calories today. That’s just too difficult to do with syringe. It’s a struggoe to get anything into him. But I figure some calories are better than nothing. I left his raw freezedried kibble out for him in case he feels up to eat on his own again.
 
When Neko went off her food, I tried to give her raw by syringe, even ones with bigger tips. It wasn't easy. I ended up moving to canned food which was so much easier to blend with water and get something I could get in her. The good news was that once I got a little food in her, it "primed the pump" and she'd often start eating more on her own. I guess the food settled her tummy.
 
Wendy&Neko said:
When Neko went off her food, I tried to give her raw by syringe, even ones with bigger tips. It wasn't easy. I ended up moving to canned food which was so much easier to blend with water and get something I could get in her. The good news was that once I got a little food in her, it "primed the pump" and she'd often start eating more on her own. I guess the food settled her tummy.
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I hope that will be the case with him. The fact that he’s drinking gives me hope. Thanks so much for your advice!
 
Just wanted to update everyone - especially @Wendy&Neko and @Bandit's Mom that I dropped Raven at the vet this morning so they can run comprehensive tests/give fluids. He did not start eating on his own and I was getting worried that there might be another underlying issue. His numbers never dropped though and he stayed in the low 300s through this morning. He hated being syringe fed and a lot ended up on the towel/floor etc, but he did not throw up again and he drank from his fountain throughout the night.
 
Wendy&Neko said:
Are they going to run the test for pancreatitis? I hope the vet can find answers.:bighug:
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Sadly he has acute pancreatitis and stage 4 kidney disease. Had bloodwork done in July and then kidneys were perfect. I’m heartbroken for him, but not willing to give up on him. He‘s being transferred to the Pet ER and they‘re giving him a little more than 50% chance of survival. Please keep my buddy in your thoughts. I love him so much. I know he can do this! I hate that he‘ll be without me, but he‘s on pain meds and gabapentin. I hope he won‘t suffer too much!
 
SophieFRA said:
Sadly he has acute pancreatitis and stage 4 kidney disease. Had bloodwork done in July and then kidneys were perfect. I’m heartbroken for him, but not willing to give up on him. He‘s being transferred to the Pet ER and they‘re giving him a little more than 50% chance of survival. Please keep my buddy in your thoughts. I love him so much. I know he can do this! I hate that he‘ll be without me, but he‘s on pain meds and gabapentin. I hope he won‘t suffer too much!
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I should clarify, not necessarily stage 4 kidney disease (which vet said would be unlikely given that he had perfect kidney values in July) but values in blood work that correspond to stage 4 but are likely exacerbated by severe dehydration. We‘re at ER now with Raven.
 
:bighug::bighug::bighug::bighug: Sending tons of healing thoughts your way for Raven. See if the vet thinks it might be a kidney infection - that can make kidney numbers look much worse too.
 
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Wendy&Neko said:
:bighug::bighug::bighug::bighug: Sending tons of healing thoughts your way for Raven. See if the vet thinks it might be a kidney infection - that can make kidney numbers look much worse too.
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Thanks so much for your healing thoughts! Unfortunately, Raven’s blood work this morning showed declining kidney values showing both kidneys operating at only 25%. On the upside his BG and liver values were significantly improved with liver almost normal. They are doing an ultrasound today in the early afternoon. The worst case they were trying to prepare us for would be renal lymphoma. But it could be an infection too. He’s already taking antibiotics for that case. I’m really hoping it’s not lymphoma because the prospects seem very grim. Of course I assume infection could also be fatal if kidneys keep declining. Please keep him in your thoughts. We love him so much and it breaks my heart to know he’s suffering.[/QUOTE]
 
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