Help Need Advice Dropping fast 1-15 Picchu his AMPS #260,now 57

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lantuslantus1234

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I am sorry if this is considered multiple posts. We are trying to figure out our way through this with Picchu, our 16 year old cat. We are really stressed out and wondering if this is the end or just meant to be this tough.

Picchou was diganosed last week, BG was in the 500, lots of water consumption. Started insuline (prozinc) on Tuesday and proceeded to go DKA that same day (vomitted all day), admitted to ER for 2 nights. Diagnosed with pancreatitis, abnormal liver function, they also found a heteregeonous mass in his liver. When he got discharged Thursday, he was on Lantus 1UI along with Cernia antinausea and got a antibiotic shot for a precation in case of UTI. His BG was around 350, but was much higher on Friday. We upped his dose to 1,5 UI Friday as hail mary (with vet advice).
His numbers seemed to be getting better but his digestion has been off. He stopped eating Sunday night after his Cernia anti nausea meds. He had slowed down his water consumption that day and not had a bowel movement in 36 hours. He was clearly not well, roaming confused, trying to find comfort, meowing loudly for the first time in a week, looking to hide, licking plastics. He finally passed a stool, then diarrhea, and then some urine. Ketones came back as trace.
He finally calmed down and rested. We had to skip insuline that night based on vet advice. He started eating again in the middle of the night and being thirsty again. Levels were >400 again all night (no insuline). This morning, he was very thirsty, took a bit of convincing but he hate some 1.5 oz fancy feast classic wet food with a bisque topper and very few kibbles (purina DM). He got his shot. Within a couple hours he dropped back to 380. He seemed a bit better in the morning but then he started camping out in the shower, he just seems off.

I dont want to make rash decisions but I am worried he is unwell and in pain, I keep hoping this was a bad reaction to the antinausea med but vet says it is not in line with bad reactions to the meds. At best ,the most we have succeeded to get him to eat since discharged was about 120-130 calories a day (2/3 of a 3 oz can per meal, most often just about 1/2, plus whatever calories the treat we add to it for him to eat adds/and or the few DM kibble we add to get him to have enough cal for the shot). Most likely closer to 100 calories. I am worried he is not eating enough. The lowest is BG got was 228 this weekend which seemed like a win. but he just does not seem like himself. I dont want him to suffer. Is this part of the "normal" process at the beginning or is he just struggling more than average? He was free feeding 100% IAMS proactive Senior kibble before being hospitalized so these are big changes for him, and we try to be conscious of that too. I had noticed that he did not eat very much for a while before getting diagnosed. The feeder was full for much longer than usual.

I will try to test his ketones today again.
 
lantuslantus1234 said:
I am sorry if this is considered multiple posts. We are trying to figure out our way through this with Picchu, our 16 year old cat. We are really stressed out and wondering if this is the end or just meant to be this tough.

Picchou was diganosed last week, BG was in the 500, lots of water consumption. Started insuline (prozinc) on Tuesday and proceeded to go DKA that same day (vomitted all day), admitted to ER for 2 nights. Diagnosed with pancreatitis, abnormal liver function, they also found a heteregeonous mass in his liver. When he got discharged Thursday, he was on Lantus 1UI along with Cernia antinausea and got a antibiotic shot for a precation in case of UTI. His BG was around 350, but was much higher on Friday. We upped his dose to 1,5 UI Friday as hail mary (with vet advice).
His numbers seemed to be getting better but his digestion has been off. He stopped eating Sunday night after his Cernia anti nausea meds. He had slowed down his water consumption that day and not had a bowel movement in 36 hours. He was clearly not well, roaming confused, trying to find comfort, meowing loudly for the first time in a week, looking to hide, licking plastics. He finally passed a stool, then diarrhea, and then some urine. Ketones came back as trace.
He finally calmed down and rested. We had to skip insuline that night based on vet advice. He started eating again in the middle of the night and being thirsty again. Levels were >400 again all night (no insuline). This morning, he was very thirsty, took a bit of convincing but he hate some 1.5 oz fancy feast classic wet food with a bisque topper and very few kibbles (purina DM). He got his shot. Within a couple hours he dropped back to 380. He seemed a bit better in the morning but then he started camping out in the shower, he just seems off.

I dont want to make rash decisions but I am worried he is unwell and in pain, I keep hoping this was a bad reaction to the antinausea med but vet says it is not in line with bad reactions to the meds. At best ,the most we have succeeded to get him to eat since discharged was about 120-130 calories a day (2/3 of a 3 oz can per meal, most often just about 1/2, plus whatever calories the treat we add to it for him to eat adds/and or the few DM kibble we add to get him to have enough cal for the shot). Most likely closer to 100 calories. I am worried he is not eating enough. The lowest is BG got was 228 this weekend which seemed like a win. but he just does not seem like himself. I dont want him to suffer. Is this part of the "normal" process at the beginning or is he just struggling more than average? He was free feeding 100% IAMS proactive Senior kibble before being hospitalized so these are big changes for him, and we try to be conscious of that too. I had noticed that he did not eat very much for a while before getting diagnosed. The feeder was full for much longer than usual.

I will try to test his ketones today again.
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@Wendy&Neko
@Sienne and Gabby (GA)
@Bron and Sheba (GA)
@Bandit's Mom
@Suzanne & Darcy

@lantuslantus1234
When you test for ketones can you put what they are in the remarks section on your spreadsheet

Please remove the GA from your title, it means a kitty has passed Guardian Angel
 
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@lantuslantus1234
I see on your spreadsheet that Picchu has been eating kibble, you need to add that to your signature please . Have you read about the 2 dosing methods to choose from , each one will tell you when an increase or decrease is needed.
If you must feed any kibble you would have to follow the SLGS method. If you cut out the kibble you could probably switch to the TR method so you can increase the dose sooner , his numbers are high
I'll give you the link

https://felinediabetes.com/FDMB/thr...-low-go-slow-slgs-tight-regulation-tr.210110/

Please add it to your signature and spreadsheet up top

What do you mean when you said on your signature
FancyFeast wet (to be changed soon)?
I see you added SLGS to your signature , can you please add it to your spreadsheet also up top where it asks you
 
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There is a lot to learn in the beginning, but we all remember what it was like so are here to help.

See if you can get ondansetron prescription from the vet. It's a better drug for nausea. Is he getting any pain meds? Pancreatitis is incredibly painful and that may be stopping him from eating too.

What food was he eating before diagnosis? With recent DKA, we just need him to eat, even if it's not the best food for his diabetes.
 
Wendy&Neko said:
There is a lot to learn in the beginning, but we all remember what it was like so are here to help.

See if you can get ondansetron prescription from the vet. It's a better drug for nausea. Is he getting any pain meds? Pancreatitis is incredibly painful and that may be stopping him from eating too.

What food was he eating before diagnosis? With recent DKA, we just need him to eat, even if it's not the best food for his diabetes.
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@Wendy&Neko

Hi Wendy you know I'm no expert , if She stops feeding the kibble would it be better for her to do TR since his numbers are so high.
I gave her the link for the dosing methods and told her since she's feeding kibble she would have to follow SLGS
 
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hi, I think I have a prescription for Ondansetron from our discharge paperwork, although I am worried about giving him anything else given how poorly he takes pilling and how he reacted last night. Food wise: He was transitioning from Purina One + high protein to IAMs Proactive Senior before the diagnoses (over the last couple of months). Although as of last year and for the last 6-7 years prior he was on vetenirary urinary food (royal canin and pro plan I think) because his sister had some urinary issues and they were fed together.
He was getting gabapentin while being hopsitalized (mostly for "behavioral issues" according to the hospital, which tells you how much tough a time he was having there) and we do have gabapentin on hand but have been told it is not needed right now (I will ask again my vet). It is also hard because it makes him zone out a bit and that gets hard to differenciate with hypo symptoms.
I do want to note that while he was in the 500 when he first got tested, the meter I have stop at 400 (our Libre3 dont go higher than that, and just note HI). We have reasons to believe that he has been hovering in the 400s when on HI but the spreadsheet does not allow for that.
I just know my kitty does not seem like himself. I have followed the food advice not to free feed so we can get him to eat 1/2 can at shot time. The vet tells us we cant inject him if he does not eat at least that. He is hovering between sleeping a ton/being out of it and going to the shower for water, then not even reacting when being provided the water (although sometimes he seems more alert and drinks a lot at once). he now refuses to drink from his fountain or any water bowl.
 
Don't worry about your cat eating half a can before the shot. It is OK if he grazes. The Lantus doesn't kick in until a couple hours after the shot so you have time for him to eat a good amount. With history of DKA, it's very important that you not miss shots.

You can get ondanseton as an injectable format, though I've heard it might sting. Not used it myself.

All of the dry foods you mention are too high in carbs.
 
Thanks, Right now, the only kibble I gave him is the Pro Plan DM vet diet and that is as an add on if he does not eat enough (maybe 10 kibbles a day, 1/16 of cup at most)
 
quik question: when the doc states he HAS to eat a meal before the shot is that because they are worried about him going hypo? At level >400, is that really a risk? It sounds like what you are saying is, as long as he is eating some we should keep going steady to get his levels down.
 
lantuslantus1234 said:
We are really stressed out and wondering if this is the end or just meant to be this tough.
Click to expand...
I am sorry you and Picchu are struggling at the moment. After DKA some cats can struggle to start eating again, and if he is in any pain from pancreatitis, this is only exacerbated…
This should not be the end. Picchu has had an acute illness and is going to need time and care to get over it. Some cats recover quickly but many have bumps along the way especially if they are nauseated and can’t eat much. Your main aim at the moment is to sort out the nausea and pain issues to make it easier for him to eat and feel better and to keep giving insulin doses and not skipping them.

I agree with Wendy…try giving him the ondansetron and see if that helps the nausea. You can give it 3 or 4 times a day and ondansetron can be given at the same time as the cerenia as they work on different pathways.
I would also look at some pain meds in case the pancreatitis is causing pain. As long as you are testing the BGs you can see if he is dropping lower and you will be able to tell is the gabapentin causing the drowsiness. You could maybe give a smaller dose. But I would address the issue.

Picchu really does need to be eating a lot more food. Remember he needs to be eating 1 and 1/2 times as many calories as normal to combat the ketones. Food and insulin are what keeps ketones at bay.
Do you think he would eat his old food? If he will eat that, let him have that because eating any food at the moment is more important than what it is he is eating. We can worry about low carb food once he is a bit better.

I would also ask the vet about subQ fluids which you could give at home.
 
Thank you everyone for your support. Yesterday went better thanks to your advice. I am feeding him more and with the vet's approval, providing more options including kibbles to make sure he gets enough calories/food. Yesterday he was VERY lethargic, today he is already doing better, being more alert and moving a bit more. So the food intake seems to work. He still seems to have digestive issues with the new wet food (burping, and very reduced bowel movements). Tested ketones again last night and he is showing Traces, same as Sunday so I take that as a win, nothing got worse. (he sure was looking like he was) We got the ondansetron, but I am waiting another day to give that to not introduce so many variables that I dont know what is going on. Note: walgreens is the worst priced for these, and the ER vet prescribed a 1/2 pill 8mg version that was $150 vs the 4mg that was $40. They would not budget so we had to get 5 pills for $35. This is insane.
The vet is discussing increasing his insuline dose again if he is feeling ok, I am not yet ready since we increased on Friday already but will try to read more on the different protocols, particularly SLGS. I am really concerned that the change in litter use is a sign of something real bad.
 
Try Costco for ondansetron. You paid even more than we pay in Canada where it's really high priced. I typically get the 4 mg pills.
 
I ordered the Dr Elsey kibbles but my spouse is very nervous because apparently he fed a sample of duck kibbles from this brand, which is when Picchu started vomitted all day before being hospitalized. I am assuming it is not related but that may not be something we want to attempt right now.
 
lantuslantus1234 said:
I ordered the Dr Elsey kibbles but my spouse is very nervous because apparently he fed a sample of duck kibbles from this brand, which is when Picchu started vomitted all day before being hospitalized. I am assuming it is not related but that may not be something we want to attempt right now.
Click to expand...
So sorry that happened , then I would wait also :cat:
I have only fed the chicken flavor
 
lantuslantus1234 said:
I am sorry if this is considered multiple posts. We are trying to figure out our way through this with Picchu, our 16 year old cat. We are really stressed out and wondering if this is the end or just meant to be this tough.

Picchou was diganosed last week, BG was in the 500, lots of water consumption. Started insuline (prozinc) on Tuesday and proceeded to go DKA that same day (vomitted all day), admitted to ER for 2 nights. Diagnosed with pancreatitis, abnormal liver function, they also found a heteregeonous mass in his liver. When he got discharged Thursday, he was on Lantus 1UI along with Cernia antinausea and got a antibiotic shot for a precation in case of UTI. His BG was around 350, but was much higher on Friday. We upped his dose to 1,5 UI Friday as hail mary (with vet advice).
His numbers seemed to be getting better but his digestion has been off. He stopped eating Sunday night after his Cernia anti nausea meds. He had slowed down his water consumption that day and not had a bowel movement in 36 hours. He was clearly not well, roaming confused, trying to find comfort, meowing loudly for the first time in a week, looking to hide, licking plastics. He finally passed a stool, then diarrhea, and then some urine. Ketones came back as trace.
He finally calmed down and rested. We had to skip insuline that night based on vet advice. He started eating again in the middle of the night and being thirsty again. Levels were >400 again all night (no insuline). This morning, he was very thirsty, took a bit of convincing but he hate some 1.5 oz fancy feast classic wet food with a bisque topper and very few kibbles (purina DM). He got his shot. Within a couple hours he dropped back to 380. He seemed a bit better in the morning but then he started camping out in the shower, he just seems off.

I dont want to make rash decisions but I am worried he is unwell and in pain, I keep hoping this was a bad reaction to the antinausea med but vet says it is not in line with bad reactions to the meds. At best ,the most we have succeeded to get him to eat since discharged was about 120-130 calories a day (2/3 of a 3 oz can per meal, most often just about 1/2, plus whatever calories the treat we add to it for him to eat adds/and or the few DM kibble we add to get him to have enough cal for the shot). Most likely closer to 100 calories. I am worried he is not eating enough. The lowest is BG got was 228 this weekend which seemed like a win. but he just does not seem like himself. I dont want him to suffer. Is this part of the "normal" process at the beginning or is he just struggling more than average? He was free feeding 100% IAMS proactive Senior kibble before being hospitalized so these are big changes for him, and we try to be conscious of that too. I had noticed that he did not eat very much for a while before getting diagnosed. The feeder was full for much longer than usual.

I will try to test his ketones today again.
Click to expand...

I'm sorry you're having to adjust to all this, it's hard and a lot. I don't have much to offer, but Petey is in a similar situation, pancreatitis, lesion on liver, 14ish yo. I swear by probitoics, I think they bought us a lot of time with Petey since we adopted him two years ago. Wishing you both healthier, happier days.

Oh, and Petey cannot handle duck or beef, both of which are very fatty and not good for pancreatitis. They say fat may not be a factor for cats but I think it is for Petey.
 
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With DKA in the recent past we tend to be more aggressive with dosing if there are still any ketones present. Because he is still showing grace of ketones I would agree with your vet to increase the dose. I would suggest going up to 1.75 units.
I would not wait to give the ondansetron. Start it today. And I would increase the food a bit more if you can. Remember let him eat whatever he will at this point. We need him to eat well.
It is food and insulin which will combat the ketones.
 
HI everyone, I am trying to increase the food while keeping him some hunger for the shot, as there are stretches were he doesnt eat for 4+ hours.
He is now eating 1/3-1/2 3z can+1/8 cup of kibbles twice a day, and grazes on the remaining of the can of wet food that I leave out/present to him during the day. Id say he eats 1/2 can a day on top of that. He has access to wet food all day, just not kibbles like usual.
He is more alert, mobile, meows for water, more his normal self.
However: he has not pooped since Sunday. (he used to be very productive on the high carb kibble), and last time he did, he seemed to be in real pain, and that was followed with diarrhea.
He has been burping more since being on wet food.
His level are starting to drop more than we have seen before. He was a 250ish for the first time ever pre AM injection. He drops pretty quickly after the shot, even with the meal.HE is at 168 now! 90 minutes post shot.
He spent most of last night under 300 which is a first as well. Is this good news or possible sign that something is going too fast/wrong?
I will push more food to him, but frankly all he likes is carbs. Kibbles, gravy, treats etc..
I will start the meds today.
 
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He is dropping really fast. He refused his kibbles but i got him to eat a bit of fancy feast classic pate with chorro treat topper. He was at 144 showing a fast dropping arrow. He is now at 150 dropping slightly less fast. But still only <2 hours after his AM shot. Worried about the trajectory he is on.
 
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lantuslantus1234 said:
HI everyone, I am trying to increase the food while keeping him some hunger for the shot, as there are stretches were he doesnt eat for 4+ hours.
He is now eating 1/3-1/2 3z can+1/8 cup of kibbles twice a day, and grazes on the remaining of the can of wet food that I leave out/present to him during the day. Id say he eats 1/2 can a day on top of that. He has access to wet food all day, just not kibbles like usual.
He is more alert, mobile, meows for water, more his normal self.
However: he has not pooped since Sunday. (he used to be very productive on the high carb kibble), and last time he did, he seemed to be in real pain, and that was followed with diarrhea.
He has been burping more since being on wet food.
His level are starting to drop more than we have seen before. He was a 250ish for the first time ever pre AM injection. He drops pretty quickly after the shot, even with the meal.HE is at 168 now! 90 minutes post shot.
He spent most of last night under 300 which is a first as well. Is this good news or possible sign that something is going too fast/wrong?
I will push more food to him, but frankly all he likes is carbs. Kibbles, gravy, treats etc..
I will start the meds today.
Click to expand...
@Bandit's Mom
@Wendy&Neko
@Bron and Sheba (GA)
@Sienne and Gabby (GA)
@Angela & Cleo
 
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@lantuslantus1234
I tagged a few members for you, please update your spreadsheet with the numbers you posted
You can change your title to
Help Need Advice Dropping fast 1-15 Picchu his AMPS # and all the other tests you just took
To do this tap on Thread Tools to the right then tap on Edit Title and erase what you have and type what I daid
 
He is now climbing back to 102, acting somewhat normal. after eating an entire can o gravy lovers, a fair amount of karo syrup, etc.. If I was not home and didnt check hourly, I would not have caught this...
 
@lantuslantus1234
I don't want to sound like I'm being a pain in the neck but you need to put each BG number on your spreadsheet so members can see , it's hard to look back at each of your posts to see what the BG is or when it was. Same thing in your title

That 58 @+2.5 hours on your spreadsheet
You have it in the +3 cell ?
I don't understand that

For Example only
Let's say he was 68 @+4 so that goes in the 4 cell
Then you test him 15 minutes later and get 70
In the same cell which would be the 4 cell you would put 70@+. 25 which means 15 minutes
And so on
.5 means 30 minutes
.75 means 45 minutes

Members need to see all the numbers you have on your spreadsheet to see what was going on

I hope you understand :cat:
 
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lantuslantus1234 said:
ohhhhI did not realie that is how it worked.
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That's ok I'm just trying to help you ☺️
That 58 @+2.5 hours on your spreadsheet 2.5 hours was when ?

Like if you tested 4 hours after his AMPS that goes in the 4 cell , then if you test again 30 minutes later you would put that number in the 4 cell also and then put @+.5 for 30 minutes. You just keep stacking them in the same cell .
If you test 5 hours later after his AMPS that goes in the 5 cell and so on
 
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He is now climbing back out fairly quickly. I am assuming that means his body is having troublr regulating? his BG increased +50 to 150 within 30 minutes. Granted he ate a bunch of carbs an hour ago.
 
I’m new here and can’t give much of an opinion but want to mention two things that may be reassuring. First, human meters read cat blood lower than it really is, especially when the numbers are below 100. So it probably was higher than 58.

second, the Libre (a human device) tends to read lower than even the human hand held meters (because it’s measuring a fluid other than blood) AND reading can be off if there’s pressure on the sensor. So in humans if they lean on their arm, or if a cat lays on the sensor it reads low when it’s really not

This is when you’d want to double check the likely erroneous reading with a hand held meter. @Heike & BInie and @Staci & Ivy can tell you more about Libres.

good luck
 
SmallestSparrow said:
I’m new here and can’t give much of an opinion but want to mention two things that may be reassuring. First, human meters read cat blood lower than it really is, especially when the numbers are below 100. So it probably was higher than 58.

second, the Libre (a human device) tends to read lower than even the human hand held meters (because it’s measuring a fluid other than blood) AND reading can be off if there’s pressure on the sensor. So in humans if they lean on their arm, or if a cat lays on the sensor it reads low when it’s really not

This is when you’d want to double check the likely erroneous reading with a hand held meter. @Heike & BInie and @Staci & Ivy can tell you more about Libres.

good luck
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Good morning, I hope things are going better today. I saw there may be some questions about using the Libre. The things that were pointed out by Colleen above are correct.

I have noticed each cat seems to read differently on a handheld meter when the ear is poked versus the Libre. Some cats seem to be within 10 or 15 points of the Libre some more. My cat tends to have more of a larger spread between the Libre numbers when low And the handheld meters. For example, sometimes my Libre reads LO which is under the 40s and she can be anywhere from the 60s to 100 on a handheld device.

So it seems every cat is different and every handheld device is different. You just have to get used to how your cat reads and how you’re meter reads. There’s a lot of experimentation, but you always want to double check “Lo” values on the Libre especially, to keep them safe.

If you have any questions about using a Libre, please feel free to ask me or Heike, as we have both used them for quite some time.
Please let me know if there’s anything I can do to help you with the Libre.
:bighug::bighug::bighug:
 
Good afternoon, we also used the libre a lot and I can relate, how scary the fast drops are. You already got some excellent advice from Colleen and Staci. Staci already mentioned, that the lows on the libre are sometimes actually higher, if you measure the bg with a handheld. So it is good to always double check if they drop below 100. Another thing to consider is, that the libre also tends to "exaggerate" the higher numbers. So very often it can show HI but on the handheld the cat will be somewhere in the 300s. Practically that doesn't matter, because both - 300 and above 400 - is higher than you want them. But for the user it looks like steep drops when they are coming down and that is scary. So I would recommend to take a deep breath in these situations and always test with the handheld if they drop below 100. It happened to me a lot in the beginning, that I didn't manage to test on the handheld and overcarbed poor Binie because of low numbers on the libre, even though it was not necessary.

This disease is overwhelming first but you will manage. I hope Picchu feels better soon! :bighug::bighug::bighug:
 
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