Side note: Copper began eating more consistently after I started giving quick-dissolving Ondansetron as powder on tongue every 6-10 hours.

Original post title: Very thin cat has stopped eating last 2 meals.

@Wendy&Neko @squeem3
Copper ate little last night, and is unwilling to eat at all this morning. I've given Ondansetron 3 times the last day and it hasn't helped.
Should I syringe some powdered egg or canned food?
I have Mirtazapine on hand and could give some if that's a good idea right now. If so, recommended dose in this situation?
How should I determine how much Vetsulin to be giving for the next few doses? I may be too high. It's been really hard for me to know.
I don't have ketones test strips but am picking up later today.
I did 4 glucose tests yesterday (on spreadsheet). Lowest was 213. I don't think I tested during nadir.
Family time pressures are extreme right now, so I've been trying to rehome him, sadly, but no one has responded so far.
Vets are pretty far away, too, and I don't feel good about him getting extensive treatment.
Thoughts are appreciated. It's a very hard time with him, and with my family.

Just tested. Glucose 72!! @ 11.5.
I gave honey and he's perking up. Hooray! He eagerly ate treat, and I'll feed meal shortly.
I wonder why he would barely eat previous meal. His blood sugar was 213 then.
Hmm... I think I gave his Vetsulin mid-meal last night in case it would help him feel like eating more. I've done that a couple times before that helped, but didn't help last night.

Please would someone look at his spreadsheet & give me advice at how much Vetsulin to give after meals the next few times?
This meal, it looks like he's going to eat mid to large size meal. I've got to leave for 12 hours after that so won't be here to watch him afterward.

Don't shoot below 200 when you are new and don't have data to shoot low. With Vetsulin, you wouldn't shoot below 90 even when experienced. One option is for you to stall, ie. wait for an hour and see if he's up enough then to shoot. But sounds like today you skip. More next post.

Tonight, how about trying 2.0 units. As I mentioned in one of your earlier posts, I think you've increased too fast and too much. Normally with Vetsulin people start on 0.5 or 1.0 units and hold the dose for a week.

Don't worry if he's high tonight because you've skipped. That's OK, he will get back on track soon enough.

Thank u very much for guidance!
I will check his BG again before leaving & skip if it's not above 200 yet.
I'll also drop his dose & try to identify nadir.

I'm posting this on the chance that someone might be up this late time of night.
He just had a BG of 411 @ +8. Although I don't have pinned down what hour he tends to reach nadir, I was surprised it was so high at that time. He's been bouncing amidst recent happenings, but I'm still concerned that maybe I need to give more since he's eating larger meals and his numbers are so high.
Maybe I did partial fur shot last time, but I don't think so.
I did give him a few extra freeze-dried chicken chunks during gap time, and one dry kibble.
My care schedule continues to be not uniform, too. I'm doing what I can.
I need to give him his shot within the next few minutes since he just ate.

I'm really seeing I'm not going to be able to give the requisite amount of care and timing to keep him feeling good and healthy, even if I switched to glargine. My time availability is going to decrease soon, too.
However happy and comfortable I can help him be right now, I want to, though. I'm so glad he's been feeling much better physically, and happy and peaceful, also.

I guessed at 2.25U and will see how things go. Maybe he's flatlining in a bounce. I'm sure a number of things are needed to get his BG to better numbers.

I'll be taking BG within an hour & would love if I can get any input based on it after I post! With the variety of dynamics going on, figuring by myself is hard.

Please can anyone help?

BG is now 504 @ 9.75, right before I was going to feed meal.
He is acting somewhat distressed & restless, but otherwise ok.

Copper's BG has been in 300s & 400s at +8 the last few days, & I think he's bouncing.
I've been giving his injections on a quite consistent 10-14 (mostly 12) hour schedule, but a 1 or 2 missed time so gave late.

Meal start & end times have varied more. I've had to figure how to coax, & try to keep an eye while he eats.

I can't find his ketostix, but I hope he isn't starting ketoacidosis. Since the BG is pre-shot, I hope it's not as crisis as if it was more between doses.

Ideas for Vetsulin dose?
I'm thinking I need to give him a small dose before feeding anything.I did that at 0.6U a couple days ago when he got this high, too.
Maybe wait 30 mins first at least, in case that gives some little time for potassium to get a head start.
Then another dose after 1 hr - 1.5 hours.

Also, what & how much to feed? I have canned chicken (but it has salt), Friskies canned pate foods, powdered eggs, & various Iams Kibble foods.

I gave him 2.5 pills of 550 mg potassium yesterday, and 1/2 pill 15 mins ago.

@Wendy&Neko
Thanks, Wendy, for how you've been helping me!

@carfurby (GA) @Katie & Mego (GA) @Marje and Gracie @tiffmaxee
I hope you guys don't mind me messaging you, too! I just chose a few people randomly to message from Notable Members in case one of you is available soon.

Thanks so much!!!

I tried varying Kobe's dose depending on how high his BG was and I am lucky that he lived. His numbers only improved after I followed a dosing schedule. When you have data about how a particular dose affects your cat, the members here can help you safely adjust the dose to find one that is effective.

Wendy&Neko said:

Tonight, how about trying 2.0 units. As I mentioned in one of your earlier posts, I think you've increased too fast and too much. Normally with Vetsulin people start on 0.5 or 1.0 units and hold the dose for a week.

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If it were my cat, I would do this recommended dose unless another qualified member said to increase.

I am so sorry you are going through this. We are here for you!

Food: you want a low carb wet food. Here is a chart that has Friskies on it, and you can check the carb % https://www.bizave.com/foodlists/Combined_Food_Lists_Feeding_Guide.pdf. Look at the third column from the left, carbs % of cals. You're looking for a food that has below 10% carbs. Many of us feed Fancy Feast Classic Pates. Wet food is preferred over dry, as most dry is too high in carbs, and it doesn't have the moisture in it that cats need.

Did your vet prescribe the potassium? I saw the conversation you had with Wendy and Sienne the other day, and I know they encouraged you to check with your vet regarding potassium supplementation.

Also, as an aside to what you've asked in your 911 post, can I suggest that you strongly consider a switch to Glargine/Lantus. I think you will be much happier with the results. I had Jude on Vetsulin to begin with, and his numbers were all over the place, like Copper's. Some of that was because he was early in his treatment (their numbers can be quite irregular at the beginning), but a lot of it was the insulin. Once we switched and began following a dosing method, Jude's numbers began to regulate.

This post is our guide to dosing with Vetsulin: BEGINNER'S GUIDE TO CANINSULIN/VETSULIN and more information in here: INTRODUCTION TO CANNISULIN/VETSULIN & N/NPH. You really do want to feed and make sure he's eating before giving Vetsulin. Lantus is a little more foregiving about that, but they do need to have food on board before giving Vetsulin.

Copper is bouncing. Plus what is muddying the picture is different shot times. Ideally you should be more consistent on the time of day and night that you give insulin.

Bless you, @Kobe (Dean and Lesley)!
I'm seeing the importance of a consistent dose, too. Earlier on I particular sweat about the amount because I had a mis-impression that BGs he was getting were unusually high. Plus the amount he would eat varied quite a bit. His eating has stabilized more, & I'm thinking I should keep consistent unless he eats only a little.

@Mary & Jude I just calculated carbs in his Friskies (using How to calculate carbs in cat food) & they are 16.8%. So, not ideal. But I have been giving chicken & powdered egg as substantial part of his diet, so carbs probably reasonable. But salt level has been too high, especially when I was giving the broth from chicken early on.

@Wendy&Neko
Thank you for referral back to those. I'd started but not gotten through all. I'll read more today, too.

I gave 0.5U Vetsulin a few minutes ago, to start him coming down. I hope that's okay, since he's hungry & I know he'll eat at least a fair amount. Is 1.5U what you'd recommend for after his meal if he eats well?

I hear you about the shot times. And I haven't figured nadir either.

I'm not going to be able to keep caring for him.
Do you think 2.0U is the dose that help him feel the best the next few days?

I haven't wanted to waste people's time asking for help more than would be appropriate. I've been trying to know how to do long-term treatment because I've had hopes he could go to a good new home, or that his care could fit in for me to do it. I want Copper to be as happy as he can be for as long as he can have, and appreciate everyone's caring, and information anyone can share to help him do well for this time.

Frankly, my husband went on hospice the day after Copper got diagnosed with diabetes. He's had to wait so much many times for me to visit while I've been trying to help Copper. I need to shift to trying to help my husband's health more and helping him enjoy life for as long as he can have.

Within an hour after giving this next shot, I'm going to need to be gone up to 8 hours. So I won't be able to monitor him.
He is eating heartily right now, though. He looks like he'll be okay. Thank you, God!!
And thank you to all of you!
It's been really struggling trying to do the right things. I've had some really sweet connections with Copper during this time, and he's gotten feeling a lot better.
I know everyone here has a lot of challenges with their cats and their lives. It's great how everyone reaches out with care to each other

Felicity, here is the Facebook link to an organization called Diabetic Cats in Need: Diabetic Cats in Need | Minot ME. I believe that you will very likely get to a point of being able to care for Copper (I care for Jude and work fulltime) and manage the other very important priorities in your life, but I want to share this resource in case it is helpful for you and you need it. It is most difficult at the very beginning of diagnosis with a diabetic cat: there is so much to learn, and you've got this learning curve combined with your husband's care. But getting to a point of management is possible. The good news is that the folks here have so much first hand experience and knowledge, and they can offer so much solid advice and guidance to you. I cannot imagine how difficult this time has been for you! I honor your commitment to try to balance it all. You are NOT wasting anyone's time here--we want to help you care for Copper. We encourage you to reach out whenever you need.

Just tested 407 pre-meal, 11.75 post-shot. Tested 207 once between meals. I realize nadir is the core thing used for dose adjustments, & don't know how close to nadir that measurement was.
The last 2 meals, he's been eating a little more than a large meal. Should I be increasing dose a little after a meals where he eats extra, since his numbers are reaching so high at times?? I'd rather not limit his meal size because he'd lost a lot of weight and has only recently started eating well.
I'm planning to do the conservative dose of 2.0U as baseline unless experienced eyes have different suggestions.
Thanks for any help!

@Wendy&Neko @Mary & Jude

Felicity, I’m not comfortable giving dosing advice, especially with Vetsulin, since I’m more familiar with Lantus. Hopefully Wendy will jump in here. I’ll also tag @Christie & Maverick and @BanditsMom to see if they’re available to help.

Felicity said:

Just tested 407 pre-meal, 11.75 post-shot. Tested 207 once between meals. I realize nadir is the core thing used for dose adjustments, & don't know how close to nadir that measurement was.
The last 2 meals, he's been eating a little more than a large meal. Should I be increasing dose a little after a meals where he eats extra, since his numbers are reaching so high at times?? I'd rather not limit his meal size because he'd lost a lot of weight and has only recently started eating well.
I'm planning to do the conservative dose of 2.0U as baseline unless experienced eyes have different suggestions.
Thanks for any help!

@Wendy&Neko @Mary & Jude

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I know it's tempting to increase a dose because he ate a lot, but it's not safe for your cat. He gets to eat a lot right now because his body isn't getting all of nutrition he should be from his food. Eating is good. Follow the dosing protocol. 407 to around 207 is a good cycle. The insulin is working. We have to be patient because their bodies don't recognize what "normal" BG is right now. He didn't get to 407 in an instant. It takes take to go back. They kind of need reprogramming. It happens bit by bit. You don't want him diving from 407 to 100. That's to much at once. 207 is the sweet spot right now. He's doing good. Give him a hug!

Mary, thank you for being so thoughtful and supportive!
Your message last night was really comforting. Thank you for sharing the Facebook resource, too!

I'm grateful for all the info and help people so generously give here! I plan to tell the vet who saw Copper about this website.
I'm also going to tell him how clients can get Lantus inexpensively, too. That will help people help their sweet kitties more optimally from the start, which I wish I'd been able to do for Copper's initial treatment.

@Kobe (Dean and Lesley) Aww-- Thank you for the sweet follow-up!
Okay, deep breath and hold the course. Thank you for your reassurance!
I also went & got canned cat food last night that has lower carbs than the Friskies I'd been feeding. He loves it, & it should help his BG, too.

Consistent feeding (and dosing) is best. Numbers can still vary between cycles for various reasons. You'll better be able to collect data on how he is doing with a particular dose if you keep that food and insulin dose the same. Obviously if he goes low you have to give more food.

What new food are you trying?

BG 375, and would only eat a little this meal. I alternated falling asleep and waking up and switching between different foods, and gave another dose of Ondansetron, hoping he'd eat more. Finally gave up and took another BG 432. He was willing to eat low-salt canned chicken then, so I fed small amount.

I gave 1.8U and will shift his next dose to later.

I got Blue Buffalo Tastefuls Chicken Entree. It calculates as approx 9% carbs on dry matter basis, but doesn't list ash content, so it's actually somewhat lower.
The other food I got was Fancy Feast Tuna Feast Flaked. Not as optimal, I saw after calculating to be approx 14.4% carbs on dry matter basis.

This last meal was a tricky one, but I'm keeping his insulin low like you suggested.

We use %calories from carbs, not dry matter basis. The FF Tuna Flaked Feast is 4%. Not sure about the Blue Buffalo.

By my suggestion of consistent dosing, I meant 2.0 units each time.

Any chance you can test 4-4.5 hours after the shot more often? That's when the Vetsulin low point or nadir tends to be. I see that he got to low 100's tonight. That's good numbers but after his nadir time so he might have been lower earlier.

Side note, since the subject of this thread originally included the Copper wasn't eating much:

Copper began eating more consistently after I started giving quick-dissolving Ondansetron (Zofran) as powder on his tongue every 6-10 hours, and increasing dose to 1.5-2 mg each time. Thank you @Wendy&Neko for sharing that Ondansetron can be given more frequently than twice a day, and at a higher dose! (With caution that if cat is low in potassium, check if it would be advisable to give potassium supplementation at same time.) I posted a thread with some discussion about potassium.

Importantly, I found out that quick-dissolving type of Ondansetron does not take effect very quickly if swallowed, just like the "normal" type of Ondansetron. So I stopped "pilling" Copper. The manufacturer says Ondansetron in general can start taking effect within 30 minutes but may take up to 2 hours to have full effect.

Instead I put a couple pills in a small container, crushed them, dipped my finger in so some powder stuck to it, and then wiped onto his tongue. He got used to that, I think after sensing it helped relieve his nausea. I tried to wait a couple minutes for powder to dissolve before giving a reward treat, and then waiting at least 20 minutes (I've read elsewhere and personally experienced that quick-dissolving ondansetron sometimes start taking effect in 10-20 minutes) before feeding him.

However, sometimes he still wasn't interested in eating a lot. In two instances where his blood sugar was above 500, I went ahead and gave him 1/4 of his dose before his meal, which I think helped him feel better and eat more.

Here is info from some websites about other factors that may apply when a cat is having nausea and/or reluctance to eat and taking Ondansetron.

Ondansetron for Cats: Nausea Control and Safety
How quickly should ondansetron start working in cats?
Some cats show changes in nausea behaviors within hours, while others take longer because the underlying illness is still driving inflammation, pain, or dehydration. The earliest improvement is often behavioral: less lip-licking, less drooling, and a calmer approach to food.
If there is no improvement, or if vomiting continues repeatedly, contact the veterinarian. A lack of response can mean the nausea pathway is different, the cat needs fluids, constipation is contributing, or the problem is not nausea at all (for example, mouth pain).

Important Facts – IBDKitties
Be careful what medications you give your kitty with Zofran. Some like Mirtazapine or Mirataz can cause serotonin syndrome. If you’re giving zofran, maybe try Elura instead or give it as far apart from those other meds as possible.

Additional detailed info about Ondansetron
Side effects, contraindications, and more.

Good to hear that Ondansetron is working! We also use the quick melting tabs. Jude is a very large cat (19 lbs), and I cannot get my hand around his head to position him to receive pills, so I resorted to melting the Ondansetron in a teensy bit of warm water and syringing the very small amount in his mouth. He hates it, but the amount is so miniscule, that the objection is relatively brief.

Odansetron is also available as an injectable. Chewy's Pharmacy sells this with a prescription. The dose depends on the cat and what the vet prescribes. Leroy's dose was 1 ml once a day. If you don't have 1 ml syringes and needles, you'll need to get them. Needles usually require a prescription but not syringes. Or just use 1 cc (aka 1 ml) insulin syringes around 27 gauge. It will take longer to inject with thinner needles.