05/13 Bubba +12 43; +13 59 (skip AM dose); +16 117; +17 142; PMPS 250; +3.5 221

Yesterday

AM INSULIN DOSE: I will re-test his sugars in approx. 20 minutes and then determine if I will administer a half dose (3U) or SKIP his insulin this morning; I will also take into consideration Bubba's "hunger strike".

Of course after having two limes last night, we start off today with another lime. And of course Bubba is off his food again - he licks like 3 licks of food, then turns away from it. Just now I syringe fed him MC + honey to get something into him.
Bubba was due for a REDUCTION! to 6U from 6.5U due to his limes last night. I would celebrate more if this cat of mine would bloody eat!

I'm calling the vet this morning for someone to prescribe me ondansetron & more mirtazapine as clearly the mirtazapine Bubba got on Thursday morning has worn off and I have yet to hear from my vet (I emailed them Thursday Nx).

.....
Bubba had two limes last night at approx +6 & +7... I fed him MC + honey and it went up to 77. Bubba is off his food again, so I syringe fed him last night. I went to bed when his sugars were 77 (I was already awake for nearly 24hrs and was at the (human!) ER last night). I am exhausted and frustrated.

 

Luckily Bubba went up to 3.3 / 59 approx. 30min after I syringe fed him MC + honey.
However, I've decided to skip this morning's insulin dose - Bubba has no Hx of ketones and he's currently unreliable to eat should his sugars drop further, and I'm dead exhausted.

Also, after Bubba's limes last night he went up to 4.3 / 77; however, this morning he dropped again to 2.4 / 43

 

With a 43 he earned a reduction. Are you planning to take it?

 

Yes. His new dose would have been 6U this morning (down from 6.5U). Was also debating giving half dose of 3U this morning too.

 

Good. How late are you? Think about how much off schedule you will be and if you can monitor.

 

I made the decision to skip his AM dose already earlier this morning. His shot would have been 2hrs ago. I know skipping isn't best, but since he is unreliable to eat independently I made the decision to skip and since his numbers dipped again into the limes this morning (after going up last night).

Luckily his vet is in today, so hopefully I can get an ondansetron Rx and more mirtazapine to stimulate his appetite.

 

Wise decision.

 

Thanks for checking in

 

Bubba has been sleeping all day so far. Tried to feed him some MC + steamed salmon just now and he had no interest

I'm going to the vet to pick up ondansetron & mirtazapine to get this boy feeling better and to eat - fingers, toe beans, paws, legs and tails crossed!
He was purring this morning at least. And he had a drink of water a short time ago. He also had a little poop in his box this morning too. His last BM was last Friday (he had big BMs 3 days in a row last week)
It's a real cooker today in my neck of the woods, just got the AC up and running so hopefully Bubba will feel more comfy soon.

 

Good luck with the reduction, I hope Bubba will feel better with the meds you are going to pick up at the vets

 

I hope the meds stimulate his appetite. Sending big love and hugs to you and Bubba

 

@Diane Tyler's Mom @Deb and Sylvester

Thank you; I appreciate your kind words.

It's hard to see my precious boy like this
He was doing sooo good last week too! Perky, purring, snoozing on the patio / wanting his fresh airs, good elimination, decent appetite (I was expecting it to decrease as his sugars have been getting so much better!).

 

What a night! I'm going to suggest something totally off book here, but am taking into consideration Bubba's appetite and seamingly newly developed reactions to insulin. Plus your lack of sleep. Next dose, when you can, I think I'd try 5.0 units. He went low in spite of a half dose and a skip, which should have helped drain the depot. I think you need a break. I'd rather you find the dose is a little low and have to increase back up, than keep fighting these lows.

There could be so many factors causing the lower numbers, but safety is the first consideration.

I'm also wondering if Convenia was not the correct AB for his infection, since you don't have urine culture results. Do try to get Mirartaz, it's a much better way to give mirtazapine, and easy to tweak the dose down if you need.

 

Thanks Wendy for that suggestion! I agree about having a dose that creeps up the BGs rather than fight the lows… especially since they usually happen late at night when I’m already a zomboid LOL

I got a Rx for ondansetron oral liquid… I’ve been running around and/or calling 6 different pharmacies as NO ONE had it in stock I even called the vet clinic to see if my vet could write a Rx for tablets instead, but…
One nice pharmacist gave me the generic DIN and I was able to find the generic version of ondansetron at one local pharmacy, thank god!!! I was about to burst into tears; none of the pharmacies would have been able to get it in stock till mid next week; I think there’s a shortage. What a day. It’s also 4000 degrees outside I’m ready for a drink
I also got mirtazapine tablets (I’ll see how these go vs the topical option).

 

Liquid oral form of ondansetron? Never heard of it. Unless maybe compounded. You can get a version you can inject, but apparently it's even more expensive. Though good if kitty won't take pills easily and won't eat. Thank goodness for sympathetic pharmacists! I get mine at my local Save On pharmacy, just renewed a months or so ago. Sometimes it takes them a day to get them in, but often in stock. I think the sublingual might be more available. But I just get the 4 mg pills. What dose did the vet suggest?

Got all fingers, toes, and paws crossed for the ondansetron/mirtz combo.

 

I got a generic version of ondansetron, not compounded... it is a strawberry flavour, sweetened with fructose? I didn't know until I gave it to Bubba and it had a super sweet smell; so I called the pharmacy as well as googled it and found out about the flavouring - FML. I might just ask for a tablet Rx on Monday anyways. Literally nothing has been going right. It was so late into the day today - I should have just gone back to the vet right away and asked for a tablet Rx (I did call, but then found a pharmacy that had the generic oral liquid version and it was super late into the day and then cancelled the tablet Rx request) - but I was in such a panic.

His dose is 0.4mg (0.2ml ) q6-q12hrs / day. The concentration is 4mg/5ml. I have no idea if that is sufficient enough.

Bubba is still not eating. Will try to spoon feed. His sugars are 13.9 / 250 tonight.

This is what I found about the Apo-Ondanestron, I think this is the same one I got:

Oral Solution
Each 5 mL of ondansetron oral solution contains 4 mg of ondansetron base in the form of ondansetron hydrochloride dehydrate. Nonmedicinal ingredients: citric acid, hydroxyethyl cellulose, purified water, sodium citrate dihydrate, sodium benzoate, and strawberry flavour. Ondansetron Oral Solution is sweetened with fructose.

 

As per the Consensus Guidelines on the Diagnosis & Management of Feline Chronic Kidney Disease - compiled by the International Society of Feline Medicine (ISFM)
~ Journal of Feline Medicine and Surgery (2016) 18, 219-239

The dose of ondansetron is 0.5-1.0 mg/kg of cat, q6-8. A 0.4 mg dose would be good for a less than 1 kg cat, a kitten. I rather suspect that dose should be 4 mg every 6-8 hours. Assuming he weighs 4-8 kg. Note, many vets under dose ondansetron - I had that experience with Neko. Since then I've had more experience with a couple other kitties where the right dose works.

 

Yeah, I was wondering if the dosing calculation was off when I took a look at it and compared it to the dosing recommendations

 

Bubba's sugars were 13.9 / 250 this evening. I syringe fed him First Mate MC + pumpkin + beef bone broth - he had zero desire to eat on his own volition.

I administered 5U - based on @Wendy&Neko suggestion above & since Bubba's BG's booped into the yellows this evening.

 

Spreadsheet says 250, subject title says 150. 150 would have been surprising with a skip following limes. Hope he stays steady tonight.

 

thx! fixed it! should be 250
it was 13.9