? 05/13 Eddie AMPS +3 70 +6 50 +6.5 104 +7.5 54 +8.0 166 +8.5 140 +9.5 86 +10.5 108 PM 124

Jodey&Eddie&Blue

Jodey&Eddie&Blue

Very Active Member
Good afternoon,

This update is somewhat complicated by the fact the clinic decided not to give Eddie insulin this morning. I couldn't get what woudl normally be the AMPS # but I did get one just now for what would be AM + 3. = 70 without insulin.

They say they are really short-staffed. Eddie is regulated somewhat and the Mirtazapine situation is over. Whether or not he got Mirtazapine instead of Cabergoline is not known and no longer pertaiins.

He's unhappy in clinic. Will eat when hand fed and mostly wants only the Churu lickables. I want to bring him home but am absolutely in fear of him not eating again.

But here he is. They reduced his dose last night back down to 12. I can't get numbers from them yet with the exception of just now the +3 70 with no insulin.

I need some help. The clinic thinks he'll do better at home and I agree, for the most part. But here's Eddie, no insulin and low numbers. They said they will try again at what would be +6 and do a test and possibly give him 3u insulin and then send him home. The issue, again, is a) Eddie really wants out of clinic; b) Eddie's not doing so well in the eating department; c) Eddie has low BG; d) Eddie was not given insulin and e) they are so under-staffed right now that I imagine he's just sitting in a kennel.

I need some help. @Wendy&Neko @JL and Chip or @anyone with suggestions. Thank you.
 
I would bring him home. He needs the more monitoring you can give than the busy clinic is doing. And some help encouraging him to eat. Can they give him some ondansetron before sending him home? And maybe Cerenia too - both can be given.

Skip, it's almost exactly mid cycle isn't it? If he soars high, test for ketones, but with him being 70, I wouldn't worry. And doing even a small dose now messes up the evening shot.
 
Wendy&Neko said:
I would bring him home. He needs the more monitoring you can give than the busy clinic is doing. And some help encouraging him to eat. Can they give him some ondansetron before sending him home? And maybe Cerenia too - both can be given.

Skip, it's almost exactly mid cycle isn't it? If he soars high, test for ketones, but with him being 70, I wouldn't worry. And doing even a small dose now messes up the evening shot.
Click to expand...
Am just on phone waiting to talk with vet. What to do if they have given him shot already???
 
You can't unshoot it. Let's discuss closer to PMPS and see what his numbers look like then.
 
Wendy&Neko said:
You can't unshoot it. Let's discuss closer to PMPS and see what his numbers look like then.
Click to expand...
They are not giving him insulin at all. In fact, he's getting IV glucose/dextrose now because they just took his BG and it's 50. I'm to call back in 10 mins and discuss.
 
Last edited:
Ok, this is getting crazy. He dropped again @ 7.5 to 54 and they gave more dextrose and up again to 166!!!!

I really need help. The vet is so new that I thought I was talking to an inexperienced vet tech.

Update: I sent an email to the IM vet to ask for advice. I pointed out:

But now, he’s all over the place with BG. Last night they gave him 12u and today nothing. His BG pretty much looks like this:
8:30 I don’t know
11:30 3.9
2:30 2.8 (Give dextrose)
3:00 5.8
3:30 3.0 (Give dextrose)
4:00 9.2

The IM vet responded:
"His BG is looking good, if anything a bit too low at times. Why? Something is working bringing the anti-insulin effects down.
We will see what his BG does, that will guide us for further therapy.
These data are not horrible and show that progress is being made. Insulin dose needs to come down, I would cut dose to 6-8 IU or so and see what BG does.
Once we are more in equilibrium with his BG, a recheck is recommended."

Am I out to lunch thinking he's not paying attention??????

:
 
Last edited:
And now the IM vet emailed to say I should bring Eddie home. "His BG behavior is logical, not eating, BG is coming down. None of the values is life threatening (yet) but I think that he will do best at home in your care with small frequent foods like Chiuru etc to entice him. "
Please, if someone can help evaluate these comments....
 
update @8.5 140. They said he's continuing with the Churu and has licked at his Open Farm Wild Salmon. They are checking again in a hour. I thought I was going to be able to bring him home.
 
I still think you should bring him home. Is he off the dextrose IV yet? If so, how long ago since he's been off. I want to see numbers when he's clear at least a couple hours from that extra sugar.

I'm good with a one time (tonight) half dose, provided he's on his way up. I don't want you to have drama tonight.
 
Wendy&Neko said:
I still think you should bring him home. Is he off the dextrose IV yet? If so, how long ago since he's been off. I want to see numbers when he's clear at least a couple hours from that extra sugar.

I'm good with a one time (tonight) half dose, provided he's on his way up. I don't want you to have drama tonight.
Click to expand...
I'm going to call again now. I don't know if he's off dextrose yet. I'll advise them to take him off and do another test before he comes home. I asked them to do a ketone test and, thankfully, it's once again .2, which is what it usually is.
 
Ok, here we are.
Wendy&Neko said:
I still think you should bring him home. Is he off the dextrose IV yet? If so, how long ago since he's been off. I want to see numbers when he's clear at least a couple hours from that extra sugar.

I'm good with a one time (tonight) half dose, provided he's on his way up. I don't want you to have drama tonight.
Click to expand...

Ok, just called, @ approx. 9.5 he's back to 86. However, he's been off dextrose for 2 hours and has eaten on his own. They will check again and I'll call in about 45 mins since the last time was 30 mins ago. It's hard to enter on spreadsheet as these are times that are relatively approximate.

My worry (I have far too many!), is that I have to start teaching tomorrow for summer session, meaning that I'm teaching 3 days per week/2.5 hours each class. Class starts at AM +3.5 according to our schedule. I teach T-W-Fri.
 
Is there any chance that a mirtazapine overdose (if it happened) can have a lingering effect on either lowering BG or increasing sensitivity to insulin? I think I’d want to have a clear answer before bringing Eddie home, especially given your current stress level and upcoming school schedule. Might require another call to an animal poison control line or some research on the vet’s part. You can do certain things at home but IV dextrose isn’t one of them.
 
From VCA Canada website:
Pets with a history of leukemia, diabetes, glaucoma, difficulty urinating, low platelets, or any blood disease should use mirtazapine cautiously, and blood test monitoring may be recommended.
Click to expand...
 
JL and Chip said:
Is there any chance that a mirtazapine overdose (if it happened) can have a lingering effect on either lowering BG or increasing sensitivity to insulin? I think I’d want to have a clear answer before bringing Eddie home, especially given your current stress level and upcoming school schedule. Might require another call to an animal poison control line or some research on the vet’s part. You can do certain things at home but IV dextrose isn’t one of them.
Click to expand...
Hi JL, I will confirm with the clinic that Eddie is cleared with the animal poison control. This next BG just be instructive since it will be over 4 hours since IV. And, that's for sure about IV dextrose at home...
 
Sorry, one last thing - the possible 1.1ml you gave a couple nights ago, do you know how many mg that would represent? The study above included cats given 15 mg. :eek: Back in the day when they gave just pills which were 15 mg for the entire pill. Current dosing is more like 1.88 mg. So the study included cats almost given 10 times too much.
 
:eek:
Wendy&Neko said:
Sorry, one last thing - the possible 1.1ml you gave a couple nights ago, do you know how many mg that would represent? The study above included cats given 15 mg. :eek: Back in the day when they gave just pills which were 15 mg for the entire pill. Current dosing is more like 1.88 mg. So the study included cats almost given 10 times too much.
Click to expand...

Yes, if it happened it was 15mg/ml and, if it happened, he got 1.1ml, which is what he's supposed to get for Cabergoline.:eek::eek::eek::eek::eek:
 
Ok, his BG has risen from 85 to 108 (again, the hours are a bit wonky but pretty close). They want to do another one in about 40 minutes and will call me. He hasn't had any dextrose on board for six hours and is eating as long as someone is handing him the food. I don't know what that is about.

I ended up calling the animal poison control centre myself and talked to a tech for about 30 mins. She affirmed/confirmed that the Mirtazapine, if he got it, should not affect his BG. She went and consulted with a vet, I believe.

I asked the poison control tech what she would do if Eddie was her cat and she said she would leave him one more night for good measure because there's more to a potential overdose than changes in BG. The clinic vet said she would call after the next test and if it's too late then Eddie can stay one more night.

Of course that means he would be there tomorrow during the day as I have to work and I wouldn't feel good about picking him up and leaving for work. I believe they were planning on not giving him insulin. How does that sound to you @Wendy&Neko
 
If he's at the clinic, and they are busy and might not have time to monitor like you would, a skip tonight would be safer. If he's sky high tomorrow morning, maybe half dose?
 
Wendy&Neko said:
If he's at the clinic, and they are busy and might not have time to monitor like you would, a skip tonight would be safer. If he's sky high tomorrow morning, maybe half dose?
Click to expand...

Clinic has slowed down. I’ll be better able to judge at next test. My thing about bringing him home is leaving him tomorrow without being able to watch him. I also have to zoom home to get Max and take him to other vet to look at his patellar issue. This he’ll be alone from a +2.5 or 3 to + 7.5 or 8….
 
Ok, here we are. It normally would be PM +1 and he is 124. I spoke at length with the vet. She does not want him to have insulin as she thinks it's possible that even if he did receive Mirtazapine overdose that the BG issue might not be related and the OD issue is just a happy accident; that is, he might be going into real remission alongside Cabergoline.
She said leaving him overnight would work and that I might be able to pick him up first thing in the morning and if his BG was on the rise (high enough, that is) indicating a need for insulin to give him no more than 6u.
I am so tired I'm losing my language. I hope you think this plan is a good one @Wendy&Neko . Thanks everyone.
 
You must log in or register to reply here.
Back
Top