08/03 Eddie (Advice/Help Needed Please) | Feline Diabetes Message Board - FDMB

08/03 Eddie (Advice/Help Needed Please)

Jodey&Eddie&Blue

Jodey&Eddie&Blue

Member since 2021
Good afternoon,

Phew. I've just spoken with the clinic vet who has been working with the IM vet regarding Eddie's situation and I really, really need some advice about the dosing recommendation:

Eddie has been eating really well. His BG levels have been kept @ 162-180 on purpose; they don't want him going too low.

This morning they gave him 4u Levemir and he's been hydrated. (The IM vet wants me to start giving sub-q fluids every few days but that's another story). The advice I need has to do with the IM vet recommendation to start him on 8u Levemir and I responded quite surprised to say you mean from 4u to 8u all in one day?

The clinic vet says she gets it re: Eddie's complications (acro, SRT, etc.) and says if I wasn't comfortable with 8u that we might try 4u again or maybe 6u starting tomorrow before going to 8u. I said I can hear you trying to work this out as you are speaking but it freaks me out to give him 8u when he's had only 4u, even if he's been on R overnight.

The thing about dehydration is the question of WHY is he getting dehydrated? It's happened twice. What is the mechanism? The IM vet thinks sub-q every second day! Eddie will never tolerate that.


I really would appreciate some advice here.

@Wendy&Neko
@JL and Chip
 
Absolutely agree with the vet (for once). I think 8 units might even be a bit low, but it's a good start. R, sounds like given several times?, plus 4 units of Lev has kept him in a decent range. But the removal of R will make a big difference in the Lev dose needed. He earned a reduction on the 27th, seems like ages ago now. But he was on 12 units then and I wouldn't have reduced to 8 units. The 5 units "petsitter" dose was clearly way too low cause it caused his current condition. His BG's went sky high and his kidneys went into overdrive trying to clear the excess sugars by peeing it all out.

If you have any BG values and dosages from the vet regarding R and L given, it will greatly help us help you with dosing if you can put that information in the spreadsheet.

My concern is the fluids, have they said how much they want you to give? As you are unfortunately aware :bighug::bighug:, acros have tricky hearts. Fluids can send them into heart failure if the heart is not in good shape. It happened to Neko when we started fluids for her kidney disease. What makes you think Eddie will never tolerate fluids? He's getting them at the vet isn't he? Are you talking about his personality, or his heart not tolerating it?

The link to your previous post here: https://www.felinediabetes.com/FDMB/threads/08-02-eddie-amps-434-update-threshold-hhs.280136/
 
Wendy&Neko said:
Absolutely agree with the vet (for once). I think 8 units might even be a bit low, but it's a good start. R, sounds like given several times?, plus 4 units of Lev has kept him in a decent range. But the removal of R will make a big difference in the Lev dose needed. He earned a reduction on the 27th, seems like ages ago now. But he was on 12 units then and I wouldn't have reduced to 8 units. The 5 units "petsitter" dose was clearly way too low cause it caused his current condition. His BG's went sky high and his kidneys went into overdrive trying to clear the excess sugars by peeing it all out.

If you have any BG values and dosages from the vet regarding R and L given, it will greatly help us help you with dosing if you can put that information in the spreadsheet.

My concern is the fluids, have they said how much they want you to give? As you are unfortunately aware :bighug::bighug:, acros have tricky hearts. Fluids can send them into heart failure if the heart is not in good shape. It happened to Neko when we started fluids for her kidney disease. What makes you think Eddie will never tolerate fluids? He's getting them at the vet isn't he? Are you talking about his personality, or his heart not tolerating it?

The link to your previous post here: https://www.felinediabetes.com/FDMB/threads/08-02-eddie-amps-434-update-threshold-hhs.280136/
Click to expand...
Hi Wendy,
thank you so much! Well, this makes me feel way more confident, then. Really.

I will get the BG values and dosages from the vet and post them in the spreadsheet.

I'm concerned with the fluids, too, for that very reason. When I said he wouldn't tolerate the fluids, I did mean his personality but your point is taken. Also I'd have to be doing it alone and I cannot emphasize enough how intolerant Eddie is of physical interventions. He would never bite or scratch but holding him down and trying to insert a needle into his "tent" between shoulder blades would be epic. I see all the demos online have cats who seem not to be dehydrated, that is their little skin tents are easy to pull up. When Eddie is dehydrated that little area gets quite tight. But I guess the point is to hydrate him before that happens.
I was thinking if he could get away with fluids once a week I would gladly bring him to the regular vet and have them do it and keep an eye on him, especially since we are talking tricky hearts...
 
See if there is a vet tech willing to stop by your house every couple days for fluids. If he is going to get fluids, and his heart is OK with it, once a week won't be enough.

I've always had to do fluids on my own. I do it in the bathroom with a closed door. Neko surprised me by loving lying on the heat reflective pad in front of the warm air vent. Treats to nibble on nearby. Needle generally goes into scruff above shoulder blades, not between. More flexibility in the scruff. Might want to check out the EZ IV harness.

Regarding tricky hearts - get into the habit of checking his resting respiratory rate. You want to count the number of complete in an out breaths per minute (timer on your phone) when he's resting at home. Neko's RR would go up when fluids got to be too much.
 
Wendy&Neko said:
See if there is a vet tech willing to stop by your house every couple days for fluids. If he is going to get fluids, and his heart is OK with it, once a week won't be enough.

I've always had to do fluids on my own. I do it in the bathroom with a closed door. Neko surprised me by loving lying on the heat reflective pad in front of the warm air vent. Treats to nibble on nearby. Needle generally goes into scruff above shoulder blades, not between. More flexibility in the scruff. Might want to check out the EZ IV harness.

Regarding tricky hearts - get into the habit of checking his resting respiratory rate. You want to count the number of complete in an out breaths per minute (timer on your phone) when he's resting at home. Neko's RR would go up when fluids got to be too much.
Click to expand...
that's great! I just spoke with the vet tech who is caring for Eddie right now and she's on board to do sub-q here at home on days that I'm working and can't keep an eye on him.

Love the E-Z harness!! Thank you!!! Just waiting for the vet to call....
 
Update: just spoke to vet nurse and we have determined that Eddie will be getting 8u Lev tonight and they will continue to monitor him throughout as I've decided to keep him in one more night given the complexity of his situation and the treatment.

The thing about the R insulin is that he was originally given a bolus of 1u and then they started CRI (Constant Rate Infusion), which is the protocol for managing DKA. So, 28u went into a 100ml bag and was infused according to his BG levels, meaning that at times he got 7ml or 5ml or 10ml/hr. So, the dosage varied according to BG [and included Dextrose when necessary] and can't really be entered into the spreadsheet...although his BG numbers and times can and I'll get those when I can.

Anyway, they sent me a good photo of him looking quite alert and the nurse said he is "grumpy" and we laughed because that means Eddie is on the mend. He also has eaten again and peed, which is a relief, also. I decided to keep him overnight at the clinic because I really need a break and they can also monitor his BG following all of that.

I'm hoping to be able to visit him tonight and will report back on that as well.

Thank you so much. I really appreciate all the support. It's been a bit rough. They have been incredibly kind at this clinic as they also knew Blue quite well.
 
I’m late to the party but, for what it’s worth, I was thinking pretty much what Wendy said.

I used R on two of my diabetics. It does require special care and knowledge to use safely and effectively, and can potentially impact L dosing.

Eddie will be back to just Lev (no R) when he comes home, correct?

Do you know what type and amount of subQ fluids they’re recommending? I’ve had someone or another in my crew needing subQ for the better part of 10 years and administering does usually get easier after you’ve figured out a routine.

Ditto also Wendy’s comment about getting in the habit of checking resting respiration rate. It’s such a small, noninvasive thing to do and can really clue you in early to impending issues (especially because cats mask things so well).

Since you’re going with the 8u and are a bit concerned about it, I’d suggest you get in some additional BG tests. It’ll be good data to have and hopefully will allay your fears. It might take a few days for the dust to settle after the hospitalization, fluids, R, and so forth, to see the true impact of the dose, but all data is good data. :)

I have been thinking of you a lot lately … wish I could do something to help. One foot on front of the other… :bighug:
 
JL and Chip said:
I’m late to the party but, for what it’s worth, I was thinking pretty much what Wendy said.

I used R on two of my diabetics. It does require special care and knowledge to use safely and effectively, and can potentially impact L dosing.

Eddie will be back to just Lev (no R) when he comes home, correct?

Do you know what type and amount of subQ fluids they’re recommending? I’ve had someone or another in my crew needing subQ for the better part of 10 years and administering does usually get easier after you’ve figured out a routine.

Ditto also Wendy’s comment about getting in the habit of checking resting respiration rate. It’s such a small, noninvasive thing to do and can really clue you in early to impending issues (especially because cats mask things so well).

Since you’re going with the 8u and are a bit concerned about it, I’d suggest you get in some additional BG tests. It’ll be good data to have and hopefully will allay your fears. It might take a few days for the dust to settle after the hospitalization, fluids, R, and so forth, to see the true impact of the dose, but all data is good data. :)

I have been thinking of you a lot lately … wish I could do something to help. One foot on front of the other… :bighug:
Click to expand...

Hi JL,
thanks so much for your suggestions. It's really quite a challenge to keep focussed on the details while I'm feeling a bit out of it in the wake of the past few days.

I'll be posting an update for today but briefly, Eddie is not on R any longer. Solely L. They told me last night they were going to give him 8u but ended up giving him 6u. Further explanation for today.

As for the sub-q: it's just the regular fluid LRS they use for cats with CKD. I don't yet know the amount...

Thanks, again, JL.
 
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