1/13/25 Raven AMPS 253 (293 Libre) - dose increase; taking to vet today

SophieFRA

SophieFRA

Member
Hi all, Raven‘s internist who is monitoring the Libre sent me instructions to adjust his dose up by 0.25 to 3u late last night. I did that this morning, though his numbers have dropped to mid-200s. Realize it‘s still too high and dose increase is warranted. But I find it curious that it dropped so much. Perhaps because he‘s not feeling well? He‘s getting as much food as previously and as far as I can tell did not throw up overnight. It was colder in the house last night - not sure if that has and bearing. Our hot water heat cut out last night. Supplemented with our minisplits, but they just don‘t quite cut it when it‘s freezing outside,

He‘s still not eating and his poop is still very dry. Taking him to his primary vet today. Internist follow up scheduled for Wednesda.y

https://felinediabetes.com/FDMB/threads/1-12-25-raven-amps-340-vomited-again-pancreatitis.297408/

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Unfortunately not looking good. They think gallbladder is again obstructed despite stent placement. We‘re being transferred to ER for another ultrasound - only thing to do if confirmed would be another surgery with lesser chance of recovery. This is something my vet would not recommend to put him through again with all his other health issues. I tend to agree. Very sad day but we‘ll see what the ultrasound brings.
 
Better than expected news for this evening - ultrasound did not confirm obstruction. They think there‘s a chance it‘s a liver infection or inflammation, which if confirmed could be treated with antibiotics or steroids. It‘s been such an emotional rollercoaster. I don‘t want to get my hopes up too much. I‘m so tired… but I hope my Ray will keep fighting! He‘s at the ER overnight.
 
Hi all, Raven is hanging in there at the ER. I don‘t actually know his preshot numbers, so didn’t want to start a new post. His blood work has been static, which his internist thinks is positive vs worsening. He’s on antibiotics and we’re hoping that as they start working his values will improve. He’s even eating a little bit again.

But his BG has been super low - like on the verge of hypo. They stopped giving him insulin and they say they are tube feeding him 3 times a day in addition to feeding him. I went to visit him this evening and reconnected to the Libre and it showed he had dropped below 50 a couple of times this evening even through he hadn‘t given him a shot. Has anyone experienced this before? Could it be that the 3u yesterday was too much? Or is he not getting enough food? Or is it related to him being unwell? @Wendy&Neko tagging you in case you have insights.
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Glad to hear the internist thinks things are going better.

Rather than adding the graphs from the Libre, could you put some of the data in the spreadsheet? I like to see the context of several days or more of data, not just a single snapshot.

A couple reasons you are seeing lower numbers. First, the larger depot can influence 4-6 cycles after you reduced the dose. Second, the Libre very often reads lower than a human meter when in lower numbers. We have people test with the hand held meter at the lower Libre numbers, and gotten much higher numbers. Without a check in the lower numbers, hard to say what his numbers really were. Also, if he hasn't been eating his regular amount of food, that will drop his numbers as well. And if he did have an infection, and the antibiotics are starting to help, that will also lower his numbers.
 
Wendy&Neko said:
Glad to hear the internist thinks things are going better.

Rather than adding the graphs from the Libre, could you put some of the data in the spreadsheet? I like to see the context of several days or more of data, not just a single snapshot.

A couple reasons you are seeing lower numbers. First, the larger depot can influence 4-6 cycles after you reduced the dose. Second, the Libre very often reads lower than a human meter when in lower numbers. We have people test with the hand held meter at the lower Libre numbers, and gotten much higher numbers. Without a check in the lower numbers, hard to say what his numbers really were. Also, if he hasn't been eating his regular amount of food, that will drop his numbers as well. And if he did have an infection, and the antibiotics are starting to help, that will also lower his numbers.
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Thanks so much! I really don‘t have any numbers beyond these since he‘s been at ER. But will try to add what I have when I have a moment.
 
SophieFRA said:
Just wanted to add that I just spoke to ER and they said BG is back in high 200s /low 300s after skipped insulin yesterday. So they gave him 2 u today.
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They want to keep Raven overnight at ER. Most of his blood values are slightly worse than yesterday (incl. bilirubin) but he seems outwardly ok. They have switched antibiotic and are waiting for cultures to come back to confirm if truly bacterial infection. If not, next steps would be steroids which I understand can be more finicky with diabetes. They are still assuming liver infection or inflammatioon to be the cause. No obstruction detected by internist today on quick scan (vs in depth ultrasound - not sure what that means but sounds like something they did for quick verification instead of again in depth ultrasound).

Latest blood work below. Comparative data is from 1/8 when he was doing very well in comparison. Yesterday‘s and prior day blood work was done on different system. So not available for side by side comparison. He is slightly anemic today but internist said it didn‘t yet warrant another blood transfusion.
 
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Thank you all so much for your invaluable advice and thanks for being patient with me through my mistakes. We unfortunately will have to say goodbye to our beloved Raven tonight. None of the treatments - antibiotics, steroids - are working, They think he probably has more necrosis of the pancreas. We‘ve truly done everything in our power and the vets tell us there‘s nothing left to do but let him be at peace. I have to make it through a couple more work calls and then I‘ll rush to the ER. I don‘t want my Mr to suffer any longer.

I wanted to say thank you for all your guidance. I have learned so much and yet I still have much learning to do. I think I may one day adopt another sugar kitty, despite the challenges of my commute to put this knowledge to use. For now, please keep my Raven in your thoughts as he crosses across the rainbow bridge. He was and is one special boy! I‘ve only been a pet „owner“ or rather guardian since 2020 and I never had to say farewell to a pet (though I lost my fare share of close family members).

Raven so enriched our lives. Less than two years with him was not enough but we spent many good days together and some hard ones, but always connected by love!

Thank you and all the best to your sugar babies and all those you help! @Wendy&Neko @Tim & Pookey @cecile & bella @Bandit's Mom @Margaret (and Pearl) - I so appreciate you and all the advice you‘ve offered me since 2023.
 
:bighug::bighug::bighug::bighug::bighug::bighug:
I am so sorry there is nothing more the vets can do. You have been a great cat-mom, going above and beyond. I'm sure Raven knew how well loved he is.
I'll look to the skies tonight for that new bright star. cat_wings>o
 
I’m so sorry Sophie. You are a great guardian for Raven and he was loved very much. Hang onto those sweet memories.
 
Oh Sophie, I am so sorry to read that. I am thinking about you right now. I know what you are going through, Bella just left us on Tuesday. It is so sad. Raven was very loved, you helped him through the end and he will love you forever :bighug:
 
Hi all, I have an unexpected update. Against expectations Raven is still with us. We found out on Friday after the ER had advised there was nothing more they could do for Raven that he had an infection that was resistant to the two antibiotics he‘d been on. The cultures came back that afternoon and our internist called me just before I was leaving for the ER. @Wendy&Neko @Tim & Pookey

After much back and forth, we decided to give another antibiotic a shot and give him another 12-36 hours (depending on bloodwork(. I really didn‘t think it would work and felt so guilty for letting Raven suffer longer, but our internist and primary vet both thought it would be worth a shot as long as Raven wasn‘t otherwise declining and in pain and my husband also was lobbying for another try. Yesterday after 12 hours on antibiotic, his bilirubin values were significantly worse at 17.1 vs 13.4, which was not promising and I was expecting we’ll have to let him go today. But today they were improved and better than Friday, suggesting that the new antibiotic is working.

I honestly still can‘t believe this and shudder to think if I hadn‘t been held up by work calls on Friday we might have euthanized him before we found out about the antibiotic resistant infection. He‘s not out of the woods and some of his liver and kidney values worsened (esp potassium). But the ER ran a few more tests and excluded renal acidosis. More tests to be done by his internist tomorrow (in same facility as ER).
 
cecile & bella said:
Oh Sophie, I am so sorry to read that. I am thinking about you right now. I know what you are going through, Bella just left us on Tuesday. It is so sad. Raven was very loved, you helped him through the end and he will love you forever :bighug:
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I am so terribly sorry to hear about Bella. Wishing you much strength and memories to help you through the pain. I have no doubt she lived a full life and you brought so much light to it!

Miraculously, Raven is still with us. I am so sorry for the false alarm. See more details in post below.
 
Tim said what I was thinking "Wow!". This is hopeful news, and please keep us updated. May miracles continue to happen. :bighug::bighug:
 
Hi all, I’m sorry for not updating you. It’s been an emotional week.

Unfortunately, we had to say farewell to Raven on wednesday night. His bilirubin and liver values kept overall deteriorating. At first we thought the new antibiotics might be working because his values were significantly improved last week Sunday, but then quickly deteriorated every day afterw that. My internist thought that the good results on Sunday were due to a botched test. One of the ER’s machines went out of comission shortly later.

We tried everything there was to try and his internist - who is an eternal optimist also said there was nothing left to try. On Wednesday he was also outwardly worse, not purring much, which he always did for pets before. I spent half the day in an empty office at the ER with Raven until my husband could join in the evening and we let him go. At that point my overwhelming emotion was relief that Raven no longer had to suffer. Since then I’ve been going through the motions - missing him of course — especially as I’m clearing out his things.

But it gives me comfort to know that we tried everything and he didn’t suffer for long. And most importantly that we added almost two more mostly happy and healthy years to his life after pulling him off a shelter’s euthanasia list. He made our life so much richer and I know he knew he was loved. He knew that we were his people who he could always rely on. And that makes me happy and grateful.

Thanks so much for all your advice and compassion! I wish you and your kitties all the best! Thank you for giving so much of your time to help others! You are true angels on earth! @Wendy&Neko @Tim & Pookey @cecile & bella
 
I’m sorry Sophie. I can’t imagine all those emotions right now. You did everything you could and gave him a great life, I can tell he was loved very much.
 
:bighug::bighug::bighug::bighug:. I am so sorry you had to let Raven go. What a roller coaster of emotions for you. Take care of yourself. It is especially hard losing a sugar cat.

His last home was at the best place possible for him. I'm sure he felt your love.
 
Sophie, I am so very sorry for your loss. You went above and beyond for Raven to give him two more years of life and love, followed by a gentle passing. I hope you continue to find peace in knowing that you did your very best for him. :bighug::bighug::bighug::bighug:
 
Oh Sophie, that is so sad, I am sorry that Raven left you. You went through a lot those last 2 weeks. You loved him so much, you gave him 2 great years and so much love.
I don't know what to say, it is so very sad, but I am thinking about you a lot and send you many hugs :bighug::bighug::bighug:
 
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