10/23 Ming in hospital

Crista & Ming

Crista & Ming

Member Since 2018
Here's yesterday's thread: http://www.felinediabetes.com/FDMB/threads/10-22-ming-intro.205268/

I also posted a bit in the PZI forum just because I was having a little freak out and felt better about talking to people there. It's reply #27 but I will summarize below: http://www.felinediabetes.com/FDMB/threads/a-lot-of-thoughts-going-on-in-my-head.205130/

We started Ming on 5 units of lantus last night.

When I spoke to the IM specialist, we decided to try raw twice a day with dry food out for Ming. I expressed my concern about carbs. She said it will be a controlled amount. I thought about it more and didn't like it. Then I heard from the night nurse that they're giving Ming 1/2 can of DM wet twice a day (plus some amount of the freeze dried nuggets) and 1 tbsp of DM dry four times a day.

And of course, I'm just going.. what?! Especially because his BGs are going to be stinkin' high. We don't need to add fuel to the fire. The night nurse was not happy and almost wanted to lie and just give Ming wet food throughout the night but she didn't want to screw Ming over. But she did end up only giving freeze dried food the last half of the night since he BGs stayed in the 25 mmol/L or 450 range.

I texted the specialist about my concerns and didn't get a reply. I called the hospital and heard the specialist called them and they increased his dose to 7 units and reduced his dry feedings to 1 tsp four times a day instead of 1 tbsp.

And I think they took him off fluids because his potassium was high or something. The vet I spoke to sounded like she agreed with me about the dry stuff but I think her hands are tied.

His BG was still in the 20s and 400s when I spoke to her in the morning around 1030 AM. I believe Ming gets his shot at 8 AM.

So.. that's where I'm at. I'm not happy. I'm upset. I know it's only a little bit of dry but it doesn't make sense. The good thing is Ming doesn't seem to react too much to the DM dry anyway. The two times he went low to 3 mmols or under 50, the night nurse would feed him dry and his BG wouldn't spike dramatically.

I have my night shift tonight with him so... I'm tempted to just not give any dry food. I'm in a weird position where I'm both an employee but also a client. I hope I'm able to catch the doctor at the hospital before my shift and maybe I can speak to her.

Perhaps once he comes home, it'll be better. I said in the PZI forum that I think there's too many hands meddling in his case and because of that, no one is taking 100% responsibility. They're all in his weird stalemate at the hospital. The IM specialist is a mobile vet so she's not there all the time for the other doctors and staff to consult with.

tiffmaxee said:
Are you only feeding him twice a day? My vet told me small meals often are best for pancreatitis because if they eat too much at one time they feel awful. It seemed to help Max and also to level out his BG.
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At home, I fed him whenever I felt he was hungry. He was good at telling us he's hungry. Or even when he's not asking for food, I still give him food just in case.

I didn't know about the eating all at once making them feel awful. I was talking to my mom last night and she made a good point that we need to figure out what are good portions for him if we're going to feed him small meals a day. It used to be just two large meals and then whatever small meal we felt like feeding him. He also doesn't usually eat everything all at once when I feed him during shot times anyway and I just leave his food out for a couple of hours so he can go back to it.

tiffmaxee said:
Have you ever tried ondansetron for nausea?
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No I haven't heard of it! Is cerenia not enough to quell nausea?

Wendy&Neko said:
Has Ming ever had an echocardiogram? I see his heart is slightly enlarged. Prednisolone is contraindicated for some types of heart conditions, which my girl had. She also had a slightly enlarged heart.
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No, he hasn't. I'm not even sure if he has an enlarged heart. His x-rays were sent to a ultrasound specialist and she didn't note anything about his heart being enlarged. That diagnosis was given to him years ago and since then, he's had multiple x-rays and no one has said anything about it. I did mention it to the specialist too. I guess I'll have to bring it up again.

Wendy&Neko said:
If Ming is going to be a higher dose kitty, you might want to consider Levemir instead of Lantus. The action is similar, which later onset/nadir with Levemir. At larger doses of Lantus, it's acid base can sting and some cats have a reaction to the shot.
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Is the only benefit to trying Levemir so that the shot doesn't sting? I'm a little hesitant to switch yet again. Ming seems to do well with being given cerenia sub q and I've seen other cats and dogs react to it. He doesn't even flinch lol!

And as always, THANK YOU for taking the time to read my thoughts and also all the great suggestions :)
 
Once kitties here get to six units of insulin, we suggest that their caregivers get them tested for "high dose" conditions, specifically acromegaly (IGF-1 test) and IAA or insulin auto antibodies. My Neko had both. One in four diabetic cats has acromegaly, and it's been found in cats with doses as low as 1 unit. Vet's used to be taught it was a rare condition, so your mileage may vary in getting the vet to test for them. The blood is sent to Michigan State University for the tests. Extreme hunger and heart conditions can be clinical symptoms for acromegaly.

As for Levemir, it seems to have a somewhat better duration for higher dose cats. Do not worry about switching now, but maybe keep it in the back of your mind. I didn't think Lantus stung Neko, but she occasionally walked away from the shot. She purred through the Lev shot.

Ondansetron is less a go to med for vet's in Canada, but it targets different nausea receptors than does Cerenia. For some conditions, it works better. When things were getting complicated for my girl, she needed both it and Cerenia. Ondansetron is a people drug, you just need a script.

I would not mix raw and dry food. The two are digested at different speeds in the gut and can cause digestive upset.
 
I’ll bring the acromegaly up and also do some research on that. The steroids also might not be helping with the doses. He was on 4 units of PZI and did relatively well before his pancreatitis episode.

But I’ll ask about it but I’m also going to assume the vet won’t think much of it until we finish his steroids and find out his dose still needs to be that high.

I won’t be bringing in anymore of the freeze dried raw food then. He can just stick with eating DM dry and wet for now until he gets home. @Kris & Teasel recommended a supplement and I’ll be looking into that to help with his possible IBD issues.

Thank you for your response! I think I’ll go read some of your threads since it sounds like you and Neko have gone through some similar situations as Ming :)

ETA: maybe I’ll bring up the whole possible IBD issue. So that we can stick with him just eating wet. So I don’t sound like a crazy client trying to get my way because I’m hung up on a certain food and more of someone who is actually not wanting to meddle with a sensitive stomach and digestive tract with all these weird foods.
 
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My Neko was on raw, until the point where she couldn't eat it due to soft tissue growth in her mouth. She never did get a difinitive diagnosis of IBD or small cell lymphoma, because her heart could not anesthesia which would have been needed for the surgical biopsy or endoscopy. Her heart also couldn't take prednisolone, so she was on budesonide, also a steroid, but more specific to the gut.

I think you are right in the raw food issue. Wait until he is home and you can control better what he eats, and more importantly, test closely when he transitions to a lower carb diet.
 
I agree that you should press for an IGF-1 test, and the IAA test at the same time whilst you are at it. Although Ming does seem to react temporarily to increase dose of insulin, his dose does seem to be going up and up.
 
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