? 12/25: MITTENS - Novolin N (TID) - Ketones Small - MDPS 223

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All - please can we keep the spreadsheet discussions to the PM chat because it is cluttering up the thread and becoming very confusing for other readers.

We need to keep clear sight of Mittens' information and Dan & Heather's questions.

(I also suggest we all delete our own off-topic posts in this thread ASAP, please!)

Thanks,


Mogs
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Kris & Teasel said:
Has this been put on Dan & Heather's list of upcoming things to do?
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I'm definitely in favor of fluids before +6.5, but I'd like to wait until we're sure we won't be administering while BG is already dropping in an active part of the cycle. So maybe hold off until the next test to decide where to put it on the to-do list?
 
@Dan&Heather -

Very sorry for the flurry of off-topic posts.

I think it would be helpful for me to kick off a new thread after you post an update after the next BG test. (I'll add a recap of key stuff at the top of the new thread.)

Is this OK for you two?


Mogs
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Critter Mom said:
All - please can we keep the spreadsheet discussions to the PM chat because it is cluttering up the thread and becoming very confusing for other readers.

We need to keep clear sight of Mittens' information and Dan & Heather's questions.

(I also suggest we all delete our own off-topic posts in this thread ASAP, please!)

Thanks,


Mogs
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Done!
 
Critter Mom said:
I think it would be helpful for me to kick off a new thread after you post an update after the next BG test. (I'll add a recap of key stuff at the top of the new thread.)

Is this OK for you two?
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Yep that would be fine

Critter Mom said:
Do you think you might be able to keep to the same schedule but get her to eat a little extra at each feed - say, 10ml?
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Yes we did plan on trying to give her two syringe's at each feeding, roughly 15mL I guess, so that we can get more food and a little bit of fluid from the water we mix in. I am pretty terrible at feeding her by myself, so I know I cant get her to sit thru two syringe's, but when we're both awake for sure I think we can do it, Dan is better at getting her to open her mouth than I am.

I did get the BG on time: +2.5 -321
Then I fed her 7.5mL fancy feast
And I was able to get her to let me give her about 7.5mL of water from the syringe. I know it's not much, but I want to wait till we decide what time would be best for fluids, which I don't want to give yet because Dan is still sleeping, but I know she needs some. She has drank a little on her own but it's been very, very little. I'm still waiting for her to head to the liter box, but I do have plastic in there in case I don't see her in the process.
 
Dan&Heather said:
And I was able to get her to let me give her about 7.5mL of water from the syringe. I know it's not much, but I want to wait till we decide what time would be best for fluids
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Dan&Heather said:
She has drank a little on her own but it's been very, very little
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Every little drop helps, Heather. :bighug:

If you did have a little bit of chicken to poach in a pint of water that might help. Doesn't have to be a big piece of chicken at all - it's just needed to give the broth a bit of flavour (a flavoured water with cat appeal, essentially). The little bit of flavour can encourage a kitty to drink more water under its own steam. As usual, raising the bowl and very slightly warming the broth can help (tepid to the fingers). If she likes the broth don't give it to her via syringe because that might put her off drinking the broth from the bowl at a later time. Stick with plain water if syringing fluids.

Re timing for fluids I think it looks like she needs them sooner than later. I suggest testing at +3.5 and doing the fluids after that if she is still high (and it's looking that way).

Please post the +3.5 BG result when you get it. Especially if number is under 220 - a safe number but in the target range Meya recommended.

Mittens needs to run lower. I am asking others for their input here.

@Kris & Teasel,@Nan & Amber,@MrWorfMen's Mom

@Meya14, @Jill & Alex (GA), @Chris & China: Please can you offer further guidelines to Dan & Heather for sub-q fluids and also dosing for the next insulin cycle to get BG numbers into a better range.


Mogs
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Good to hear that you're getting a decent amount of food into her, and every bit of water helps. With that 321, she's still running flat as she has previously on the insulin, but it's higher than we'd like.

Mogs, what say you to fluids? Should we do it when Dan wakes up, or wait until the next test? With Novalin N, we're still short of peak activity-- Mittens has been pretty flat overall, but her one dip below 200 was at +6, so it's still possible for her to drop. [edit: ok, this whole question just got superceded by your post above-- thanks, Mogs!!!]
 
I wonder whether the significantly high BGs so far at double the dose point to that dose being too high. Not sure how to dose between 0.50 u and 0.25 u though ...
 
As long as the numbers are high, you can give the subQ. So actually right now might not be a bad time. What you do want to avoid is giving them close to the peak if numbers are dropping rapidly, this can further tank the BS for a bit. Also want to avoid giving too close to shot time to avoid a diluted test. I'm not sure about how fast cat kidneys process the fluid but in humans it's about 30 min to one hour after you drink, fluids are eliminated. Given the fluids may take up to 30minutes to absorb, you are looking at 1-1.5 hours of potential dilution.
 
@Meya14 -

Thank you again for replying. What would your guidelines be for Dan & Heather do about insulin and food for the next two cycles?

Also would it be possible for them to tag you for help later today should they need it?

(I won't be here for much longer today, plus I don't have your knowledge or expertise.)


Mogs
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I'll be in and out all day today, so I should be able to reply, but it may not always be timely. I'll keep and eye out. As for insulin dose, i'd stick with the 0.5 for the next cycle and see what happens, especially if fluid is administered (the next cycle may have a lower start point). It'd be useful to know the current ketone status today to see if the dose needs to be higher as well.

If the vet is open today, is there any way to call and get a box of cerenia?
 
Meya14 said:
As long as the numbers are high, you can give the subQ. So actually right now might not be a bad time. What you do want to avoid is giving them close to the peak if numbers are dropping rapidly, this can further tank the BS for a bit.
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I agree with both points.
Meya14 said:
Also want to avoid giving too close to shot time to avoid a diluted test.
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I disagree with this point to a certain extent.

For some reason, many cats will show an interest in eating on their own immediately following the administration of fluids when sick/not feeling well. If your cat is one of them (Alex was), it's an unintended bonus! The order is fluids, test, feed, shoot. This is a technique that has been used favorably for years with cats. The trick is to make sure fluids and the insulin shot are given on opposite sides of the body to alleviate possible dilution problems.
 
Meya14 said:
I'll be in and out all day today, so I should be able to reply, but it may not always be timely. I'll keep and eye out.
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Thank you so much, Meya.

FYI Dan & Heather aren't sure when Mittens last had a bowel motion. I don't know anything about hypokalaemia but I remember you recommending metoclopramide for Saoirse after her post-anaesthesia motility problems. Is this something Dan and Heather should enquire about with their vet?

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Metoclopramide may be useful to help with constipation induced nausea in this case, however, the mirtazapine can interact and I would not personally feel comfortable giving without a few days in between. Also, there is the rare chance of a bowel perforation if completly obstructed and given a medication to stimulate movement. Hypokalemia can lead to complete obstructions at times. The potassium alone should be enough to get things moving, and if not, I'd try a softener first like miralax. I would also consider going back to the vet if there hasn't been any bowel movements in a few days, in case there is a complete obstruction.
 
I'd also like to make a suggestion...
Getting enough calories into Mittens is important. A very rough guideline when exact number of calories is not always known is to feed approximately twelve 10 mL syringes of food over a 24 hour period.

When shooting TID, if at all possible, try to feed 20 mL prior to every shot and then another 20 mL sometime within each of the three cycles... a total of 12 10mL syringes.
 
Critter Mom said:
Ready to give the fluids?
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I could. Dan is still sleeping and I don't want to wake him up as this is the first real sleep he's gotten in several days, he needs to sleep as long as he can. But I can try hanging the bag on something, I think if I can do that I could do the fluids by myself.

Meya14 said:
what fluids did they give you, what does it say on the bag?
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Says 1000ML Normosol -R pH7.4 multiple elecrolytes injection type 1, usp
Do you need all the specific things it has listed that's in there? I can copy them down if needed, that's what is says on the top of the bag though.

Meya14 said:
If the vet is open today, is there any way to call and get a box of cerenia?
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I don't think so actually. We don't have any money left. DCIN said they are sending us insulin, syringe's and a testing kit. But we ran out of lancets last night and we were on course to run out of test strips at some point today, I'm sure these things will be included in the package they send us, but they couldn't wait so I had to go get some a few hours ago and it took the last of what we had.

Meya14 said:
The potassium alone should be enough to get things moving, and if not, I'd try a softener first like miralax
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About how long would we want to wait for the potassium to help before we started trying other things? I've been concerned about this.

Jill & Alex (GA) said:
Getting enough calories into Mittens is very important. A very rough guideline when exact number of calories is not always known is to feed approximately twelve 10 mL syringes of food over a 24 hour period.

If at all possible, try to feed 20 mL prior to every shot and then another 20 mL sometime within each of the three cycles... a total of 12 10mL syringes
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We will work on this for sure. When we're together feeding her I don't think it will be too hard and I'll just have to step my game up when I'm by myself with her.

Kris & Teasel said:
I think that Mittens needs those fluids ASAP Dan/Heather
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Ok, I will get it ready and have it done very very soon. I'll be back when I'm done
 
Yes-- I think it's a pretty forgiving process. I used to give fluids to foster cats way back when. The memory is fuzzy, but if I remember right I used to do it entirely on my own sitting with the cat in the middle of the kitchen floor, not hanging the bag on anything just holding it. It does probably depend on the cat-- having one that will sit still helps a lot!
 
The higher you can hang the bag the faster it will run as it runs in gravity.
For 1 of mine I hung it on the bedroom drape rod and sat on the bed with her.
With dre I hang it on the highest part of the amour and sit on the floor. It takes about 6 minutes.
 
Dan&Heather said:
Says 1000ML Normosol -R pH7.4 multiple elecrolytes injection type 1, usp
Do you need all the specific things it has listed that's in there? I can copy them down if needed, that's what is says on the top of the bag though.
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No, that's all I wanted to know, just checking what electrolytes are in the fluids.

As far as constipation, you can start miralax if you are nervous and think she is constipated. The potassium won't start helping until it's close to normal range, especially if she is dehydrated. I haven't used miralax personally, but there are others here that can help with dosing. Try to keep an eye on the litterbox, and if she is going, or if she is straining and trying to go. Also, signs of obstruction include frequent vomiting, signs of pain (howling), hissing or howling if you touch her abdomen, frequent trips to litterbox with straining, abdominal swelling. Get to the vet ASAP if you have these. Ideally, you could take her to the vet now to get an abdominal x-ray, but I know that is not possible. So keep an eye out.
 
I have been watching/reading Mittens' story over last few days and am AMAZED at the outpouring of love, devotion, guidance and care shown by the members of this board. You all are so wonderful and I am moved beyond words by how much support you have provided to Dan and Heather in what must be an incredibly scary and confusing time for them.

Dan and Heather- you guys are doing such an awesome job with Mittens and I know it probably feels like you are drinking info on here from a firehose! Keep up the good work!! Mittens is SO lucky to have you are parents. Your vet sounds like an ass btw..but I truly believe if Mittens pulls through it is due to your devotion and the help from the folks here. Good luck to you over the next few days as you support Mittens and eachother.

My kitty just survived a serious bought of DKA a few weeks ago. We also had to syringe feed for a few days. My hubby became an expert at this because it was so stressful for me to do. Ozzy acted exactly the way you are describing your kitty when syringe feeding. What Bob did was sit in the recliner with the chair reclined, place Ozzy on his lap with a towel beneath (you will need one because you probably already know it is messy), have kitty face you laying down and then point the syringe towards his back teeth and insert from the side under his lip towards his back teeth and throat. You may need to hold his head securely. This was the easiest way to get the food down. Hope this helps if you are still syringe feeding. Hope you are not though!

Good luck Mittens, Dan, and Heather!! We are all rooting for you! XO:bighug:
 
Dan & Heather, I've just posted a 911 message in the main health forum asking for more help with Mittens' treatment from people who have more experience than Linda, Mogs, Nan and I have. The 911 tag is aimed at getting attention. I'll remove it later. Please go read what I wrote and let me know if you approve.
 
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Wow that's terrifying, should I be alot more scared than I am? I just got her to eat 7mL of fancy feast and gave her the fluids so I thought things were not great, but not 911..
 
Dan&Heather said:
Dan helped me, we got done with it about 5 minutes ago. I'm going to see if she's interested in food at all right now.
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Great job! As advised above, this might bring her blood glucose levels down for the next hour or so, so keep in mind that will affect any blood glucose tests you do in that period. You usually test at +6, which shouldn't be as affected, but just in case you were thinking of testing earlier than that.

What we really need to know right now is the ketone status, but that's on Mittens' to cooperate :rolleyes:.

I hope she starts to get more interested in food on her own soon, but other than that, just keep doing what you are doing and getting as many calories as possible into her. Poor Mittens!

When you get a chance, could you get a count of what supplies you have on hand until tomorrow? Number of test strips and lancets, principally, but if you think you are running low on anything else, that too. Just so we know what we are working with.
 
Kris & Teasel said:
I'll remove it and put in a question mark if you like. Let me know.
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Not necessary to remove it, I read it, I thought it was going to sound a whole lot scarier than that. Thank you for doing that, anyone who has suggestions is appreciated, maybe someone will have some input.
 
Dan&Heather said:
Wow that's terrifying, should I be alot more scared than I am? I just got her to eat 7mL of fancy feast and gave her the fluids so I thought things were not great, but not 911..
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The "911" tag is used to denote urgency.

In this case, Mittens is not presently in a life-threatening crisis, but you can probably tell from the anxious tone of some of us, she is in a very precarious position right now. With her blood glucose levels more elevated today and with her having some ketones in the past, we are worried that she is at risk for going into full-blown diabetic ketoacidosis (DKA), and that is a life-threatening situation.

The fluids should help, as will the insulin, and every bit of food you can get her to eat will also help.
 
Nan & Amber said:
The "911" tag is used to denote urgency.

In this case, Mittens is not presently in a life-threatening crisis, but you can probably tell from the anxious tone of some of us, she is in a very precarious position right now. With her blood glucose levels more elevated today and with her having some ketones in the past, we are worried that she is at risk for going into full-blown diabetic ketoacidosis (DKA), and that is a life-threatening situation.

The fluids should help, as will the insulin, and every bit of food you can get her to eat will also help.
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Actually, the 911 is to be used for medical emergencies, not on a thread to round up extra help. If there is a medical emergency, the 911 prefix would be put on this thread. A question mark is appropriate for the other thread.

I know everyone's trying to help, but let's work within the guidelines set by the owner of the board. :)


Edited to add: Given the number of views on this thread and the ones before it, I believe many are watching, but are being respectful in not wanting to clutter up this thread with chit chat/non-essential posts. I have faith in my fellow members. If anyone can add to or has another opinion, I count on them jumping in to address issues at hand.

Great suggestion from Mogs, "ask for experienced members in different time zones to check in and keep an eye on Mittens' BG numbers over the next 2 cycles and to help Dan & Heather with general queries and perhaps pitching in if Mittens should need a bit of help staying in good numbers."


 
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Kris & Teasel said:
How is she behaving? Moving around? Interacting with you?
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She's just kinda laying in the kitchen like she usually does, she's usually either in there or behind the couch lately.
er of 50 that I got from Walmart today, i bought the box of lancets earlier too

Nan & Amber said:
When you get a chance, could you get a count of what supplies you have on hand until tomorrow? Number of test strips and lancets, principally, but if you think you are running low on anything else, that too. Just so we know what we are working with.
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We have 2 more test strips in the container we've been using and a new container of 50 that I got earlier, and the box of lancets had 100 in there and I think I've only used maybe 3, we have 8 cans of fancy feast classics, 4 cans of fancy feast gravy lovers, 4 jars of baby food, some cat treats (that she hasn't been getting), honey, the bottle of insulin is still just about full because she's gotten such small amounts, I think 7 more treatments worth of fluids. I think that's everything.

Nan & Amber said:
In this case, Mittens is not presently in a life-threatening crisis, but you can probably tell from the anxious tone of some of us, she is in a very precarious position right now. With her blood glucose levels more elevated today and with her having some ketones in the past, we are worried that she is at risk for going into full-blown diabetic ketoacidosis (DKA), and that is a life-threatening situation.

The fluids should help, as will the insulin, and every bit of food you can get her to eat will also help
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Ok, I understand. I will watch her so we can get a urine sample to find out if there's any change in that. I test her BG again in 10 minutes, I'll post the results when I have them.
 
Dan&Heather said:
Not necessary to remove it, I read it, I thought it was going to sound a whole lot scarier than that. Thank you for doing that, anyone who has suggestions is appreciated, maybe someone will have some input.
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At Admin's request I've replaced the 911 with a question mark. The message is also posted on the Lantus/Levemir forum which has many members.
 
Have you tried giving her treats to see if she's interested? Treats sometimes are very palatable even if cat is ignoring other food.
 
Meya14 said:
Have you tried giving her treats to see if she's interested? Treats sometimes are very palatable even if cat is ignoring other food.
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Yes we've tried since they used to be one of her very favorites, but she has no interest at all unfortunately.

Just tested again +6 -331
 
Meya14 said:
Have you tried giving her treats to see if she's interested? Treats sometimes are very palatable even if cat is ignoring other food.
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Yes, treats! Or is there any "people" food Mittens likes? Alex loved Cheetos or White Cheddar Cheeze-It crackers! Sometimes I could get her eating if I crumbled a little bit and sprinkled it on her food. Sprinkling Parmesan cheese on her food also helped.

You may find a few other ideas that'll work for her here:
Suggestions on How to Stimulate Kitty's Appetite
 
@Dan&Heather -

Are you keeping Mittens in the same room as the litter box with the plastic wrap ready to collect a urine sample next time she pees?

(Not meant to be naggy - just checking what's happening at your end. :) )

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