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

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SITREP: (All clock times are in 24-hour format / EST = GMT -5 Hrs)


HUMAN METER - NOVOLIN N INSULIN - Regular Assist Feeding via Syringe

DIABETIC STATUS: Dx - 19 Dec 2016; Insulin started PM 23 Dec (extremely poor vet support caused delay)

URINE KETONE STATUS:
23 Dec - c. 12:00 EST - Positive SMALL (at vets)
25 Dec - c. 06:00 EST - SMALL to TRACE (closer to Trace) - +7.5 post-insulin
25 Dec - c. 12:30 EST - SMALL / +4.75 post-insulin / +6.5 post-subq

Guidelines for Ketone Management from Meya14 (DON'T copy dosing! It's for a specific on Vetsulin.)

MEDS:

Potassium Deficiency - Supplement Administraton (1 tablet q12 for 2 weeks)
- Treatment Start Date: 23 Dec 2016 (PM)
- Most Recent Dose Given: 25 Dec 07:00 EST
- Next Dose Due: 25 Dec 19:00 EST

Sub-q Fluids - Vet Rx: 100ml every 24-48 hours (depending on oral fluid intake)
- Most Recent Admin: 25 Dec c. 05:30-06:30 EST (>1.25 hrs before insulin dose / +7-8 since prev dose)

Appetite Stimulant - Mirtazapine (1/8 of 7.5mg tablet every 48-72 hrs)
- Most Recent Dose: 24 Dec 02:30 EST

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INSULIN - Novolin N (U100) - 8/8/8 DOSING - RELION METER (Target Range: 150-220)
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24 Dec 2016

AMPS - *** - (no insulin)

PMPS - 305 - Dose: 0.25IU (22:30 EST) - Assist fed 7.5ml - tested immediately after food.
+1.50 - 306 - 7.5ml food after test
+2.50 - 263 -
+4.00 - 228 - 7.5ml food before +5
+6.00 - 284
+8.00 - *** - Sub-q fluids 100ml given some time between +7 and +8 (05:30 - 06:30 EST)

(Technical hitch with fluid giving set. Next insulin dose will be +1.25 hrs after scheduled time.)
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25 Dec 2016 -

NB: Dosed at +9.25 relative to previous insulin dose (fluids given >1.25 hrs BEFORE insulin)

AMPS - 298 - Dose: 0.25IU (07:45 EST) - 7.5ml (?) food + Potassium supplement (07:00-07:15 EST)
+1.50 - 268 - Fed 7.5ml @ +0.50
+2.50 - 228 - Fed 7.5ml + 10ml @ +3.00
+4.00 - 236 - Fed 7.5ml @ +5.25
+6.00 - 189 -

MDPS - 223 - Dose: 0.25IU (16:15 EST) - Fed 7.5ml FFC @ 15:15 EST (PS test at AM+7.50).
+1.50 - 227 - Fed 7.5ml FFC @+2.25 + Potassium Supplement (c. 18:30 EST)
+2.50 - 223 - Fed 7.5ml FFC @ +3
+4.00 - 226
+6.00 -



(Note: Addnl BG test just before dose and after food: 220 (Dose a little behind schedule - @ +8.5 hours after previous dose administered.)



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FOODS AVAILABLE:
* FF Classics (FFC): <= 5% carbs
* FF Gravy Lovers (FFGL): >=20% carbs
* Beechnut Baby Food (BBF): <=3% carbs

24 Dec - PM CYCLE - fed FF Classics
25 Dec - AM CYCLE - fed FF Classics

OTHER:

Anti-nausea:
- Cerenia administered at vet - c. 12:30 EST 23 Dec - (NB: NO CERENIA DISPENSED FOR HOME TREATMENT!!!)
- B12 administered at vet (same time as above)
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@Dan&Heather -

If I'm right it's 16:07 EST - you're slightly running behind schedule. Are you ready to give the insulin?

I've not heard from Linda or Meya so in the absence of other input please stick to the 0.25IU dose.

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Was the 189 on the first or second cycle of 0.25 u? If on the second cycle I think it's safe to increase to 0.5u considering there's still small ketones. You can mix a few drops of honey with the syringe feeding to keep sugars in the right range. Range 150-220mg/DL on human meter.
 
Second cycle.

ETA - Thanks, Meya.

I wasn't confident enough to suggest the increase (thanks for tip about adding honey to feeds).


Mogs
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ok, we did BG it's 220, then we gave her 0.25 insulin cause I didnt see this message. should we give her another 0.25 right now?
 
Just saw your post @Critter Mom re: dose. Need to catch up a bit here but with that 189 earlier, I'd go with the 0.25u again too!
ETA - oh I see Meya weighed in and was thinking 0.5U. Is someone going to be able to monitor tonight? I can't as I have to go out tomorrow and it entails a hefty drive for which I can't risk being tired unfortunately.
 
MrWorfMen's Mom said:
Just saw your post @Critter Mom re: dose. Need to catch up a bit here but with that 189 earlier, I'd go with the 0.25u again too!
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Thanks for responding, Linda. Meya recommended 0.5 (ETA - with drop of honey in food to bump up the carbs a bit) but Dan & Heather didn't see the message in time.

0.25 IU administered - Waiting to see if Larry will respond to tag for input on question above this post.

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How much of the FF Classics did Mittens eat before her current insulin dose?

(FYI re your earlier question, Heather, on the board we often refer to Fancy Feast Classic varieties as Fancy Feast paté style food.)

Also can you confirm the exact EST dose time, please?

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Critter Mom said:
How much of the FF Classics did Mittens eat before her current insulin dose?

(FYI re your earlier question, Heather, on the board we often refer to Fancy Feast Classic varieties as Fancy Feast paté style food.)

Also can you confirm the exact EST dose time, please?

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Click to expand...

We gave her .25U insulin at 4:15pm, one hour before she ate 7.5ml of fancy feast and im about to feed her again in 30 minutes
 
Woodsywife said:
Is she eating anything on her own yet? Keep offering, eventually she will start you don't want to miss any opportunity.
Click to expand...

Not yet she isnt, i keep some of the Fancy Feast out by the water(raised up a few inches so she dont have to bend over as much to eat). She looks at it like she wants to but then just turns around and walks away.
 
@Dan&Heather -

- If you haven't done a +1.5 BG test, then please test Mittens BG straight away.

(Very important to see where this cycle is headed.)

-----------------------------
Note:
- Target time for next potassium is 19:00 EST - c. 50 mins from now (so give with nearest feed to this time?)

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Critter Mom said:
@Dan&Heather -

- If you haven't done a +1.5 BG test, then please test Mittens BG straight away.

(Very important to see where this cycle is headed.)

-----------------------------
Note:
- Target time for next potassium is 19:00 EST - c. 50 mins from now (so give with nearest feed to this time?)

.
Click to expand...

Sorry got distracted from posting because my mom stopped by and wanted to see how Mittens was doing. I had the BG test done and typed out, just didnt post it.

So far today
4:15pm MDPS -220
5:45pm +1.5 -227
 
Thank you! Needed to check for dose onset. As Meya commented earlier, it can take a few cycles to see how effective a dose is going to be.

Dan&Heather said:
I had the BG test done and typed out, just didnt post it.
Click to expand...
I've been doing a fair bit of that myself today. :oops:

Will keep an eye out for the +2.5 test. Also please can you keep posting the feeding info as you go (also in '+' notation if possible, please! :) ). Also a note of the feed containing the potassium supplement.


Mogs
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Critter Mom said:
Also, when was the last time Mittens had a poop?

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Click to expand...
Im not exactly sure when she pooped last, it might have been a few days ago. The last time i know for sure was a few days ago. If im not there to see her go in, im not sure who left it her or my other cat. All ive seen her do latley is pee.

Critter Mom said:
Will keep an eye out for the +2.5 test. Also please can you keep posting the feeding info as you go (also in '+' notation if possible, please! :) ). Also a note of the feed containing the potassium supplement.


Mogs
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Click to expand...

To post her food would i just put "+10ml of Fancy Feast" alongside the BG results?
 
Dan&Heather said:
Im not exactly sure when she pooped last, it might have been a few days ago.
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Meya advised that the low potassium can slow the gut. If Mittens is a bit constipated that could contribute to the nausea.

Dan&Heather said:
im not sure who left it her or my other cat.
Click to expand...
Keep a note of all bowel motions. Even with two kitties in the mix we may be able to deduce who pooped what. Also monitor the litter box for any signs of liquid/runny poop.

Dan&Heather said:
To post her food would i just put "+10ml of Fancy Feast" alongside the BG results?
Click to expand...
Format example:

+2.50 - 201 - 7.5ml Fancy Feast Classic at +3

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Critter Mom said:
Meya advised that the low potassium can slow the gut. If Mittens is a bit constipated that could contribute to the nausea.


Keep a note of all bowel motions. Even with two kitties in the mix we may be able to deduce who pooped what. Also monitor the litter box for any signs of liquid/runny poop.


Format example:

+2.50 - 201 - 7.5ml Fancy Feast Classic at +3

.
Click to expand...

Ok i will start keeping track of their bowel movements, im guessing hers should be easy to distinguish since she hasnt really eaten any solid food for a while.

Thanks for clearing up how to post the food, i will start posting that as well(im keeping track of it here on a notepad on the computer too). Got another 7.5ml warming in a cup of water now, will post after her next BG Test in just over a hour from now.
 
Another thing re the stools, watch Mittens in the litter box to see if she strains to go - a very hunched position.

Position of cat when urinating:

iu
iu


When having a poop the position is more 'hunched', the bum is more in the air, and the hind legs tend to be more tucked under the body (if you get what I mean - can't find a pic).

Watch out for any 'marbles' or very hard stools. ETA - also watch for liquid/runny poop.

Let us know about 'developments'; they can be a very valuable diagnostic aid.

It's good fun round here, innit! (Joys of kitty parenthood ... :rolleyes:)

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Hey all--

Popping back in for a couple hours-- looking really good tonight so far! :)

How are you guys holding up, Heather and Dan? Are either of you scheduled to work tonight/tomorrow?
 
Hi Nan,

Glad to see you here. :) I hope you've been having a good Christmas.

How long will you be around for? (Getting very, very punchy at this end.)

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Hi Mogs--

I can be around for a couple hours at least-- I might be able to stay up until the next shot time in four hours (I think), but I won't last much past then :(. I was thinking it might be good to put another call out soon, but I don't know who would be most likely to be able to help in the relevant time frame.
 
Nan & Amber said:
Hey all--

Popping back in for a couple hours-- looking really good tonight so far! :)

How are you guys holding up, Heather and Dan? Are either of you scheduled to work tonight/tomorrow?
Click to expand...

Im still kicking lol, Im actually not working atm(1st time ive been happy for that) and Heather is at work right now for 6 more hours and off tomorrow so we'll be able to catch up on some sleep tomorrow. Well probably sleep in shifts so someone can keep an eye on Mittens, pretty much what weve been doing.

Just tested her BG again +4 -226

So far today:
4:15pm MDPS -220
5:45pm +1.5 -227
6:45pm +2.5 -223
8:15pm +4 -226 7.5ml Fancy Feast at +3

I think i did the Food portion right? I'll start adding the food everytime, i just did the most recent this time. I got it all written down tho so if i need to i can.
 
Nan,

Next dose is due at 00:15 EST (05:15 UK time). Meya suggested earlier to increase the dose to 0.5IU Novolin N and up the carbs in the food. (A larger carb load can enable a support larger dose of insulin so as to reduce ketone levels. Here are her guidelines:

Meya14 said:
Was the 189 on the first or second cycle of 0.25 u? If on the second cycle I think it's safe to increase to 0.5u considering there's still small ketones. You can mix a few drops of honey with the syringe feeding to keep sugars in the right range. Range 150-220mg/DL on human meter.
Click to expand...

We need eyes of experienced members confident in steering curves on Mittens because it's the first cycle on that dose. All is made trickier, of course, by the nausea issue plus we're still in the process of gathering data to help us learn how Mittens' BG levels respond to the Novolin N and to food.

We need to keep an eye out for who's around. I'll be here for a little while yet (still trying to get stuff into the spreadsheet! :rolleyes: )


Mogs
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Looks good on food!

One question: what's going on with the potassium dose-- was that included in the +3 feeding?

Mogs: I will keep an eye out for experienced members. I'm definitely not in that category, but I'll be here as long as I can in the "moral support" role!
 
Dan&Heather said:
I think i did the Food portion right? I'll start adding the food everytime, i just did the most recent this time. I got it all written down tho so if i need to i can.
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Spot on, Dan! Thank you. :)

I'm noting stuff as you post it as well (brain is v. fuzzy so it's taking me longer to collate stuff).

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Thanks for helping out Nan. I'll be signing off now as I need to sleep and go to work tomorrow.
I wonder if starting the increased dose at AMPS (8:15am) tomorrow wouldn't be smarter as there would be more people around to help out.
 
Nan & Amber said:
Looks good on food!

One question: what's going on with the potassium dose-- was that included in the +3 feeding?

Mogs: I will keep an eye out for experienced members. I'm definitely not in that category, but I'll be here as long as I can in the "moral support" role!
Click to expand...
Sorry, the potassium was in the feeding right before that one, we fed her the potassium at 6:20pm today(approx 2 hours ago).
 
Nan & Amber said:
I'll be here as long as I can in the "moral support" role!
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I could do with a bit of that meself, Nan! :D

If you can keep tabs on who's around that would be really helpful. Just on the off chance I fade unexpectedly, if I go quiet but you haven't seen a 'formal sign-off' on this thread or if I don't respond to tags then work on the principle that I've passed out and go whoever you can find. (If FH is quiet try going over to L&L to round up a posse.)

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Dyana said:
I'll be signing off now as I need to sleep and go to work tomorrow. I wonder if starting the increased dose at AMPS (8:15am) tomorrow wouldn't be smarter as there would be more people around to help out.
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If ketones weren't in the mix I'd very much agree with the above but we're a bit caught between Scylla and Charybdis at the moment: not enough insulin and the ketones aren't getting dealt with as well as possible; an active cycle without experienced eyes on Mittens and numbers could go low.

This cycle seems to be quite flat at the moment. With so little data it's tough trying to make a call this early.

Sleep well, Dyana. :bighug:

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@Nan & Amber -

Can you keep an eye on Team Mittens for a little bit, please? I'm having great difficulty shifting focus now and I'd like to try to get some of the BG data into Mittens' spreadsheet.

If you need me send me a PM because I'll see the alert for it easier (can't manage going through all my normal alerts at the moment).

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Dyana said:
I wonder if starting the increased dose at AMPS (8:15am) tomorrow wouldn't be smarter as there would be more people around to help out.
Click to expand...
Critter Mom said:
If ketones weren't in the mix I'd very much agree with the above but we're a bit caught between Scylla and Charybdis at the moment: not enough insulin and the ketones aren't getting dealt with as well as possible; an active cycle without experienced eyes on Mittens and numbers could go low.
Click to expand...
Perhaps holding off on a dose increase is a call for Dan and Heather to make. Not only will there be more people around to help in the morning, but Dan and Heather may need a little bit more rest which they might be able to get if the dose remains at 0.25u for tonight. Things have been rather intense and no one will be of any help (especially Dan & Heather) if they can't get "some" rest.

Just throwing this out there for consideration...

 
Jill: would that suggestion apply if Mittens is still throwing "small" ketones at the next test (whenever she decides to cooperate :rolleyes:), or only if she's back down to trace or negative? She's doing great on the 0.25IU so far, keeping numbers in the low 200's, so I'm hopeful things will keep under control but I just don't know enough about how these things go to guess.
 
@Jill & Alex (GA) -

I really appreciate your experienced input on this, Jill. I would be very, very much in support of keeping to the 0.25IU dose for the next cycle. (My only worry was what to do about the ketone levels.)

I desperately need rest myself. I'm likely to be the only person around on the UK side in the morning.


Mogs
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