12/29: Double-dose: need advice|Cliff Care (bringing him home)

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MiCo

MiCo

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http://www.felinediabetes.com/FDMB/...pdate-cliff-to-vet-12-29.170289/#post-1855879

Starting new thread for tonight. We're gonna need it! Put your thinking caps on for this one-Cliff got double dosed at the vet's office today. He got 4units pro zinc in AM (around 11A) and then 2units around 2:30pm est. They told me, & said they were "concerned, but not worried."

He was 313 at last BG test. Gonna pick him up and go straight home. Will post other notes when I have time, but said he is not DKA. I will be testing at home and trying to get him to eat.

Anyone with experience in staggered dosing? I do not have experience and have no idea when i need to worry about lows, or when to think about dosing again? Tomorrow am, or wait until pm? Or don't worry abt that now and get thru tonight. See how #s are in AM?

My thoughts, he had previously received insulin as high as 4.5. He went without since 12/28 at 4a est was last insulin 4units, so he had gone 24+ hours since last insulin before receiving 6units today total. Will update ss with today's #s when home.

Thank you!! Driving to get him now.
 
Well, normally you'd watch for two nadirs - each 5-7 hours after each shot. And there is a potential for a "double dose" to hit after the second shot, when it's onset adds to the what is left in the first shot. I would plan to monitor carefully for 8-10 hours after the second shot (probably skipping tonight's shot but at least giving it late), have high carb gravy available and your vet's number in case he hypos. If you are all prepared, then he will probably be fine.:D

What were they thinking?
 
As I am not an experienced Prozinc user I can't offer any advice at this point. However Prozinc is a longer acting insulin so the chance of Cliff dropping down too low is a definite possibilty. Please change your title to include the "?" icon and change the post to something like Double Dose need advice so that the more experienced Prozinc users can weigh in.

My own opinion is that if the people at the clinic were not concerned I would consider finding another clinic.
 
Were they thinking he was possible DKA and they wanted to increase insulin? Reading your other thread, it looks like they thought possible ketones. You can give water and food via syringe but ketones are scary.
 
Sue and Oliver (GA) said:
Were they thinking he was possible DKA and they wanted to increase insulin? Reading your other thread, it looks like they thought possible ketones. You can give water and food via syringe but ketones are scary.
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There was a mis-communication and 1st dose was given and not recorded. 2nd dose given (thankfully a half-dose.)

They are concerned, but not worried since they know we can monitor at home and have helped him through a low/hypo before.
 
11:40a est 4.0 units Prozinc
+2.67 2:20p est 2.0 units Prozinc
+4.33 4pm est BG=313
+6.33 6pm est BG=282
+8 (from 1st dose) BG= 275

Ate a treat and some dry food. Just a few kibble. Gonna try wet food in a few, just waiting for him to get settled in here.
 
MiCo said:
11:40a est 4.0 units Prozinc
+2.67 2:20p est 2.0 units Prozinc
+4.33 4pm est BG=313
+6.33 6pm est BG=282
+8 (from 1st dose) BG= 275

Ate a treat and some dry food. Just a few kibble. Gonna try wet food in a few, just waiting for him to get settled in here.
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You'll have to watch for that nadir/overlap from the two different doses probably around 8 - 9 PM EST. Hard to say what effective dose the 2 u plus the remnants of the earlier 4 u will create. What meds did Cliff come home with?
 
Kris & Teasel said:
You'll have to watch for that nadir/overlap from the two different doses probably around 8 - 9 PM EST. Hard to say what effective dose the 2 u plus the remnants of the earlier 4 u will create. What meds did Cliff come home with?
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  • He came home with cerenia tablets (but since he got injection today, I was told not to give next dose until tomorrow at noon.)
  • We just picked up the cyproheptadine for appetite. Gonna cut that up and try to give in pill pocket now (or toss down his throat.)
  • He was given antibiotic injection today (something he has had before)
Gonna pill him and then try to get him to eat. Hypo kit on standby. Have Karo and a syringe, if needed. :) hoping and praying for an easy night. We are calling vet in AM to discuss next steps, which include when to give next dose and how much.

What a day! My poor buddy.
 
  • Just gave appetite stimulant, and he gobbled up the pill pocket. This is good. He has been picky with those in past.
  • Ate about 1/8th of a 5oz can of friskies pate sprinkled with freeze dried chicken.
 
Don't know what they were thinking but at least they told you and didn't hide it. Your prepared should you need to intervene and FDMB is here for you.

I hope you get bw results tomorrow and they know what is going on. :bighug::bighug::bighug:
 
Woodsywife said:
Don't know what they were thinking but at least they told you and didn't hide it. Your prepared should you need to intervene and FDMB is here for you.

I hope you get bw results tomorrow and they know what is going on. :bighug::bighug::bighug:
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Thanks! I know they feel bad about it, and in the end I am glad they told us so that we are prepared. So far, he looks good BG # wise. I am thrilled he ate a little. Seems happy to be home.

I know fdmb is here for me, should something come up. I know where to post (main board) & what tag to use... Should the need arise.
 
Sue and Oliver (GA) said:
Sounds like he is happy to be home!
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So happy! He is cleaning (stinky vet smell!) and just started purring when I pet him. I put his carrier in my closet so he has a little cave to retreat to. I told him if he just starts eating again, he won't have to go back for a while!!
 
+10 (from first dose) BG=139 --we are +7.33 from 2nd dose

Ok with this #, but will check again in 3omin at +10.5 or at +11
 
Happy he is feeling better, but I am still concerned about the 2+ ketones in his urine. I think that is worrisome .. According to the urine scale, there is trace, then 1+, then 2+, 3+ and 4+. Anything above trace is very worrisome.. Did they say anything about that when you brought him home?
 
BG looking good so far. Coming up on +12 for that first dose which is good. You're handling this perfectly!! Sending good eating vines and hugs.
 
Carol & Murphy said:
Happy he is feeling better, but I am still concerned about the 2+ ketones in his urine. I think that is worrisome .. According to the urine scale, there is trace, then 1+, then 2+, 3+ and 4+. Anything above trace is very worrisome.. Did they say anything about that when you brought him home?
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Not ignoring this post, just need to focus on BG #s tonight. both vets assured me while ketones present, he's not dka. I have to believe that, at least for tonight. Also, he got subq and electrolytes today. Thanks!
 
+11ish (about 30min after last test) BG=110

He ate *a little* more of gravy food with treats. (For clarification-offering gravy bc he hasn't been eating. Just trying to get food in, any food.)
 
+11.25 (abt 20min after last check) BG=103

I moved the treat bag and he seemed interested, so I gave another treat and he ate a little more gravy food.
 
Finally, +12 from when the 1st shot of insulin was given!! Bg=128

Gonna test again in 1hr to make sure we're rising.
 
You handled it like a champ, Michele, and learned something about the perils of double dosing. How's he feeling this morning?
 
Kris & Teasel said:
You handled it like a champ, Michele, and learned something about the perils of double dosing. How's he feeling this morning?
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Thanks! He seems good. Relaxing. I kept poking him well into the morning hours. :)
  • I will be giving next dose of his appetite stimulant here soon.
  • Waiting on vet to call me back abt today's dosing, but was just abt to post here asking abt that.
    • He was 273 this am at 5a (close to our normal dosing time, +3 from when that 2nd dose would've been worn off, I guess +15 since that last shot?)
    • He was 502 just now at 8a (+18 since last shot.)
    • 4 units seems safe? I really need a quiet day. We were up until 2a, me and cliff.
Let me know your thoughts! He's still not eating a lot, but we made it thru yesterday on 2shots/6units/little food. I can only hope as meds kick in his appetite improves and he starts to feel better.
 
MiCo said:
Thanks! He seems good. Relaxing. I kept poking him well into the morning hours. :)
  • I will be giving next dose of his appetite stimulant here soon.
  • Waiting on vet to call me back abt today's dosing, but was just abt to post here asking abt that.
    • He was 273 this am at 5a (close to our normal dosing time, +3 from when that 2nd dose would've been worn off, I guess +15 since that last shot?)
    • He was 502 just now at 8a (+18 since last shot.)
    • 4 units seems safe? I really need a quiet day. We were up until 2a, me and cliff.
Let me know your thoughts! He's still not eating a lot, but we made it thru yesterday on 2shots/6units/little food. I can only hope as meds kick in his appetite improves and he starts to feel better.
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I think 4 units should be OK. Getting insulin into him is paramount to keep ketones at bay. You're there to monitor (maybe a few less pokes ... ) and can give gravy or a few kibbles to steer. What's your dosing regimen for Cerenia and cyproheptadine again? I know Cerenia is once a day.
 
Kris & Teasel said:
I think 4 units should be OK. Getting insulin into him is paramount to keep ketones at bay. You're there to monitor (maybe a few less pokes ... ) and can give gravy or a few kibbles to steer. What's your dosing regimen for Cerenia and cyproheptadine again? I know Cerenia is once a day.
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Cyproheptadine is twice daily. Started low, to make sure no adverse side effects, but can increase dose tonight (which I will do!)

Just gave insulin-4 units. We are on a 9a/9p schedule now, but I need to get this moved back before I return to work Tuesday.

Probably gonna start a new thread for today! :) thanks.
 
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