Jill & Alex (GA)
Member Since 2009
Dr. Lisa has also posted about the dangers of having a cat loose in the car...
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13 Feb - Pedro (UK, RVC trial) eating, back on 0.25U insulin
- Thread starter KleineMue
- Start date
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KleineMue
Member Since 2014
I will ask them to give me the data they collected in the time Pedro was at the clinic. They connect electrodes to him to get 24/7 data about his blood sugar level and then check with the alphatrak in regular intervals (every 2 hours I think).
I'm thinking about the bounces and the high dose and the drop and all and I remember something Chris mentioned at the check-out, that cat's diabetes is much like a human with diabetes 2, administering a basal amount of insulin twice daily and then small amounts in line with food to manage the blood sugar more tightly and accurately.
So I wonder if ultimately there is something missing in the way they manage the variable dose and that being that each cat needs a basal amount of insulin plus whatever top-up is required for the food/blood sugar/everything that brings the blood sugar up or down.
Do you know what I mean?
Because if, say, 0.25 units is Pedro's basal insulin amount then maybe it takes much smaller top ups of 0.25 throughout the day to manage his BG? Obviously that isn't necessarily realistic for cat owners but what if the answer is two different insulins? Lantus as elongating basal and something else to top up?
Probably futile thinking about this, but whatever better sounding board to explore these ideas?
As for save cat transports, well, the vision alone of having Pedro crawling under my legs and obstructing me driving the car safely is enough to have me thinking about a big metal cage basically that would sit alongside the back seat (in our car the back bench can be taken out in two parts and the floor is level) So big enough for a cat toilet and a resting area. We usually have a break and offered a little food and drink, but he wouldn't usually eat or drink much while travelling. I guess that's not a bad think considering that what goes in must come out again somehow...
Well, and as for our evening, things have been going well with the syringes so far, he is cooperative in eating what I feed him via the syringe, and has been holding healthy low numbers early evening and is now at 8.8 (158), down from 9.2 (166) an hour ago. Sleeping and resting, shall wake him and feed him again now. As per recommendations feeding him actually gravy vicious food as he turned his nose up to Purina DM the last 30 hours and if syringe feeding potentially is putting him off the food used then that's not the food to use if the trial relies on it so heavily.
Cancelled work tomorrow and my lovely mother in law is picking Josie up so she can have a more entertaining day than watching me monitor the cat.
Hurrah!
Can't wait to talk to Ruth and Chris and hear what they think!
julie & punkin (ga)
Member Since 2011
That's not futile thinking at all. Many of us have used Lantus or Levemir as a basal insulin and then used "R" insulin, either Humulin R or Novolin R, which are quicker acting insulins, as bolus insulins as needed. However, I doubt any of us would suggest that it would be a good step for Pedro to have a secondary insulin. That would likely not fit with the whole dosing protocol of the trial. Usually we reserve the suggestion of a second insulin for cats that either have a high dose condition (acromegaly, insulin autoantibodies or cushing's) or for cats who have really given a good effort to following the TR protocol and still need some extra help. It's used much in the way you described. See, you are more forward-thinking and brilliant than you knew.
I would double-check with your trial people to find out what they want you to dose when Pedro is in normal blood sugar. Following the TR protocol, we would hold the dose the same and not skip or reduce the dose unless the person was new to FD, the cat wasn't eating normally, or the cat couldn't be monitored after the shot. I would ask specifically about this so you know what to do next time you are confronted with a lower preshot. Once you start getting green preshots you often will find them happening again, and it's good to have a plan. With Lantus/Lev being depot insulins, when you skip a shot the depot will drain some and it can influence how flattened out you can get the blood sugar. If that makes any sense at all.
KleineMue
Member Since 2014
Right, I am off to bed for a little while.
Wrote a long email to Ruth and Chris and also checked Pedro's bg every hour, it has steadily been climbing back up and was just 15.4 mmol/L (275)
He is taking ok to the syringes of food and water but I think I need bigger syringes, because the ones I have are tiny! Pharmacy tomorrow!!
Night night!
Mue x
Wrote a long email to Ruth and Chris and also checked Pedro's bg every hour, it has steadily been climbing back up and was just 15.4 mmol/L (275)
He is taking ok to the syringes of food and water but I think I need bigger syringes, because the ones I have are tiny! Pharmacy tomorrow!!
Night night!
Mue x
Elizabeth and Bertie
Member Since 2010
Absolutely.
I have a friend who lost her kitty that way. My friend had a minor car accident and wasn't hurt herself, but the kitty was knocked unconscious and died later that day.
Sometimes, when I've brought a rescue/foster kitty home for the first time, I've put their cat-carrier straight into a large dog crate. There is room in the dog crate for food, water, and a small litter tray (I make disposable ones from cardboard to fit the available space). Then I open the door to the cat-carrier inside the crate, and the cat has access to food/litter tray etc, but still remains confined in a small space.
Maybe something like this would work for your long journeys?
If it seems feasible then you could set it all up indoors a while before the journey, so that the kitty has time to get used to it (perhaps put some cat treats inside to tempt kitty to explore).
Maybe a friend or neighbour has a folding crate you could borrow? If not, they're not expensive to buy, £30 to £40 maybe for a basic crate. You'd need to be sure to get one that had a door big enough to get the cat-carrier inside; and make sure the crate would fit in the back of your car.
Eliz
KleineMue
Member Since 2014
Love the idea of a custom size recycled cardboard letterbox, Eliz! Genius!!
So, time for an update!!
Went to bed last night when he was stable in the mid tens and when I woke up this morning he was 24.8 mmol/L (446) at 8.15am. I had a long conversation with
Chris and shortly after with Ruth at the clinic and here is what we spoke about:
Dose reduction and cut off point, variable vs steady:
For the next couple of days we will go with no insulin if he is below 10 mmol/L (180) and once he stabilised a bit more it will be no insulin below 7 mmol/L (126).
They expect his blood sugars to be quite 'out of control' for a couple days and we are reducing the dosage, however we will stick with the variable dose rather than going steady for a while. We spoke about steady dose versus variable at this stage and felt that where it worked best was with the numbers at the lower end, however more work is needed to calculate the right dose to account for the 'bounce'. We spoke about the similarity to Diabetes 2 in humans and the idea of a basal dose (say 0.25 units for Pedro) and a bit more to accommodate his glucose, food, the bounce, etc, but it needs more observation of the bounces and finding ways to calculate this.
Considering Pedro's sensitivity to the insulin we are also reducing all dosages by 0.25 units although the next couple days will be mostly about shooting after consulting with Ruth and Chris.
Food and drink, nausea:
Chris and Ruth also echoed what their colleague at the clinic had said as well as my vet and you all: Pedro not eating was not about hime retreating from the world, from life but down to feeling rotten and Chris suggested to go and see our vets again today to get an anti-nausea injection or tablets. He said he wouldn't usually want to 'mask' symptoms of nausea in healthy cats but he felt that with diabetic cats it is helpful to get them back on track with feeding. He also suggested to get Pedro more subcutaneously water if needed (albeit with a smaller needle, slower pace and water heated to 30 - 35 degrees Celsius.) He also suggested to observe him when squeezing his tummy to see if he might be in discomfort and if necessary administer a mild painkiller.
As for the assisted feeding, he was not too keen on it, mostly down to the food aversion that can develop. He said unless Pedro would lick drops coming off the tip of the syringe he would not really recommend it but instead create an environment in which the cat is more comfortable and happy to eat. So raised bowls, great variety of fresh foods (blanched fish, etc.) and such like. He said to use the syringes as last resort.
He called my vet and explained all of these things and preliminary booked an appointment for me later this afternoon.
So far so good!
MEANWHILE in the living room...
When I got up I woke up Pedro who was sleeping by the heater on top of the sofa headrest and he greeted me with cuddles and all. I went upstairs to get dressed and much to my delight Pedro came upstairs, tail erect, alert, initiating lots of stroking and cuddles (he paws me gently as if to tap me to say "Hey, cuddles! Now!!"), he even meow'd a couple times!!! Sweetest sound EVAR!!! He also did his usual morning thing of walking ahead of me down the stairs, turning round regularly to make sure I was still behind him en route into the kitchen to feed him. AMAZING!!!
In the kitchen he made all the usual moves about wanting food, paws up against the kitchen cupboard, circling round me legs, moving forth and back, etc., but he was not best pleased with the selection, sniffing at it, drinking a little water but not eating anything. He went outside for a quick stroll and probably a wee and when he came back he was throwing up bile and grass. At the time I was on the phone to Ruth to discuss what to do with his morning injection.
Ruth and I agreed to inject him 0.25 units (GAAAAH! Are there any smaller syringes?!?!?!) and obviously close monitoring and so at injection time (still "late" at 10.45am) he was 22.6 mmol/L (407), down a little from the 24.8 mmol/L (446) he was at 8.15am. She said we would be extremely unlucky to see him drop as quick and low on that low a dose but obviously I am home today to make sure I can monitor him. Incidentally his glucose is coming up and has gone into black figures 28.6 (515) at 11.54 am and 28.8 mmol/L (518) at 12.55pm. I will let them know in a moment to see if they want me to do anything about it.
Well, and then my lovely mother in law came to pick up Josie and Pedro came in from another stroll round the garden and came for cuddles and then he crouched down and ATE PURINA DM DRY FOOD FROM A BOWL! He ate!!! He ate he ate he ate!!!!! He ate!!!!
Best news EVAR! He finished the bowl, not a huge amount but a great start!
So I am feeling giddy and excited and sooooooo relieved! Obviously plenty more to do, he needs to eat considerably more to catch up to his usual portions and I am out to get some fish in a moment, but what a lucky turn! Yay yay yay!! And then we need to stabilise his blood sugars, no biggie.
Mue x
So, time for an update!!
Went to bed last night when he was stable in the mid tens and when I woke up this morning he was 24.8 mmol/L (446) at 8.15am. I had a long conversation with
Chris and shortly after with Ruth at the clinic and here is what we spoke about:
Dose reduction and cut off point, variable vs steady:
For the next couple of days we will go with no insulin if he is below 10 mmol/L (180) and once he stabilised a bit more it will be no insulin below 7 mmol/L (126).
They expect his blood sugars to be quite 'out of control' for a couple days and we are reducing the dosage, however we will stick with the variable dose rather than going steady for a while. We spoke about steady dose versus variable at this stage and felt that where it worked best was with the numbers at the lower end, however more work is needed to calculate the right dose to account for the 'bounce'. We spoke about the similarity to Diabetes 2 in humans and the idea of a basal dose (say 0.25 units for Pedro) and a bit more to accommodate his glucose, food, the bounce, etc, but it needs more observation of the bounces and finding ways to calculate this.
Considering Pedro's sensitivity to the insulin we are also reducing all dosages by 0.25 units although the next couple days will be mostly about shooting after consulting with Ruth and Chris.
Food and drink, nausea:
Chris and Ruth also echoed what their colleague at the clinic had said as well as my vet and you all: Pedro not eating was not about hime retreating from the world, from life but down to feeling rotten and Chris suggested to go and see our vets again today to get an anti-nausea injection or tablets. He said he wouldn't usually want to 'mask' symptoms of nausea in healthy cats but he felt that with diabetic cats it is helpful to get them back on track with feeding. He also suggested to get Pedro more subcutaneously water if needed (albeit with a smaller needle, slower pace and water heated to 30 - 35 degrees Celsius.) He also suggested to observe him when squeezing his tummy to see if he might be in discomfort and if necessary administer a mild painkiller.
As for the assisted feeding, he was not too keen on it, mostly down to the food aversion that can develop. He said unless Pedro would lick drops coming off the tip of the syringe he would not really recommend it but instead create an environment in which the cat is more comfortable and happy to eat. So raised bowls, great variety of fresh foods (blanched fish, etc.) and such like. He said to use the syringes as last resort.
He called my vet and explained all of these things and preliminary booked an appointment for me later this afternoon.
So far so good!
MEANWHILE in the living room...
When I got up I woke up Pedro who was sleeping by the heater on top of the sofa headrest and he greeted me with cuddles and all. I went upstairs to get dressed and much to my delight Pedro came upstairs, tail erect, alert, initiating lots of stroking and cuddles (he paws me gently as if to tap me to say "Hey, cuddles! Now!!"), he even meow'd a couple times!!! Sweetest sound EVAR!!! He also did his usual morning thing of walking ahead of me down the stairs, turning round regularly to make sure I was still behind him en route into the kitchen to feed him. AMAZING!!!
In the kitchen he made all the usual moves about wanting food, paws up against the kitchen cupboard, circling round me legs, moving forth and back, etc., but he was not best pleased with the selection, sniffing at it, drinking a little water but not eating anything. He went outside for a quick stroll and probably a wee and when he came back he was throwing up bile and grass. At the time I was on the phone to Ruth to discuss what to do with his morning injection.
Ruth and I agreed to inject him 0.25 units (GAAAAH! Are there any smaller syringes?!?!?!) and obviously close monitoring and so at injection time (still "late" at 10.45am) he was 22.6 mmol/L (407), down a little from the 24.8 mmol/L (446) he was at 8.15am. She said we would be extremely unlucky to see him drop as quick and low on that low a dose but obviously I am home today to make sure I can monitor him. Incidentally his glucose is coming up and has gone into black figures 28.6 (515) at 11.54 am and 28.8 mmol/L (518) at 12.55pm. I will let them know in a moment to see if they want me to do anything about it.
Well, and then my lovely mother in law came to pick up Josie and Pedro came in from another stroll round the garden and came for cuddles and then he crouched down and ATE PURINA DM DRY FOOD FROM A BOWL! He ate!!! He ate he ate he ate!!!!! He ate!!!!
Best news EVAR! He finished the bowl, not a huge amount but a great start!
So I am feeling giddy and excited and sooooooo relieved! Obviously plenty more to do, he needs to eat considerably more to catch up to his usual portions and I am out to get some fish in a moment, but what a lucky turn! Yay yay yay!! And then we need to stabilise his blood sugars, no biggie.
Mue x
KleineMue
Member Since 2014
Confirmation of the reduced variable dose for the next couple days and beyond:
Next couple days: no insulin below 10 mmol/L
once his blood sugar stabilised again a bit more: no insulin below 7 mmol/L
While he hasn’t picked up food properly yet I stay in close consult with the clinic over his dose.
After that:
if blood glucose <7mmol/l, give 0 unit glargine s/c
if blood glucose 7.1 - 10mmol/l, give 0.25 unit glargine s/c
if blood glucose 10.1 - 12.5 mmol/l, give 0.5 unit glargine s/c ?
if blood glucose 12.6 - 15.5 mmol/l, give 0.75 unit glargine s/c ?
if blood glucose >15.6 give 1 unit glargine s/c ?
Mue x
Next couple days: no insulin below 10 mmol/L
once his blood sugar stabilised again a bit more: no insulin below 7 mmol/L
While he hasn’t picked up food properly yet I stay in close consult with the clinic over his dose.
After that:
if blood glucose <7mmol/l, give 0 unit glargine s/c
if blood glucose 7.1 - 10mmol/l, give 0.25 unit glargine s/c
if blood glucose 10.1 - 12.5 mmol/l, give 0.5 unit glargine s/c ?
if blood glucose 12.6 - 15.5 mmol/l, give 0.75 unit glargine s/c ?
if blood glucose >15.6 give 1 unit glargine s/c ?
Mue x
Elizabeth and Bertie
Member Since 2010
Elizabeth and Bertie
Member Since 2010
and then he crouched down and ATE PURINA DM DRY FOOD FROM A BOWL! He ate!!! He ate he ate he ate!!!!! He ate!!!!
Best news EVAR! He finished the bowl, not a huge amount but a great start!
So I am feeling giddy and excited and sooooooo relieved! Obviously plenty more to do, he needs to eat considerably more to catch up to his usual portions and I am out to get some fish in a moment, but what a lucky turn! Yay yay yay!! And then we need to stabilise his blood sugars, no biggie.
Mue, that's super-duper news!
Fingers crossed that his eating will continue and increase.
It sounds like you covered a lot of ground in your conversations with the vets.
So, the insulin sliding scale has been reduced by .25 of a unit? It's good that it's been reduced (but I have to say that I still wonder if that is too high a dose...and I think it needs to be watched really closely (which I know you will.))
Here's a link to a page from the Lantus forum that has photos of small doses in a syringe. You need to scroll down the page a bit, just past the diagram of the cat (and injection sites).
http://www.felinediabetes.com/FDMB/threads/lantus-levemir-new-to-the-group-please-read.18139/
Please do post on the forum if you have any concerns that Pedro's numbers show signs of dropping too low at any point.
Hugs to you, and chin scritches to Pedro.
Eliz
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KleineMue
Member Since 2014
Pedro didn't repeat his eating trick yet unfortunately and when I took him to our vet this afternoon as arranged by Chris they gave him 100ml of water under the skin, apologising that he looked a bit bloated but reassuring me it would be absorbed soon... 
They also gave him an anti-nausea injection which they reckon shoud last around 24 hours.
When we got home he was a bit unsteady, I imagine all that extra water in the system probably, and he curled up and slept by the fire. I tested him every couple of hours and he actually has come down a fair bit now, just a few minutes ago he was 9.4 mmol/L (164), so we still have about 30 - 60mins to injection time but since it's unlikely to come up again by then I don't think he will get any insulin again tonight, especially without having ate anything of substance. In fact in a conversation with Ruth after the vet visit she reckoned no insulin if under 15mmol/L and not having eaten a proper amount. And if he would have eaten a small amount then only 0.25 units.
So, not quite there yet.
Just picked josie up from he Nan and came home to a very active Pedro, initiating lots of contact, wanting to be near me all the time, cuddling, looking at me intently and all. Also watching Josie play with our other cat Enzo, following a thrown toy mouse with his eyes and all. He is purring, licking/cleaning himself and generally awake and alert, lovely sight!! Hope it's soon followed by him raiding the cat food buffet wee have set up for him.
Anyhoooooo, I will have to settle Josie and then it have to syringe feed him if he hasn't eaten by then.
Let's see.
Will keep you posted!!
Mue x
They also gave him an anti-nausea injection which they reckon shoud last around 24 hours. When we got home he was a bit unsteady, I imagine all that extra water in the system probably, and he curled up and slept by the fire. I tested him every couple of hours and he actually has come down a fair bit now, just a few minutes ago he was 9.4 mmol/L (164), so we still have about 30 - 60mins to injection time but since it's unlikely to come up again by then I don't think he will get any insulin again tonight, especially without having ate anything of substance. In fact in a conversation with Ruth after the vet visit she reckoned no insulin if under 15mmol/L and not having eaten a proper amount. And if he would have eaten a small amount then only 0.25 units.
So, not quite there yet.
Just picked josie up from he Nan and came home to a very active Pedro, initiating lots of contact, wanting to be near me all the time, cuddling, looking at me intently and all. Also watching Josie play with our other cat Enzo, following a thrown toy mouse with his eyes and all. He is purring, licking/cleaning himself and generally awake and alert, lovely sight!! Hope it's soon followed by him raiding the cat food buffet wee have set up for him.
Anyhoooooo, I will have to settle Josie and then it have to syringe feed him if he hasn't eaten by then.
Let's see.
Will keep you posted!!
Mue x
Vyktors Mum
Member Since 2011
Wishing you more good luck and appy vines for Pedro
BJM
Member Since 2010
Those, too ...
Sorry BJ, couldn't resist it....
.
Glad to see he is eating again.
Another concept that might be useful to discuss with the study folks - with a low pre-shot, stalling for 30 minutes without feeding to see if the glucose is coming up or not. (options, not mandates!)
Elizabeth and Bertie
Member Since 2010
Just looked at Pedro's SS, Mue. That is a lovely run of blue numbers. 
.
.
KleineMue
Member Since 2014
Morning!! It is, isn't it?
I had a chat with Ruth this morning to catch her up on our night.
After out visit to the vet Pedro drank a little but mostly rested near the heater, initiated lots of cuddles and stroking and in the evening, very unusual, he ate only a little when I stroked him quite strongly. It reminded me of newborn kittens who drink and get licked by their mum to reinforce the positive behaviour...? Might interpret too much into this, but he stopped when I stopped stroking and started again when I started stroking again. Usually our cats don't want to be touched when they eat. He mostly licked the gravy off the gravy Sheba (trying to get a boost into him yesterday evening as his numbers came down a little) plus a couple bites.
I stayed up with him a wee while, and watched his numbers coming down gradually, by 8.30pm he was below the threshold of injection which was 15mmol/L for grazing and 0.25 units and by actual injection time around 10.30pm he was below 10mmol/L. So no insulin.
And this morning basically Pedro is still only grazing, not eating properly, and he was deeply offended when I blended his food to make it easier to lick
Other than that he is active with initiating cuddles and stroking, not meowing much, but happy to sit, licking/cleaning himself, went out for a wee, steady numbers, so far so good. Obviously they're still below injection thresholds.
Ruth and I spoke about Pedro's extreme sensitivity to the insulin and the word 'remission' was uttered, although of course with what his body has been through the last 4 days this might well be a fluke and not the beginning of anything as he isn't eating properly. He also lost quite a bit of weight because of it, he was 4.3kg when I picked him up Friday in London, he was 3.7kg on Sunday.
I asked Ruth to explain the extreme sensitivity a bit more, i.e., does it mean that the insulin works even better or does it mean it doesn't actually work very well at all and the answer is it works extremely well, meaning far less is needed for his blood glucose to come down.
And with this in mind his variable dose schedule was revised yet again. Ruth sent me an email to confirm this:
"As for dosing Pedro tonight, I think he can have 0.25U if his blood glucose is more than 20 mmol/l and he is eating only tiny amounts. If he eats well (Here’s hoping…) he can have 0.5U as long as his blood glucose is 20 mmol/l or above, or 0.25U if his blood glucose is 10-20 mmol/l."
A friend is opening my shop for me this morning, I just got to head over for 1pm, so a bit more time with Pedro to entice him to eat and I am back at our vets this evening to get Pedro another anti-nausea injection (they tend to last around 24 hours) and some pain killers as Ruth suspected he might be masking any discomfort. Am cooking chicken and fish for him as well to see if he fancies anything like this.
Really could do with him eating so I can go to bed a bit earlier tonight...
Mue x
I had a chat with Ruth this morning to catch her up on our night.
After out visit to the vet Pedro drank a little but mostly rested near the heater, initiated lots of cuddles and stroking and in the evening, very unusual, he ate only a little when I stroked him quite strongly. It reminded me of newborn kittens who drink and get licked by their mum to reinforce the positive behaviour...? Might interpret too much into this, but he stopped when I stopped stroking and started again when I started stroking again. Usually our cats don't want to be touched when they eat. He mostly licked the gravy off the gravy Sheba (trying to get a boost into him yesterday evening as his numbers came down a little) plus a couple bites.
I stayed up with him a wee while, and watched his numbers coming down gradually, by 8.30pm he was below the threshold of injection which was 15mmol/L for grazing and 0.25 units and by actual injection time around 10.30pm he was below 10mmol/L. So no insulin.
And this morning basically Pedro is still only grazing, not eating properly, and he was deeply offended when I blended his food to make it easier to lick
Other than that he is active with initiating cuddles and stroking, not meowing much, but happy to sit, licking/cleaning himself, went out for a wee, steady numbers, so far so good. Obviously they're still below injection thresholds. Ruth and I spoke about Pedro's extreme sensitivity to the insulin and the word 'remission' was uttered, although of course with what his body has been through the last 4 days this might well be a fluke and not the beginning of anything as he isn't eating properly. He also lost quite a bit of weight because of it, he was 4.3kg when I picked him up Friday in London, he was 3.7kg on Sunday.
I asked Ruth to explain the extreme sensitivity a bit more, i.e., does it mean that the insulin works even better or does it mean it doesn't actually work very well at all and the answer is it works extremely well, meaning far less is needed for his blood glucose to come down.
And with this in mind his variable dose schedule was revised yet again. Ruth sent me an email to confirm this:
"As for dosing Pedro tonight, I think he can have 0.25U if his blood glucose is more than 20 mmol/l and he is eating only tiny amounts. If he eats well (Here’s hoping…) he can have 0.5U as long as his blood glucose is 20 mmol/l or above, or 0.25U if his blood glucose is 10-20 mmol/l."
A friend is opening my shop for me this morning, I just got to head over for 1pm, so a bit more time with Pedro to entice him to eat and I am back at our vets this evening to get Pedro another anti-nausea injection (they tend to last around 24 hours) and some pain killers as Ruth suspected he might be masking any discomfort. Am cooking chicken and fish for him as well to see if he fancies anything like this.
Really could do with him eating so I can go to bed a bit earlier tonight...
Mue x
KleineMue
Member Since 2014
Most fascinating to observe Pedro's curve. Very gradually his blood sugar is rising, we left th blue numbers behind and are into yellow figures now, although not high enough to shoot as per Ruth' adjusted variable dose.
He also isn't eating.
Am torn between Chris' recommendation of not feeding by syringe and letting him sit this out and trying to get some food into him. :/
He weighed 3.86kg and he really could do with food. *sigh*
He also isn't eating.
Am torn between Chris' recommendation of not feeding by syringe and letting him sit this out and trying to get some food into him. :/
He weighed 3.86kg and he really could do with food. *sigh*
If he won't eat, I'd try syringe feeding. He's lost quite a bit of weight. Cats can get hepatic lipidosis after a couple of days of not eating. Think of the syringe feeding as supplementing his diet, he needs to get calories into him. What did Pedro's regular vet say about assist feeding?
julie & punkin (ga)
Member Since 2011
I'd be trying to tempt him to eat or assist feeding him too. cats, unlike people, can't tolerate going more than a day or two without eating enough. The hepatic lipidosis that Wendy's referring to is when they lose weight, their fat actually clogs their liver. it's very serious. Have you seen the post on stimulating a kitty's appetite? Maybe something there would help.
BJM
Member Since 2010
After 2 days of not eating, a cat may go into hepatic lipidosis. This complete disrupts digestion, making the cat very ill. It is potentially life-threatening. Do whatever you can to get food in. It may work best to do small amounts frequently, rather than large amounts which may cause vomiting.
KleineMue
Member Since 2014
Back in blue numbers.
For the last two days he has been eating very small amounts of food when I bring the bowl to him and stroke him, fuss him lots. So not completely without food, but small portions, 1/4 to 1/3 of a portion maybe once or twice a day.
This evening around 9pm uk time, (it's 6am now) I brought Sheba flakes to him and he quite greedily wolfed down a bit more than 1/3rd of the portion but then had enough. After having gotten water before he didn't seem to fancy any to drink.
After he went outside for a wee and I imagine a poo but we don't get to see those, he seems to do them in someone else's garden.
Will try him again now to see if I can tempt him.
Thank you for the encouragement!!
Mue
For the last two days he has been eating very small amounts of food when I bring the bowl to him and stroke him, fuss him lots. So not completely without food, but small portions, 1/4 to 1/3 of a portion maybe once or twice a day.
This evening around 9pm uk time, (it's 6am now) I brought Sheba flakes to him and he quite greedily wolfed down a bit more than 1/3rd of the portion but then had enough. After having gotten water before he didn't seem to fancy any to drink.
After he went outside for a wee and I imagine a poo but we don't get to see those, he seems to do them in someone else's garden.
Will try him again now to see if I can tempt him.
Thank you for the encouragement!!
Mue
KleineMue
Member Since 2014
Just tried him on Sheba flakes and he eagerly hate a fair few bites, just under 1/3 of the pouch I reckon. Trying to do this again later on and before work.
Syringes at the ready if needed. I learned that our little herb blender is great for cat food... Don't tell Graham...
Syringes at the ready if needed. I learned that our little herb blender is great for cat food... Don't tell Graham...
Elizabeth and Bertie
Member Since 2010
Hope Graham doesn't notice that his food has taken on this strange new meatier flavour...Keeping everything crossed here, Mue, that Pedro's appetite keeps improving.
Numbers still holding in those blues...
.
KleineMue
Member Since 2014
Keeping everything crossed here, Mue, that Pedro's appetite keeps improving.
Numbers still holding in those blues...
.
In won't tell him if you don't...
Was out all day and Pedro was sitting on his new favourite place when I came home.
Numbers blue as before, 8.6mmol/L (155) and when I brought him a bowl of food he ate a small amount and then later went back to finish the bowl, approx 40g of food (Sheba flakes...)
Tried to dig in the Purina dm /Sheba flakes mix I preented him shortly later
and didn't seem to fancy the Purina dry food, but at least he didn't think it needs burying...Haven't seen him drink water yet so will give him half an hour and then present him with some to see if he drinks it and otherwise it's syringe time.
No vet tonight, no anti nausea injection, no painkiller and no extra water under the skin. (My credit card is rejoicing...)
Mue x
KleineMue
Member Since 2014
Pedro just had another 40g of Sheba flakes, no other cat food will do, and a fair bit of water. Yay!
11 mmol/L at injection time (198) so no insulin.
No other changes.
Glad he is eating, all without anti-nausea injection and pain relief, just hoping I will see a bit more of the old Pedro back soon.
Puzzled by these eerily calm curves, especially since he did eat some food today. Fascinating.
Mue x
11 mmol/L at injection time (198) so no insulin.
No other changes.
Glad he is eating, all without anti-nausea injection and pain relief, just hoping I will see a bit more of the old Pedro back soon.
Puzzled by these eerily calm curves, especially since he did eat some food today. Fascinating.
Mue x
Great to hear that Pedro is eating. Is the Sheba a lower carb food? What percent of his daily calories do you think he's eating?
I too am fascinated by the blues. It can take 6 cycles for the depot to reduce, he's going into cycle 5, curious to see what the next couple of cycles bring.
Is the Sheba a lower carb food? What percent of his daily calories do you think he's eating?I too am fascinated by the blues. It can take 6 cycles for the depot to reduce, he's going into cycle 5, curious to see what the next couple of cycles bring.
KleineMue
Member Since 2014
He had a bit more food, probably had about 60g now. ^_^
I have been wondering about the depot and how his worked seeing that he got a variable dose. I wonder how "large" his depot is, iykwim?
Wish we could look at his bloods.
I also wonder how long his nausea will last and considering how dramatic and intense these last few days were, his extreme curves, the eery ca- *STOP PRESS* he is eating yet more food!!!!!!!
The eery calm of the curves, even those extra trips to the vet sat, sun, mon, tue, have been stressful for him. Needles, water shoved under his skin, the painkiller the vet on Tue gave him must have stung because he jumped - this cat has been through the mill.
My poor fur baby.
I have been wondering about the depot and how his worked seeing that he got a variable dose. I wonder how "large" his depot is, iykwim?
Wish we could look at his bloods.
I also wonder how long his nausea will last and considering how dramatic and intense these last few days were, his extreme curves, the eery ca- *STOP PRESS* he is eating yet more food!!!!!!!
The eery calm of the curves, even those extra trips to the vet sat, sun, mon, tue, have been stressful for him. Needles, water shoved under his skin, the painkiller the vet on Tue gave him must have stung because he jumped - this cat has been through the mill.
My poor fur baby.
phlika29
Member Since 2014
That's great to see.
If he isn't drinking much then I would add a little water to his food. I would also be tempted to syringe it in to his mouth carefully as long as it doesn't stress him out too much. With no insulin and raised blood glucose you need to help ward off ketones.
Are you testing for ketones?
What was his no shot number again?
If he isn't drinking much then I would add a little water to his food. I would also be tempted to syringe it in to his mouth carefully as long as it doesn't stress him out too much. With no insulin and raised blood glucose you need to help ward off ketones.
Are you testing for ketones?
What was his no shot number again?
julie & punkin (ga)
Member Since 2011
Fingers crossed that he perks up and starts eating normally again.
Sending our best to you guys!
Sending our best to you guys!
KleineMue
Member Since 2014
In the moment his shooting schedule is
0.25U if his blood glucose is more than 20 mmol/l (360) and he is eating only tiny amounts
0.5U if his blood glucose is more than 20 mmol/l (360) and he eats well
0.25U if his blood glucose is 10-20 mmol/l (180 - 360) and he eats well
Not tested for ketones yet and not bought the test strips for my human glucometer yet.
Pedro had a little bit of water, just went out to pee. Clockwork cat.
0.25U if his blood glucose is more than 20 mmol/l (360) and he is eating only tiny amounts
0.5U if his blood glucose is more than 20 mmol/l (360) and he eats well
0.25U if his blood glucose is 10-20 mmol/l (180 - 360) and he eats well
Not tested for ketones yet and not bought the test strips for my human glucometer yet.
Pedro had a little bit of water, just went out to pee. Clockwork cat.
Ella & Rusty & Stu(GA)
Member Since 2010
Pedro didn't repeat his eating trick yet unfortunately and when I took him to our vet this afternoon as arranged by Chris they gave him 100ml of water under the skin, apologising that he looked a bit bloated but reassuring me it would be absorbed soon...
When we got home he was a bit unsteady, I imagine all that extra water in the system probably, and he curled up and slept by the fire. I tested him every couple of hours and he actually has come down a fair bit now, just a few minutes ago he was 9.4 mmol/L (164), so we still have about 30 - 60mins to injection time but since it's unlikely to come up again by then I don't think he will get any insulin again tonight, especially without having ate anything of substance. In fact in a conversation with Ruth after the vet visit she reckoned no insulin if under 15mmol/L and not having eaten a proper amount. And if he would have eaten a small amount then only 0.25 units.
So, not quite there yet.
Just picked josie up from he Nan and came home to a very active Pedro, initiating lots of contact, wanting to be near me all the time, cuddling, looking at me intently and all. Also watching Josie play with our other cat Enzo, following a thrown toy mouse with his eyes and all. He is purring, licking/cleaning himself and generally awake and alert, lovely sight!! Hope it's soon followed by him raiding the cat food buffet wee have set up for him.
Anyhoooooo, I will have to settle Josie and then it have to syringe feed him if he hasn't eaten by then.
Let's see.
Will keep you posted!!
Mue x
Sorry, my finger hit something on my iPad and I can't figure out how to delete this quote! i didn't intend to reply!
Ella
julie & punkin (ga)
Member Since 2011
Yay that his appy's picked up! Sounds like he's high enough to get some insulin in according to your vet's guidelines.
ps- BJM - I do the same thing. Read and reread, press post and THEN see Just One More Thing that needs fixing. hahahhahaha
ps- BJM - I do the same thing. Read and reread, press post and THEN see Just One More Thing that needs fixing. hahahhahaha
Elizabeth and Bertie
Member Since 2010
Are you feeding the Sheba fine flakes, Mue?
I just calculated the carbs on the Poultry selection from an analysis I found online and according to that it seems to be very low; only around 1.6% calories from carbs.
I notice that it also has a high water content, 85%. So every time Pedro eats he's getting a bit of water too (and you can add a little more water to the food also).
It's interesting that he went up to 14.7 and then came down again shortly afterwards. It looks like his little pancreas is doing a fair amount of work.
Worth noting too that these are Alphatrak numbers, and so appear a tad higher than we would see on a human meter.
Eliz
KleineMue
Member Since 2014
Major improvements this morning, greeted by both cats downstairs, followed into kitchen. Put Purina dm (trial cat food) down for both of them, Pedro initially ate about 1/4 of a tin and has since gone back to have more, by now ate not quite 1/2 a tin, what would be his usual portion, also had some Purina dm dry pellets, had a little water. Amazing!!
At 8.30am this morning he was 124 at 8.30am (AMPS) and 227 half an hour after eating, no injection as I can't monitor him, have to go to work. Also it appears the pancreas might be doing SOMEthing...
In awe.
Mue x
Ps: he is having more food as I type...
At 8.30am this morning he was 124 at 8.30am (AMPS) and 227 half an hour after eating, no injection as I can't monitor him, have to go to work. Also it appears the pancreas might be doing SOMEthing...
In awe.
Mue x
Ps: he is having more food as I type...
Attachments
KleineMue
Member Since 2014
Updated Ruth and Chris, this is what she replied:
Hi Wibke,
I think Pedro’s progress sounds very encouraging. However, I’m sorry it’s given you quite a stressful time of it over the last few days!
I am very happy for both cats to be on Purina DM while you get Pedro re-established. Let me know if you suspect he’s growing to dislike this and that this could be contributing to any poor appetite.
I think his blood glucose values are very good considering that he’s eating reasonably well now and hasn’t received insulin since Monday morning. However, his numbers are still a little higher than most cats who are in remission. This might mean that he still needs some low-level insulin therapy. However, while his appetite is still improving and his numbers are reasonably good, I think we should just continue to monitor his blood glucose 2-3 times daily as you have been doing, and see what he does. At the moment, the only time I would give insulin therapy would be the following scenario:
Blood glucose 20 or more at the time of injection and has eaten well: can have 0.25 U glargine.
I think the above should be safe and should prevent him from spending too long markedly hyperglycaemia, which would not help our attempts to get him into remission.
I hope the above makes sense and well done on all of your excellent care of him over the last week!
I’m going to put a supply of Alphatrak strips and needles in the post for him today. Please do keep Chris and I informed of how he and his blood glucose values are doing.
Best wishes,
Ruth
.....................................
Hi Wibke,
I think Pedro’s progress sounds very encouraging. However, I’m sorry it’s given you quite a stressful time of it over the last few days!
I am very happy for both cats to be on Purina DM while you get Pedro re-established. Let me know if you suspect he’s growing to dislike this and that this could be contributing to any poor appetite.
I think his blood glucose values are very good considering that he’s eating reasonably well now and hasn’t received insulin since Monday morning. However, his numbers are still a little higher than most cats who are in remission. This might mean that he still needs some low-level insulin therapy. However, while his appetite is still improving and his numbers are reasonably good, I think we should just continue to monitor his blood glucose 2-3 times daily as you have been doing, and see what he does. At the moment, the only time I would give insulin therapy would be the following scenario:
Blood glucose 20 or more at the time of injection and has eaten well: can have 0.25 U glargine.
I think the above should be safe and should prevent him from spending too long markedly hyperglycaemia, which would not help our attempts to get him into remission.
I hope the above makes sense and well done on all of your excellent care of him over the last week!
I’m going to put a supply of Alphatrak strips and needles in the post for him today. Please do keep Chris and I informed of how he and his blood glucose values are doing.
Best wishes,
Ruth
.....................................
KleineMue
Member Since 2014
Ok, so maybe not quite healed just yet...
Tested a moment ago 27.4 mol/L (493)
On the plus side it I was greeted by two animated cats when I just came home, Enzo as always and Pedro eager to say hello, get cuddles and strokes, initiating head-bumps, hopping on my lap to let me test him and all. No meows still, but the progress I saw this morning definitely still here now. After the test I gave them both food, both Purina DM, not quite 1/2 a tin each and I know there is some left over as I heard Enzo wanting to dig it in, but we are on a good path.
He must have had a substantial insulin depot if 1/2 a tin of Purina DM sent him THAT high. I had a look around and there was no sign he would have had any other food or licked anything he shouldn't have and there was opportunity.
Onwards and upwards! PMPS will be 8.30pm, let's see where he goes from here!
Mue x
Tested a moment ago 27.4 mol/L (493)
On the plus side it I was greeted by two animated cats when I just came home, Enzo as always and Pedro eager to say hello, get cuddles and strokes, initiating head-bumps, hopping on my lap to let me test him and all. No meows still, but the progress I saw this morning definitely still here now. After the test I gave them both food, both Purina DM, not quite 1/2 a tin each and I know there is some left over as I heard Enzo wanting to dig it in, but we are on a good path.
He must have had a substantial insulin depot if 1/2 a tin of Purina DM sent him THAT high. I had a look around and there was no sign he would have had any other food or licked anything he shouldn't have and there was opportunity.
Onwards and upwards! PMPS will be 8.30pm, let's see where he goes from here!
Mue x
Elizabeth and Bertie
Member Since 2010
Hi Mue,
It looks to me like Pedro was doing fine until eating the Purina DM food (if you were feeding Sheba fine flakes they're much lower carb, I think (see post above)).
Was it only after eating the DM food that his numbers came up? Or have I got that wrong? He had a beautiful 6.9 this morning (which might be around 5.9 on a human meter).
.
It looks to me like Pedro was doing fine until eating the Purina DM food (if you were feeding Sheba fine flakes they're much lower carb, I think (see post above)).
Was it only after eating the DM food that his numbers came up? Or have I got that wrong? He had a beautiful 6.9 this morning (which might be around 5.9 on a human meter).
.
KleineMue
Member Since 2014
Oh my, that is a good point! I don't actually know how the Purina compares overall, carb-wise. It's supposedly diabetic management, AND I presume the sponsor of the study. Evil Nestle. >.<
The texture of the food is a bit weird, it being a pate. Pedro doesn't know whether to lick it or bite it and ends up squishing it into all corners of his bowl and finds it hard to get more out of it iyswim. I have to then scape it together into a heap in the middle. He finished his bowl, not quite 1/2 a tin which is about the right portion for his weight.
Says Catinfo.org:
Purina DM canned is sufficiently low in carbohydrates (~7%) but it is expensive and it is predominantly liver which should not make up the bulk of a cat's diet. There is absolutely no reason to spend money on this product.
Now, with these numbers the shooting regime would be 0.25 units as per Ruth' email above, so I might have a short night ahead of me if his super sensitivity means it takes him right down.
The Sheba flakes would be a much, MUCH better choice with considerably lower carb content... And a range of meats, not predominantly liver. How long would it take to proof this theory? Should I stick to Purina for a few days to see if his numbers stay high OR go straight back to Sheba fine flakes and see if his numbers come down. How quick would he respond?
Will email Ruth and Chris also to share this observation. Thank you so much, Elizabeth!! 
Mue x
The texture of the food is a bit weird, it being a pate. Pedro doesn't know whether to lick it or bite it and ends up squishing it into all corners of his bowl and finds it hard to get more out of it iyswim. I have to then scape it together into a heap in the middle. He finished his bowl, not quite 1/2 a tin which is about the right portion for his weight.
Says Catinfo.org:
Purina DM canned is sufficiently low in carbohydrates (~7%) but it is expensive and it is predominantly liver which should not make up the bulk of a cat's diet. There is absolutely no reason to spend money on this product.
Now, with these numbers the shooting regime would be 0.25 units as per Ruth' email above, so I might have a short night ahead of me if his super sensitivity means it takes him right down.
The Sheba flakes would be a much, MUCH better choice with considerably lower carb content... And a range of meats, not predominantly liver. How long would it take to proof this theory? Should I stick to Purina for a few days to see if his numbers stay high OR go straight back to Sheba fine flakes and see if his numbers come down. How quick would he respond?
Will email Ruth and Chris also to share this observation. Thank you so much, Elizabeth!!
Mue x
KleineMue
Member Since 2014
Morning!
Pedro tested high again this morning.
Not heard back from Ruth and Chris yet, so sticking to last proposed routine, 0.25 units this morning, he is eating well.
He even meowed and there are more signs of the old Pedro being very nearly back! With high blood glucose, mind...
x
Pedro tested high again this morning.
Not heard back from Ruth and Chris yet, so sticking to last proposed routine, 0.25 units this morning, he is eating well.
He even meowed and there are more signs of the old Pedro being very nearly back! With high blood glucose, mind...
x
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