2:00 in the morning and in need of advice

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@phlika29 - Thanks for BG info, Sarah. :)

Rose - well done on the home testing! I know from personal experience how much relief I experienced when I could finally check Saoirse's BG any time I needed to. Sounds like you're feeling similarly. The testing gets easier with practice, and in no time you'll have developed a routine that works well for you and Zoey. :)
 
I have taken another glucose test and it is now 407 after two hours. Is this good improvement to expect or should it have been more? She's not wanting to eat or drink, including ignoring her treats.

I will happily type out the blood results at first chance.
 
Rose said:
I have taken another glucose test and it is now 407 after two hours. Is this good improvement to expect or should it have been more? She's not wanting to eat or drink, including ignoring her treats.
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The blood glucose before insulin (what we call the 'preshot' test) was 585, so to see this 4o7 two hours later is quite a drop actually, even though the number itself is still high.
It could be that the high carb food Zoey had earlier is wearing off now too.

Well done, Rose, for getting that test. Was that on the ear or the paw pad?

And have you managed to get another ketone test yet? (Sorry, I don't mean to push you. But I think it's important to check given that Zoey seems off her food).

.
 
I did get Zoey to eat two of her treats, but she was greatly coaxed which is very out of the ordinary up to this point. I gave her a syringe full of water (need to do more) but other than that, I've not seen her drink at all.

She did just urinate so I was able to get another ketone test. It wasn't as bright as 15, but it was pinker than 5. (I had to walk through the house so it was a little longer than 15 seconds when I compared)

I am having to take the blood from her paws. Both came from her rear right pad. (Will use different foot next time) I've tried a few times in the ear and no luck getting "enough".

Do I leave her be for another two hours and check again? Force feed her several syringes of water? We moved her suitcase to the porch so she's found her way back to her comfortable spot and we are letting her rest.
 
I personally would give her more water with the syringe. I would aim for 10ml every hour or so. I would retest her blood glucose in 2 hours.

Can you explain that ketone test result. How does the scale go?

With regards the food ideally I guess you would be getting her to eat the wet food so it doesn't raise the blood glucose levels too high. You can also add water to this food.

Do you think she could be nauseous? Remi was really bad when he had his panc flair. Does she display any of these signs. Walking up to food and then turning away? Licking her lips? Grinding her teeth? Did they mention giving an anti nausea medication such as ondansteron. It might be worth getting this from the vets if you can or some cerenia if she is vomiting.

Can you edit your signature to include the insulin you are using, food, other medication and conditions. It will help others.
 
Hi, you are doing great so far. I'm glad that you got a meter and are starting to test. Knowing what the BG reading is is essential before giving insulin. It is also essential for you peace of mind. No parent would ever inject their child without knowing what the BG is. Why should we do so w/ our furbabies? Zoey will get used to testing and her ears will learn to bleed for you. Be sure to give rewards every time you test, whether you get a good sample or not. Many of our cats will purr through the whole process because they know they are going to get a treat. Try taking an old sock and put about 1/4 cup of uncooked rice in it and microwave it for about 20 seconds depending on your microwave. Use that to warm the ear and give support from behind when you prick. ALWAYS put pressure on the test site for 20 seconds after to stop the bleeding and any bruising.

It's nice to see that Zoe is coming down, but that could be from the carbs wearing off, that was a lot of Karo, we usually only give a few drops. The effects of Karo can wear off quite suddenlly. The preshot reading could also be a bounce from going too low earlier. The liver will sense low BG (or lower than it is used to) and dump glucagon and counter regulatory hormones into the blood to protect against hypo. Eventually it will learn what normal is again.

Giving half the insulin twice a day is a very good idea. Vetsulin is an "in and out' insulin, it doesn't have a long duration. Cats have a much higher metabolism and usually need insulin twice a day. The 40 on your syringe is because Vetsulin is a U40 insulin, there are 40 "units" of insulin per cc, so the syringes are always marked for the type of insulin. The measurements on the barrel are different for other insulins.

Those test results are hard to read, it looks like her potassium is low and her phosphorus? Low potassium can definitely show as muscle weakness. It also says "UTI'" hand written. Was she also dx w/ a urinary infection?

It's also quite a list of meds you were given;
Vetsulin - really a better insulin for dogs than for cats
baytril - anti biotic, for the UTI??? UTI can be infection or inflammation from crystals. Were bacteria found? If so, what type?
Methigel - for urinary ph, covering all bases in case it's crystals, but Ph was normal? Were crystals seen in the urine?
carafate - is used for ulcers
metronidazole - this is for diarrhea! and Zoey was in for constipation ?????????
Laxatone - for constipation (or hairballs) but it is really high in sugars, 3 of the first 6 ingredients are syrups, not good for diabetes!
​
I've put in links for you to check out for most of the drugs. Get used to researching and double checking everything.
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You seem to be familiar w/ Dr. Lisa's site. She has a great list of most of the cat foods and their carb content. Ideally you want to feed foods that are less than 10% calories from carbs. Check out her nutrition page and you will want all your cats on canned food. Yes, it's more expensive, but a lot less than the vet bill for the conditions that dry food causes or aggravates.
 
There are lots of options for helping cats with constipation. For me changing remi to wet food helped a lot but before that I used miralax but have heard others mention pumpkin and a few other things. I guess it depends with how chronic it is. Getting her to drink more will help.
 
The ketone tests are sensitive on the timing. Try it on yourself and see how it will change over time.

Zoey really should eat w/ her insulin, could be another reason why there was so big a drop in 2 hours. You can assist feed by blending canned food w/ water in the blender and syringing.

Apart from nausea, pancreatitis can also be quite painful and so can UTI. You didn't get any pain meds? My Tess gets UTI infections, my vet has given me buprenorphine to have on hand ( it usually starts in the middle of the night
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) She settles down and stops running to the LB, in the morning they can run the tests to see if/what anti-biotics she needs.
 
If all else fails just about any cat will eat baby food. Just get the kind w/ no onions or garlic, like Gerber Stage 2.
 
Here is a link to the IDEXX pancreatitis treatment guidelines. It covers all of the medications recommended for pancreatitis treatment. It also has food recommendations.

Inappetence and insulin treatment are hard to juggle. Saoirse was like Zoey in that she developed appetite problems not long after starting insulin treatment. It was a nightmarish time for us. :(

I'd suggest contacting your vet about generic ondansetron for nausea, an appetite stimulant such as cyproheptadine. I believe Cerenia helps with vomiting and and it also has an anti-nausea effect. It may be that you don't need the meds, but having a supply of them in Zoey's medicine chest could help you to manage her pancreatitis much more effectively. Without the cyproheptadine and ondansetron I would never have been able to manage Saoirse's treatment at home. Vitamin B12 supplementation really helped Saoirse greatly (vet gave those injections). I've actually started her on another B12 course recently. I think it's one of the best supportive treatments she has received (see IDEXX guidelines for further info). Last year it really seemed to give her whole system a boost.
 
I think I put the pertinent information in my signature line now. If I'm missing something, please let me know. I want to make everything as easy as I can for everyone who is so kind and generous for sharing your time and knowledge.

On the metronidazole -- I had looked that up and that is an antibiotic. One of the side effects (there are many) is diarrhea. Another is nausea and she has stood over her food and just looked at it.

Zoey is not throwing up and I've given about 5 syringes full of water since 10:00 but I obviously need to up that and will make sure to do at least 10 ml per hour. I feel she has a fever but for the life of me I can't find the thermometer to take her temp. I went ahead and rubbed the pads of her paws with some rubbing alcohol. (vet told me when all else fails, this will bring their temps down) Figured it wouldn't hurt her even if she didn't have a temp. I'm going to ask my husband to stop by store and pick up a new thermometer on his way home.

She absolutely has pancreatitis. I saw where it said UTI but I assumed this was part and parcel with the pancreatitis. I hate to hear that I overdosed her on Karo. I read somewhere on one of these forums that 1 T and I thought that was a little high so I did less than that, for sure.

As far as the ketostyx ... yes, I know they change depending on the time lapse. It probably took me 30 seconds to get from outside to the test bottle and grab my glasses. They recommend 15. That's why I gave the description that I did. I've been using those sticks for years when I used to low carb and the color never got all the way to 15 but it was definitely more than 5. As far as the scale, 5 is trace and 15 is small amounts. (The complete 6 color scale: negative, trace (5), small (15), moderate (40) large (80) (160) -- two shades in that large category.

I'm going to go ahead and mix up some wet cat food with some water and see if I can't get some calories in her. It will be taking care of both issues at one time. Love that I maybe won't have to shove stuff at her face as often!! (She's going to hate the sight of me! smh)

As far as her constipation .. we were not aware she was constipated and getting backed up. I had been giving her DE for worms (did I mention how bad the fleas are this year?!) and hopefully to help with the ginger coat that she had going on. I'm wondering if that didn't add to her dehydration (she was very dehydrated and they gave her fluids) and constipation. Only gave her a teaspoon daily for about 3 weeks and added to her food with extra water mixed in. (I take it and am loving what it is doing for me.)

Food ... we have a couple of cats that just will not give up their dry food. So, we do feed them all wet food but at night we usually have dry food down for the stubborn cats and the others who just want to graze. I will definitely be changing Zoey back to Pierson's plan.

If I missed something, please nudge me again. I'm trying to work from home while I pick your brains, nurse my sweet baby and pretend I'm being productive with the J.O.B. ... but we all know my mind's somewhere else.
 
Don't worry about the Karo, it wears off. Just good to know for next time.

You could try pro-biotic and pre-biotics ( fiber on which the pro-biotics feed). Pumpkin is good, but Tess won't touch it, you could try psyllium added to her food. I don't know if the constipation is a one time thing, but believe it or not there is a great website for Feline Constipation. We have crazy cat lady sites for everything!

Yes, metronidazole is an antibiotic, but it is also anti-diarrhal. Diarrhea isn't a side effect, it is used to treat diarrhea.

Got to go and get ready for class. Any more tests?
 
I'm trying to take a test now but I'm having absolutely no luck at all getting enough blood. I prick, it bleeds a tiny speck, just not enough. :/
 
I've tried two new paws and a new ear. I've used heat (rice in sock and warm wash cloth). I've massaged. I've prayed. I'm at a loss.

She really feels bad. I've forced water on her but I can't get her to touch the food or open up for it. I really feel I'm stressing her out by trying. I do have some ringers here and I can do fluids by IV. I think I will call the vet and see what he says about anti-nausea meds and the fluids. Should I continue to wait until 9:00 tonight to give the second shot of insulin? Is the idea to lower the BG slowly and that's why I didn't want to do it all at one time and we're okay with the drop that we've seen so far, although it's still high?
 
Rose said:
I think I will call the vet and see what he says about anti-nausea meds and the fluids.
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A chat with the vet sounds like a good idea at this point, Rose.
I think you should also tell the vet that Zoey's urine showed a ketone reading at above trace level (and that's something that should be watched very closely, especially given that she's off her food. You don't want that getting any higher).

You've been through a lot today...
Huge hug to you,

Eliz
 
If she were mine I'd ring the vets to let them know what's going on.

Regarding regulation of blood glucose, it's a gradual process. A cat's body needs to gradually get used to lower numbers. Giving too much insulin will either result in a hypo or possibly send numbers higher since the cat's body may react by dumping more glucose into the bloodstream to protect the cat. Even a safe number that's lower than the cat's body is used to can trigger off bounces.
 
The sub q might be a good idea as giving them water orally might fill her up.

If you speak to the vet as well as asking about an anti nausea medication I would also ask for a potassium supplement for her low levels. That will help perk her up. I give my cat kaminox in his food. He loves it as it stinks of beef. It's a little dropper amd I started off with 1/2 ml in the morning and at night. Then upped to from there. He is much stronger now he levels have improved.

If you don't manage to get a test, just give a treat and leave it for 10 minutes.

With regards the dry food, they say that even one of two bits of kibble can bring their blood glucose up by over 100 points.

Don't give any more insulin until it's due tonight. Just test ever couple of hours if you can
 
How is it going now? Did you manage to get any more tests? Speak to your vet?

When you do get back online I would recommend that you either start a new thread (and put a link to this one) with what is happening now ie dose, readings, concerns, etc. or alternatively you could amend the title of this thread by clicking on the edit button at the top by your first post. Whatever method you choose you need to title to reflect your current situation or questions you have.
 
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You've gotten a lot of great advice so far! Eliz asked if I could drop in and take a peek, and I can only think of a couple of things to add.

The "potassium low" caught my eye, because my sugarkitty, Bob, suffered from that from day one. It showed as overall muscle weakness, especially his hind legs. "looked like" neuropathy, but in his case, it was due to very low potassium. He also was severely dehydrated, so my vet dealt with both issues with the same treatment. She sent me home with a bag of lactated ringers that had potassium added to them. Bob got up to 200ml of sub-q fluids w/ potassium per day, and did so for weeks. Eventually it was reduced to 100ml every other day, or 3rd day. It took a month or longer before his potassium returned to the normal range. The way it was explained to me was that potassium supplementation needs to happen slowly and be controlled. Because "too high" is just as bad as "too low".
You should never administer sub-q fluids without your vet okaying it. And same goes for potassium. That has to be frequently monitored by blood tests, I think Bob got tested every couple of weeks to see if the level was coming up, and the amount added to his fluids was adjusted accordingly.

And on the issue of getting blood out of the ear. . .
I found that Bob bled better out of one ear rather than the other one. The very first thing I did was take that lancing device and toss it in the trash. My vet asked me "Can you sew on a button?" I said "yes, ma'am". She said, "okay then, you can do this." I "freehanded" the lancet. It really helped me to see where I was sticking it in his ear. And I felt much more in control of the process that I did trying to hold a big old plastic device that made a loud noise when I tested him. The "poking" was much less stressful for Bob and for me, and after just a few days, he gave me no trouble at all at test time. Fresh shrimp as a "test treat" certainly helped. Bob would chew through a battleship if he knew there was shrimp waiting on the other side, so if all it meant was a little poke in the ear? He'd come to me when he saw me getting the meter ready. He'd look at me like he was saying "get it right the first try, Dad, I got shrimp waiting for me!"

I agree with what others have said about dosage. Better two shots a day than just one, because Vetsulin won't work well on a once a day routine. Find out if your vet has experience with Prozinc, Lantus or Levemir perhaps, as all three are much better at treating feline diabetes. Prozinc is a "U40" insulin, like Vetsulin, so you would use the same syringes. Lantus and Levemir are "U100" insulins, so you would use U100 syringes. And with feline diabetes, the recommended routine is "2 shots per day" according to the AAHA guidelines. The biggest issue with Vetsulin for cats is that it isn't likely it will last for even 12 hours, so the other 3 I mentioned would be more appropriate for cats.
 
We have an appointment at 4:00. ....
The above sentence is what I had last written before my internet went down. I will start a new thread now. "2:00 in the morning update"
 
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