2/10 Poncho updates

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Christoph,
I'm copying your last update here in your new thread and linking the old one here too.

Poncho's Previous Condo

Christoph's first update:
Hi everyone. To each one of you I say much thanks. Poncho is resting......I got 9 hrs sleep, got up and did the feeding/fluids and meds routine and now just waiting for the next feeding. I was given appetite stimulant, tubed potassium, another antibiotic for digestive tract, and correct feeding instructions/syringe, and needle placement for fluids. Apparently needle should go in the side, not between the shoulder blades, and now I can feed him easier with a larger syringe with bigger diameter exit hole. The new vet checked his BG late afternoon and it was 177.....last shot was 1 unit @ 5am so at this point no more insulin but check urine for sugar. No ketones in the blood detected He thinks he had pancreatitis and will know if he still has it when test results come back today. What he probably had was transient diabetes from that but since his diagnosis was based on a BG of 379, it deserved further scrutiny to determine if ANY insulin was appropriate. They also should have made sure I was properly instructed in force feeding and given the right syringe and the prescribed food. I'm extremely disappointed in the SPCA clinic and I will try to go to the top there to voice that. They did a lot of good things but dropped the ball on a few crucial things that had a strong bearing on success, then threw in the towel. They actually made his condition worse and he is far from being out of the woods.....it's up to God and me now.....with the new vets guidance. He weighed 10+lbs in the Fall and now weighs 6.6lbs. Two weeks ago 8+ lbs and at time of diagnosis 7+lbs. I will update later. Prayers still needed.....thanks.
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Christoph's latest update from previous thread:
Today the new vet got the test results for pancreatitis and he does have a severe case of it. She said if he starts to vomit she'll put him on IV treatment and I think I'll ask for a 3 day pain shot and some cerenia or ondansetron tomorrow. I'm going to get some BG urine strips tonight and she said I' welcome to borrow a cat specific meter since it is essential at this point to be as accurate as possible if there is an issue with BG. She showed me the comparison with the clinic comparison and mine and it was going up to 100 points off their number up or down. I might have bought a defective Relion. Ok....time for feeding. Thanks for hugs and support. chris
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for review: Sliding scale for when feeding A/D or medium carb food
pre-shot numbers - possible dose
350 to 400 - 1.25 units
300 to 350 - 1.00 unit
250 to 300 - 0.75 units
200 to 250 - 0.50 units
< 200 - 0.25 units.
When you are ready to start reducing the carb content of food, you may need to drop the doses further
 
And your meter isn't defective.
It reads +/- 20 % of what a lab would get and reads about 30-40% lower than a pet meter.
See my signature link Glucometer Notes for feline reference numbers using human meters.
 
BJM said:
for review: Sliding scale for when feeding A/D or medium carb food
pre-shot numbers - possible dose
350 to 400 - 1.25 units
300 to 350 - 1.00 unit
250 to 300 - 0.75 units
200 to 250 - 0.50 units
< 200 - 0.25 units.
When you are ready to start reducing the carb content of food, you may need to drop the doses further
Click to expand...
BJM said:
And your meter isn't defective.
It reads +/- 20 % of what a lab would get and reads about 30-40% lower than a pet meter.
See my signature link Glucometer Notes for feline reference numbers using human meters.
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I've been wondering if their meter was either defective or the clinic vet had a tech do the test and didn't do it right. They screwed up a few other times.
 
Hi Chris,

I'm so pleased that you've got better veterinary support now, but I'm sorry to hear that Poncho has pancreatitis. I'm not sure whether I posted this link for you before, so to be on the safe side here are the IDEXX guidelines for pancreatitis treatment. It's a very comprehensive document and details all of the medications and supportive measures that can help Poncho get better. From my own experience of nursing Saoirse through a bad pancreatitis flare last year, I found that the anti-nausea med (ondansetron) in the early stages wasn't enough to help her keep eating under her own steam on its own. The addition of cyproheptadine (appy stimulant) helped her a great deal. After a while she didn't need the appy stimulant but I still need to give her anti-nausea meds at times. I always make sure I have a supply of ondansetron at home. It has been invaluable in managing Saoirse's pancreatitis symptoms since the flare-up last year and has thankfully stopped potential inappetence in its tracks for her on several occasions.

Sending more prayers for you both, scritches for Poncho, and :bighug: for you.
 
Critter Mom said:
Hi Chris,

I'm so pleased that you've got better veterinary support now, but I'm sorry to hear that Poncho has pancreatitis. I'm not sure whether I posted this link for you before, so to be on the safe side here are the IDEXX guidelines for pancreatitis treatment. It's a very comprehensive document and details all of the medications and supportive measures that can help Poncho get better. From my own experience of nursing Saoirse through a bad pancreatitis flare last year, I found that the anti-nausea med (ondansetron) in the early stages wasn't enough to help her keep eating under her own steam on its own. The addition of cyproheptadine (appy stimulant) helped her a great deal. After a while she didn't need the appy stimulant but I still need to give her anti-nausea meds at times. I always make sure I have a supply of ondansetron at home. It has been invaluable in managing Saoirse's pancreatitis symptoms since the flare-up last year and has thankfully stopped potential inappetence in its tracks for her on several occasions.

Sending more prayers for you both, scritches for Poncho, and :bighug: for you.
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Thanks Critter Mom, I'll ask the new vet about both meds. He started drinking a little water tonight. His body sure soaks up the fluids. I'm going to test his BG tomorrow since the next vet appt is Fri. God Bless.
 
Great news that he's drinking a little on his own! God bless you too, Chris. Wishing you both a restful night. :bighug:
 
As I was going to bed I noticed after Poncho used the litter box his back legs were weak so I tested his BG and it read -Hi-. I gave him 1 unit insulin and will be up again to test him again in 2 hrs. Maybe the new vet gave me a bum steer. I'm wondering if I should've given him 1.25 or 1.5 but he dropped fast into hypo at +4 at the clinic. I've been force feeding the Hills ad still and he had about 3/4 can today. This is frustrating as heck! Please advise?!
 
Hi I just replied in your other thread and so only just saw BJM new sliding scale. I think now you have given the 1 unit I wouldn't add more but for the next dose I would follow the new scale.

I mentioned in your other thread that I believe poncho should continue with the insulin. having only just got over ketones by with holding insulin poncho will be at risk of them reappearing.
 
I think you were right. What's with these vets?!!! So I guess next dose is @ +8 per the last schedule, retest @ +4? Should I delete this thread since I started the new 911 thread?
 
Keep this thread and delete the other one. This one has done good info in it. The other one just has my reply.

Yes to the +4 and yes to the next shot @+8 unless someone tells you otherwise.

Post up your results.
 
Just read your reply in the other thread. So your +2 is still high

Hopefully he will begin to drop in abit. I do think now he is getting more food he will need more insulin as BJM mentioned in her post with the new scale.

Clearly no matter what is the underlying cause your cat needs insulin to knock back the numbers. If you go back to the vet I think you need to discuss this further and I don't let her say your human meter is off and you need a cat one, you don't.

I think in the long term prozinc may not be the best I insulin for your cat and I wonder if lantus wouldn't give you better numbers for longer. It is dosed every twelve hours and builds up a depot in the cat so the effects last longer. You could discuss this with your vet perhaps.
 
Remember that at the failed curve, he was on Low carb food; the A/D is Medium carb food. When you are able to get back to the low carb, the doses will be dropped. Until then, we need to keep the glucose being matched by the insulin, so he doesn't start throwing ketones again.
 
one final thing-if you feel you need to you can edit the title of your first post to highlight your concerns about the high blood glucose reading.
 
The vet wont be there until 10am so I was told to leave Poncho as a drop off and she'll call me. In the meantime I asked them to keep an eye on him until the vet gets there since I gave him 1 u at 4am and he was still high @ +2 and next testing was +4 @ 8am after I dropped him off. I'm sure he's in pain and I'll ask for a 3day pain injection plus a script for cerenia or ondansetron, an appetite stimulant and maybe a change in insulin. I guess his pancreatitis is painful and the added stress of me force feeding him all day, the amount of the medium carb food and that he might be clogged up again spiked his BG. I'll post when she calls me.

Update: The vet's office called. Poncho was weak from lack of potassium, was clogged up again because he was too weak to go. His BG went down to the 300's and they'll check it again and dose if needed. I mentioned the ondansetron, cerenia changing insulin and pain issue so those will be addressed when I pick him up. He's already on an appetite stimulant they said. I'm relieved so far....I thought he was running out of time.
 
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BJM said:
Are you still adding some Miralax to his food?
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Not since Sunday night. I was planning to ask the vet today if it was ok with the new meds. He's going to need that daily or something similar it seems.
 
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A pinch of plain psyllium fiber helps hold moisture in the stool and keeps if soft enogh to pass. Can be done with the Miralax, if needed.
 
Miralax should be fine with the other meds but run it past the vets.

So at the vets you want to discuss getting poncho :

Ongoing Potassium supplement
Ongoing pain relief- when remi had pancreatitis I was given buprenex to give at home and I did so for a few weeks. In my experience pain relief helps them to recover quicker
An appetite stimulant should be given if nausea is suspected and so you really want ongoing anti nausea medication too.
Fluids
Another vitamin B12 injection

Discuss whether beneficial switching to lantus or levemir as it might give you better control over blood glucose
 
You need both anti-nausea and appetite stimulant meds.
Otherwise, you'll get a hungry cat who walks up to and then away from the food due to the nausea.
 
I picked up Poncho and discussed his situation with the vet. She gave him an injection of buprenorphine for pain and sent him home with the same but for oral use. He was given electrolytes and new bag of fluids infused with potassium. Poncho was plugged up due to weakness from low potassium and they fixed that and she said Miralax is ok to give. She gave him some insulin and instructed me to give him 1 unit Prozinc at 6 pm when I got home and begin 2 feedings for the night plus the fluids. At 6am I'm to check BG and give 1 1/2 unit if over 400 and if under 400 1 unit and check BG 8 hrs later and record it then give 2nd shot same dose @12 hrs after 1st shot, continue feeding, meds, fluids. Friday- repeat and come in 1:40 for check up and more electrolytes, etc. I asked about Cerenia or ordansetron and she said one of the 2 meds (Mirtazapine, Metronidazole) prescribed acts as an appetite booster.....I forgot which one.....I need to look those up. No B12 today but will ask about that tomorrow. I didn't read the new posts until I got back. Poor Poncho is a sick cat and it's going to be full time job for me. Need to feed now. Thanks to all. Chris
 
The mirtazapine is for appetite.
Metronidazole is an antimicrobial in case there is some sort of infection in the GI tract.

If you can, take in your spreadsheet to the vet and the sliding scale we were testing out so he can see how it was working.
 
Elizabeth and Bertie said:
Chris, here is a hug break:

:bighug:((((((((BIG HUG, CHRIS))))))):bighug:

Plus cuddles/chin scritches (whichever is preferred) to Poncho. :)
.
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Thanks Elizabeth. Poncho started eating a little bit on his own today. I have to get his numbers from the vet from yesterday but last shot @ 1u yesterday @7pm then this am 7am BG 318, +8 BG 143 next shot @ 6 and she wants the same 1u dose @12 hrs till tomorrow's 2 pm appt. Along with force feeding he's eating around a 5.5 can daily. He's getting more sociable also. Vet didn't say to check BG before 6pm shot but I will and call her if it's normal range. I don't want to give a dose unless I check BG. Meter is alpha check she loaned my.....insisted in it rather than my human specific meter.
 
This sounds very positive Chris. I agree I would not give the insulin unless you have a reading first. Well done, keep up the good work. I really think those painkillers are helping him to recover. V
 
Is he eating low carb food yet or just the A/D?
The more low carb food he eats, the lower the dose of insulin that will be required.
I'm glad she loaned your the AlphaTrak. Do, however, share my signature link Glucometer Notes with her (if she has e-mail, just send he the link) so she can see the feline reference levels when using a human glucometer.
 
BJM said:
Is he eating low carb food yet or just the A/D?
The more low carb food he eats, the lower the dose of insulin that will be required.
I'm glad she loaned your the AlphaTrak. Do, however, share my signature link Glucometer Notes with her (if she has e-mail, just send he the link) so she can see the feline reference levels when using a human glucometer.
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I'll relay the glucometer info and show her the website. I've been force feeding A/D (last was 7 am) and he's been grazing on Fancy Feast. I tried the A/D but he's got an aversion to it given the force feeding. I'm going to force feed him the A/D again soon but less since he's eaten 30 ml or more on his own. As long as he's eating around a 5.5 can by the end of the day I'm good.
 
phlika29 said:
This sounds very positive Chris. I agree I would not give the insulin unless you have a reading first. Well done, keep up the good work. I really think those painkillers are helping him to recover. V
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Thanks. I agree on the pain meds. I'm crossing my fingers. Next vet visit is tomorrow.
 
Be sure to indicate which readings are the Alpha Trak vs the human meter on your spreadsheet. If there is a clear separatuin, a blank line with a note in bold red font will let folks know how to interpret the numbers.
 
I would keep up with all the supportive meds for now as it is so easy for them to slip back. I certainly would be hesitant to just stop the insulin without ongoing data to indicate it is not needed anymore.

So you want to discuss getting another vit b injection, more pain meds, anti nausea injection, sub q's with the vet. I still feel that if you can get hold of anti nausea medication it will really help poncho.
 
BJM said:
Be sure to indicate which readings are the Alpha Trak vs the human meter on your spreadsheet. If there is a clear separatuin, a blank line with a note in bold red font will let folks know how to interpret the numbers.
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Ok....didn't think of that. Thanks. I noted the Alphatrak2
 
phlika29 said:
I would keep up with all the supportive meds for now as it is so easy for them to slip back. I certainly would be hesitant to just stop the insulin without ongoing data to indicate it is not needed anymore.

So you want to discuss getting another vit b injection, more pain meds, anti nausea injection, sub q's with the vet. I still feel that if you can get hold of anti nausea medication it will really help poncho.
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Ok.....if she still doesn't want to give the anti nausea med I'll see if the mobile vet will. Thanks.
 
I'm so glad to hear Poncho is eating a bit on his own and that you have a clear dx. Please be sure to stay on the ketone testing....I know you will :)

Sending many more prayers. And if you want to PM me a picture of Poncho, I'll post it for you since you are busy. We'd all love to see what he looks like. All you have to do in the PM is click on "upload file" and then browse your computer to the picture you want, click on it and it will upload.

I'm going to make a couple edits to his SS to keep it color coded correctly.

eta: don't forget you can go back to his BID dosing sheet if the vet is having you shoot every 12 hours instead of 8. It's easy to move the BID sheet into first position. Just click on the "BID" tab and move it to the left.
 
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I'm so glad that you have a diagnosis. Not glad it's pancreatitis but I thought that was it. As I mentioned before Max has lived with it for over 5 years. The number on the fPL does not always reflect how bad (or not) they feel. Max is currently dealing with it now after his dental two weeks ago. I saw my vet yesterday and he didn't test for it since the medication is working. I hope you get cerenia or ondansetron to take home. Today was the 7th day I have been giving Max ondansetron. When it kicks in well I don't need an appetite stimulant. Please let us know how Poncho is when you get home and what you were given for nausea. The IDEXX ROUND TABLE discusses the importance of it. Poncho needs to eat and as I mentioned before you don't want to add food aversion to your worry list.
 
To discuss with vet: Sliding scale adjusted for AlphaTrak meter (folks, chime in if it should be tweaked further)

glucose reading - dose
538.5 to 615 - 1.25
461.5 to 539 - 1.00
384.6 to 462 - 0.75
307.7 to 385 - 0.50
230.8 to 308 - 0.25
 
BJM said:
To discuss with vet: Sliding scale adjusted for AlphaTrak meter (folks, chime in if it should be tweaked further)

glucose reading - dose
538.5 to 615 - 1.25
461.5 to 539 - 1.00
384.6 to 462 - 0.75
307.7 to 385 - 0.50
230.8 to 308 - 0.25
Click to expand...
I'm a bit confused about this scale. Is this the dose difference when comparing Alphatrak and a human meter given the reading? I did a pre shot BG, got a 139 and they said go ahead with a 1unit dose on a 12 hr schedule. Poncho is eating well today/tonight but I'm going to monitor him thru the night and catch up on sleep tomorrow after his vet appt.
 
I took the numbers for use with a human glucometer and adjusted them for use with the Alpha Trak. Human meters read about 30-40% lower than a pet meter.
As he is starting to eat some lower carb food, you'll want to be careful. Be sure to let this vet know about the aborted curve with 1.5 units previously

.
 
Marje and Gracie said:
I'm so glad to hear Poncho is eating a bit on his own and that you have a clear dx. Please be sure to stay on the ketone testing....I know you will :)

Sending many more prayers. And if you want to PM me a picture of Poncho, I'll post it for you since you are busy. We'd all love to see what he looks like. All you have to do in the PM is click on "upload file" and then browse your computer to the picture you want, click on it and it will upload.

I'm going to make a couple edits to his SS to keep it color coded correctly.

eta: don't forget you can go back to his BID dosing sheet if the vet is having you shoot every 12 hours instead of 8. It's easy to move the BID sheet into first position. Just click on the "BID" tab and move it to the left.
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I'm not good with computer stuff, but did post a pic and it stayed up briefly. I don't know how to PM you a pic....assuming that is the right way to get it on the forum.
 
You click Upload a File in the lower left of the post box.
Navigate to the location where the picture is stored.
Click on the picture.
Select Thumbnail or Full Image
Then Click Post Reply or Create Thread, depending on if it is a new topic or adding to an existing topic.
 
Poncho and his big/little brother Remington pics 034.jpg
 
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