? 28 Dec | Girlie was at vet's; I was in hospital; schedule in disarray

[Girlie's mom]

Condo: http://www.felinediabetes.com/FDMB/...0-poo-frequency-question.188443/#post-2093496

I spend from the pm of the 23rd to the morning of the 27th in the ICU (possible heart attack; all good, though; just too much stress, way too little sleep, etc., etc.)

My flatmate took Girlie to the vet. Needless to say, without my preparing them, they did really odd things, especially with her feeding schedule; they didn't give her Mritazapine to make her heat; they didn't know how Levemir worked; she barely at the MD (which she hates); she went hypo several times; they skipped shots and moved her to a 1:00 am/1:00 pm schedule.

So I've got her home. She got the shot at 1:00 pm, but I'm going to skip the shot at 1:00 am and get her back on the 7am / 7pm schedule. Given the hypos - although I think they were vet-induced - I reduced her dose to 0.1 just to be safe. Does this seem a good idea, or should I try her at 0.25 in the AM?

Any tips for getting her back on track? I'd be really grateful!

Unfortunately, given my health scare, I have to get a lot of sleep, and sleep straight through the night and as much as I can during the day, so I won't be able to monitor her closely at night for a while (except if I get up to go to the loo or get a glass of water). Batteries and body must be replenished on my side...Sigh...

I hope everyone had a drama-free holiday and that that continues into the New Year!

 

[Alicia & Maggie (GA)]

Oh, Darrah!! I'm so glad you are both alright and at home! I don't have any advice other than to take care of yourself. Can't your flatmate help out any with Girlie?

 

[Bronx's dad (GA)]

What a huge scare for both of you Darrah, such an awful way to spend the holidays. I can't offer any advice on low-dose kitties, but glad to hear you both are home and the stress level can only go down from here. A little lower dose is in order though if you can't monitor as closely.

 

[Girlie's mom]

What a huge scare for both of you Darrah, such an awful way to spend the holidays. I can't offer any advice on low-dose kitties, but glad to hear you both are home and the stress level can only go down from here. A little lower dose is in order though if you can't monitor as closely.

Thank you! It was an adventure, I can tell you... I'm just SO glad that I cancelled the flight to the US. I can't imagine having those symptoms in the middle of a long-haul plane flight! Yikes!

I hope you had a stress-free holiday with you and yours...

 

[Girlie's mom]

Oh, Darrah!! I'm so glad you are both alright and at home! I don't have any advice other than to take care of yourself. Can't your flatmate help out any with Girlie?

Lord, I wouldn't allow my flatmate to pick Girlie up, much less help with her! He wouldn't have a clue or the ability and definitely wouldn't want to help out. He's a sweet guy, but he's clumsy around animals. He just can't read them and doesn't realise their signals that say "don't talk to me/touch me that way!". Poor guy...

 

[Girlie's mom]

Girlie clearly feels very unhappy still. I can imagine that her body doesn't feel so well after the vet's. They drew blood for each test from her neck or paw: you'd think they would have used an alpha trak or just done a manual ear prick rather that do a blood draw, for heaven's sake! Good grief.... When I got there, she was growling and giving the evil eye to everyone; I don't blame her one little bit.

 

[Alicia & Maggie (GA)]

I can imagine that her body doesn't feel so well after the vet's.

Poor baby! Getting back home and back to you must feel wonderful to her! Hope she settles back into a routine quickly.

 

[Chris & China (GA)]

I reduced her dose to 0.1 just to be safe. Does this seem a good idea, or should I try her at 0.25 in the AM?

I think considering all you (and Girlie) has been through, that's a good idea

Give her a chance to decompress and get back to a more normal schedule and then see how she's doing and re-evaluate.

It will also relieve some of the pressure off of you worrying about her while you continue to recuperate!!!

 

[Susan&Felix(GA)]

Good heavens, Girlie girl and Darrah girl! Mega-oodles of healing vines for you both! So glad things are headed in the right direction toward "normal."

 

[Stacy & Asia]

Oh Darrah! I’m so sorry you’re going through this...and very glad it wasn’t a heart attack. I hope you can sleep your way to better health and Girlie can figure a way to calm down for you with her rainbow tendencies so you both can feel better.

And a blood draw for every test? That is the weirdest thing I’ve ever heard; they are lucky all Girlie did was give them the evil eye! Sheesh!

 

[Steph & Quintus & L & O]

I spend from the pm of the 23rd to the morning of the 27th in the ICU (possible heart attack; all good, though; just too much stress, way too little sleep, etc., etc.)

Oh heck! Glad it's "ok" -- you really need to take care of yourself...

Unfortunately, given my health scare, I have to get a lot of sleep, and sleep straight through the night and as much as I can during the day, so I won't be able to monitor her closely at night for a while (except if I get up to go to the loo or get a glass of water). Batteries and body must be replenished on my side...Sigh...

Yup, oxygen mask on first for you!

 

[Steph & Quintus & L & O]

she went hypo several times

Clinically hypo or just "low numbers but normal-looking cat" hypo?

 

[Girlie's mom]

Clinically hypo or just "low numbers but normal-looking cat" hypo?

She wasn't eating and the - not so smart people - didn't realise that a) they should ring me and b) that Girlie was on Mirtazapine before! Nothing like reading her history, eh?

Hypo numbers as in 2.7 / 1.4 / 2.7 / 3. They weren't using the AlphaTrak or doing manual ear pricks; the numskulls were drawing blood from a vein for each test. I am thinking nasty words but won't write them here...

I don't know what her affect was; they didn't tell me. It was hard enough getting the numbers out of them! Also, she didn't have a dedicated carer, so it was whoever came to draw blood. This is the emergency vet hospital in Sydney, and they were flat out with desperate cases referred their way, which is their job, of course. While I was on the phone with the vet she was anxious to get off as a dog was going into cardiac arrest, for example. I don't know how much time or attention they could give Girlie. I don't know what I'm going to do when I go away for two weeks at the end of February....

The vet I saw today said, "numbers like that, she could die!" which was very reassuring, of course. Sigh. Sigh. Sigh.

 

[Girlie's mom]

Oh Darrah! I’m so sorry you’re going through this...and very glad it wasn’t a heart attack. I hope you can sleep your way to better health and Girlie can figure a way to calm down for you with her rainbow tendencies so you both can feel better.

And a blood draw for every test? That is the weirdest thing I’ve ever heard; they are lucky all Girlie did was give them the evil eye! Sheesh!

Thank you, Stacy! Sleep beckons now...

I know re: the blood draw for a BG reading. Are they nuts or WHAT? No wonder Girlie is so cranky!

 

[Steph & Quintus & L & O]

Hypo numbers as in 2.7 / 1.4 / 2.7 / 3.

Right, so 1.4 is a little low. My vet told me "meh, down until 2, no biggie". ECID of course.

 

[Girlie's mom]

I think considering all you (and Girlie) has been through, that's a good idea

Give her a chance to decompress and get back to a more normal schedule and then see how she's doing and re-evaluate.

It will also relieve some of the pressure off of you worrying about her while you continue to recuperate!!!

Doesn't Miss China look too precious with the antlers! Gorgeous pic!

Girlie is not a happy camper. I just am surprised at the drops to hypo four times at the vet's. Could stress cause a decrease in BG levels? I would have thought it would cause a rise in BG. Is not eating much food enough to case that dramatic drop as well?

 

[Girlie's mom]

Right, so 1.4 is a little low. My vet told me "meh, down until 2, no biggie". ECID of course.

I think it might be good to get more experienced people's perspective on this. From posts I've seen before, 1.4 (25) - and 2 (36) is okay if a cat is NOT on insulin: 1.4 (25) or 2 (36) is very low if a cat IS on insulin (and you're looking at AlphaTrak - or are you considering this from a human meter perspective?). I'd disagree with that, especially if you're looking at a newly-diagnosed diabetic cat like Quintus. But get others' views on this.

I frequently refer to the shooting and handling low numbers sticky. There's lots of incredibly useful info on that, including the hypo toolbox info.

I know how to get Girlie up from hypo-range numbers, but - clearly! - the vet who doesn't know what she's doing did not. Makes me pretty cranky as now I don't know that I can trust them to care for Girlie properly if I need to go away; they certainly flubbed it bigtime this time.

 

[Steph & Quintus & L & O]

From posts I've seen before, 1.4 (25) - and 2 (36) is okay if a cat is NOT on insulin: 1.4 (25) or 2 (36) is very low if a cat IS on insulin

I am indeed talking "real numbers = AT". Why the difference if the cat is or is not on insulin? From what I've seen the nadirs that are aimed for with a cat on insulin take into account a safety margin, assuming there will not be daily close monitoring. But it seems to me that 2 mmol/l BG is 2 mmol/l BG, whether the insulin in the cat's system comes from its pancreas or a needle/depot. What changes the game is what happens AFTER that: if the insulin came from a needle, there is a much higher risk that the cat is going to continue dropping. That's why we monitor, have honey handy, feed, etc. But as long as the cat doesn't drop more, I have trouble understanding why it would be a bigger problem to BE at that value if the cat is on insulin.

 

[Tuxedo Mom]

I am so sorry for the terrible experiences you went through. How frightening for both you and Girlie!!

Hypo numbers as in 2.7 / 1.4 / 2.7 / 3. They weren't using the AlphaTrak or doing manual ear pricks; the numskulls were drawing blood from a vein for each test. I am thinking nasty words but won't write them here

Since they were doing the machine test those are accurate numbers and are indeed hypo. My Maxie hit 1.8 on AT2 a few days ago and even though I test ( a lot) it caught me by surprise. I syringed syrup and HC food repeatedly and it still took me many hours of repeating this process to get her numbers into safe stable levels. She never shows signs of hypos, but this time she was actually approaching limp and lethargic in the space of 1 hour. I was totally prepared to rush her to the ER if I could not get the levels up and I have dealt with many hypoish numbers over the years.

In a normal kitty that is not on insulin the body organs all work together in harmony to maintain proper glucose levels and keep the numbers from going too high or too low. However in a FD kitty the body processes are not working well and do not respond in a "normal" way. With insulin on board, you cannot "remove" it from the system and the effects continue until the exogenous insulin is out of the system. There is a reason that the protocols set a "hypo alert" number with the lowest being 3.8 (68 US) with TR using an pet meter. Remember also that any meter can have up to a 20% variance so it is always possible that that number could be even lower than the meter shows.

I'd disagree with that, especially if you're looking at a newly-diagnosed diabetic cat like Quintus

You are absolutely right to not allow Girlie's numbers to drop down below the suggested protocol levels. High numbers can do damage over time but a hypo can be deadly or leave permanent damage. The low end numbers as stated in the protocols are there for a reason and no one should flirt with danger by ignoring them. Hypos can be life-threatening and may not always be able to be treated at home. Always better to be safe than sorry.

 

[Mandy & Rex (GA)]

Darrah, I'm glad you're okay. That's scary you went through that then with Girlie as well..

 

[LizzieInTexas]

I am so glad both of you are ok. Please get plenty of rest and take care of yourself. Girlie, please behave for your mama, she needs rest, snuggles and head bumps.

 

[Osha]

Sending vines and rest to both you and Girlie! I am happy you are both ok!

 

[Tracey&Jones (GA)]

Sending some healing vines for the both of you.

Stress is an evil component of our world. It can harm in many ways. Please take care and rest.

I hope Girlie can distress as well and then you can evaluate and take it from there.

 

[Marje and Gracie]

I think it might be good to get more experienced people's perspective on this. From posts I've seen before, 1.4 (25) - and 2 (36) is okay if a cat is NOT on insulin: 1.4 (25) or 2 (36) is very low if a cat IS on insulin (and you're looking at AlphaTrak - or are you considering this from a human meter perspective?). I'd disagree with that, especially if you're looking at a newly-diagnosed diabetic cat like Quintus. But get others' views on this.

I frequently refer to the shooting and handling low numbers sticky. There's lots of incredibly useful info on that, including the hypo toolbox info.

I know how to get Girlie up from hypo-range numbers, but - clearly! - the vet who doesn't know what she's doing did not. Makes me pretty cranky as now I don't know that I can trust them to care for Girlie properly if I need to go away; they certainly flubbed it bigtime this time.

Spot on...thank you!

I am indeed talking "real numbers = AT". Why the difference if the cat is or is not on insulin? From what I've seen the nadirs that are aimed for with a cat on insulin take into account a safety margin, assuming there will not be daily close monitoring. But it seems to me that 2 mmol/l BG is 2 mmol/l BG, whether the insulin in the cat's system comes from its pancreas or a needle/depot. What changes the game is what happens AFTER that: if the insulin came from a needle, there is a much higher risk that the cat is going to continue dropping. That's why we monitor, have honey handy, feed, etc. But as long as the cat doesn't drop more, I have trouble understanding why it would be a bigger problem to BE at that value if the cat is on insulin.

I am not sure if you understand how exogenous insulin works.

• The TR protocol and SLGS do take into account a safety margin and that’s why dropping below 68 (doing TR] on an AT for a newly diagnosed cat is below the safety margin and dropping below 90 on the AT (doing SLGS) is below the safety margin.
• A normal cat’s body working with its own insulin regulates the amount of glucose needed to be taken into the cells and it knows when to shut off the release of insulin; there is then no residual effect.
• A diabetic cat on a depot insulin will continue to get that insulin slow released unless the cat bounces. In the meantime, the cat can Hypo and Lantus/Levemir hypos can last much longer than a cycle.
• Not everyone tests as they should and may not understand how their cat reacts to food which puts the cat further into danger if numbers are low.
• Our cats on insulin are not hooked up to any monitors to see how the low BG affects their brains, etc. caution is necessary.

@Girlie's mom I’m so sorry, Darrah, that you’ve been sick and Girlie lost the progress you had made but I know you’ll get her back. It’s most important that you take care of yourself.

 

[Noah & me (GA)]

I'm so glad you're both back at home. When I posted something about disliking December a lot of people chimed in with similar thoughts, it's never brought us anything but grief. I won't slag your flatmate, that's just who he is. This is stating the obvious but we keep a lot of printed information on the side of the fridge including the most basic things like maps to the two nearest emergency clinics in case Cynthia has to jump in a taxi with an obtuse driver. We either highlite or underline important things because that's the only way to convey on paper to someone "This is important, pay attention". We lost a cat once because no one seemingly understood what "Nervous, known biter" meant.
I have some oddball medical conditions with sudden onset and have missed Noah's shots because I can't do it so you're not alone there. It's my good fortune that Noah's system is tolerant of this.
As for the next week or so I can only suggest a quiet home and a return to normalcy. Appearance and stress or the lack of it can make all the difference. I hope Girlie can climb up on the bed with you while you catch some rest.
This could have been any one of us. Get well soon to both of you.

 

[Kathy and TiTi]

Condo: http://www.felinediabetes.com/FDMB/...0-poo-frequency-question.188443/#post-2093496

I spend from the pm of the 23rd to the morning of the 27th in the ICU (possible heart attack; all good, though; just too much stress, way too little sleep, etc., etc.)

My flatmate took Girlie to the vet. Needless to say, without my preparing them, they did really odd things, especially with her feeding schedule; they didn't give her Mritazapine to make her heat; they didn't know how Levemir worked; she barely at the MD (which she hates); she went hypo several times; they skipped shots and moved her to a 1:00 am/1:00 pm schedule.

So I've got her home. She got the shot at 1:00 pm, but I'm going to skip the shot at 1:00 am and get her back on the 7am / 7pm schedule. Given the hypos - although I think they were vet-induced - I reduced her dose to 0.1 just to be safe. Does this seem a good idea, or should I try her at 0.25 in the AM?

Any tips for getting her back on track? I'd be really grateful!

Unfortunately, given my health scare, I have to get a lot of sleep, and sleep straight through the night and as much as I can during the day, so I won't be able to monitor her closely at night for a while (except if I get up to go to the loo or get a glass of water). Batteries and body must be replenished on my side...Sigh...

I hope everyone had a drama-free holiday and that that continues into the New Year!

What a nightmare! I'm so glad you're back home. Don't worry about sleeping. At 77 years old, I've often had to sleep thru the night because otherwise I, too, could end up somewhere unpleasant. TiTi has weathered my sleep thru's just fine. Like you plan to do, I've done some testing if I wake up. But my main adjustment has been to adjust TiTi's shot schedule so that I can usually get a +3 to +5 after AMPS.

We are what our kitties have - we are usually all our kitties have. What that means is that we do not play games with our health. You must stay healthy, and that means get all the sleep you need.

Hugs and hopes for a much better New Years.

 

[Steph & Quintus & L & O]

I am not sure if you understand how exogenous insulin works.

• The TR protocol and SLGS do take into account a safety margin and that’s why dropping below 68 (doing TR] on an AT for a newly diagnosed cat is below the safety margin and dropping below 90 on the AT (doing SLGS) is below the safety margin.
• A normal cat’s body working with its own insulin regulates the amount of glucose needed to be taken into the cells and it knows when to shut off the release of insulin; there is then no residual effect.
• A diabetic cat on a depot insulin will continue to get that insulin slow released unless the cat bounces. In the meantime, the cat can Hypo and Lantus/Levemir hypos can last much longer than a cycle.
• Not everyone tests as they should and may not understand how their cat reacts to food which puts the cat further into danger if numbers are low.
• Our cats on insulin are not hooked up to any monitors to see how the low BG affects their brains, etc. caution is necessary.

Yup, I understand all that. I think the key point is the one before last: not everyone tests as they should and may not understand how their cat reacts, etc. It's true that my vet was telling ME "under 2mmol/l, no fear". He's known me for 20 years and knows how I handle things. There are probably many people he would not have said this to.

Regarding your last point, I had a discussion about precisely that with my vet. He was saying that the change in glucose concentration was more dangerous than hovering around low numbers when you're already "used to low" (because of the risk of osmotic choc). But it remains that it's the number that is important and not where the insulin comes from, except in that exogenous insulin has no feedback mechanism and will continue lowering the BG no matter what.

 

[Marje and Gracie]

Yup, I understand all that. I think the key point is the one before last: not everyone tests as they should and may not understand how their cat reacts, etc. It's true that my vet was telling ME "under 2mmol/l, no fear". He's known me for 20 years and knows how I handle things. There are probably many people he would not have said this to.

Regarding your last point, I had a discussion about precisely that with my vet. He was saying that the change in glucose concentration was more dangerous than hovering around low numbers when you're already "used to low" (because of the risk of osmotic choc). But it remains that it's the number that is important and not where the insulin comes from, except in that exogenous insulin has no feedback mechanism and will continue lowering the BG no matter what.

I have to disagree with your vet about a diabetic cat hovering in the 20s and 30s on any meter at all whether it’s human or pet. There are many reasons for this but one is that a cat can be in flat numbers even after onset and then drop lower later in the cycle. It’s not likely very many vets have actually seen this but I’ve seen it happen more times than I can remember. It isn’t worth it.

I did not like Gracie surfing in the 40s on a human meter.

There have been cats in this forum who have had symptomatic hypos in the 40s. I never took for granted that just because Gracie never had one when she dropped into the 20s or 30s meant she never would.

 

[Bobbie And Bubba]

Oh Darrah! I am so sorry for both you and Girlie. First, I hope you are okay! Stress just sucks, no other nice way to say it. And your vet experience does not help. But , the good news is that you are an experienced care giver and obviously know more about FD than your vet.

If it were me, I would just skip when you need to get Girlie back to the schedule that is the less stressful for you. With hypo events, kitties can become a bit sensitive to insulin so skipping to regain your schedule and control shouldn't be a big deal.

Please take care of yourself first and foremost as if you aren't healthy and strong you can't care for Girlie.

Sending lots and lots of healing vines to you.

 

[suki & crystal (GA)]

So sorry to hear of your recent traumas, sending healing vines to you and Girlie for a speedy recovery and return to normality

 

[Chubba (GA)]

Oh my, what a nightmare! I am so glad you are both ok and back at home. Get some much needed rest and feel better soon!