4/5 amps 441 fluids yesterday maybe more today

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babbie & otto

babbie & otto

Member Since 2015
hyperosmotic state - need dosing advice
got the vet coming over today for more fluids just to keep him hydrated and try to get to a normal state. Just dont understand the dehydration but vet says its from numbers being too high. Last nite in the 200"s at +5.5 so I only increased .25. Ill talk to him about the fast track. Otto looks good but also looks a little dehydrated again , filled the cat box yesterday with pee. Happy Easter everyone and thanks for looking out for animals that fill our lives everyday with their unconditional love. Nice to have them around at holidays when family can really leave you wondering "what the hell?". I saw a bumper sticker that says "who saved who" from a rescue group. Nice.
 
I agree with Marje's comment yesterday that fast-tracking is usually reserved for a cat that has constant unremitting nadirs over 300 on a human glucometer. I think it's confusing for many of us looking at his blood sugar because it's on an AT. He's not constantly so high that i would fast track. That's best for a cat that really is nowhere near the right dosage. But I'm glad you increased his dose this morning.

I wonder if @Jill & Alex (GA) has experience with hyperosmotic state and could offer some advice for you.
 
I agree that fast tracking may not be the best way to go right now with Otto. I didn't mean to confuse you....it was just a suggestion to throw out there as well as asking others for their opinions.

The ladies here have years of experience, and they're suggestion the idea of using "R" along with the Lantus as a way to get Otto's higher numbers down so that the Lantus can work better and I think that would be the way to go if it were my cat.

Discuss that idea with your vet when he comes and if he thinks it's a good idea, let us know. There are people here like the ladies I tagged yesterday that can teach you how to use R safely and effectively.

Hope you have a nice Easter!
 
From her 4/4 condo
thank folks. What would you consider a high enough glucose level for the R dose? How do you know what a drop is? I guess I have to waste a little in the sink trying to figure it out. More fluids today just in case. Still hungry and not breathing heavy. Vet wants me at 6 and just frowned when I said i went up to4.75. He really pushed for 5u tonite.
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Since it's a holiday, it may take a little longer for people to reply, but I'll tag them again for you.

@julie & punkin (ga) @Marje and Gracie @Wendy&Neko @Sienne and Gabby @Ann & Tess
 
What would you consider a high enough glucose level for the R dose? How do you know what a drop is?
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There's not a definitive answer for that. Sometimes I shoot R into a rising number that is blue. You have to look at the number, where it is in the cycle, and if he's trending up or down. Obviously, if he's trending down, you don't want to shoot R. That's why we like someone to be with you because we can then discuss when a good time is to shoot the R.

From looking at his SS, and keeping in mind that you use an AT, you could theoretically shoot it when he's 300 and climbing, just as an example, to start. And again....that is 300 on an AT. But, with R, there are many things you have to be cautious about and one of the biggest is making sure that the nadirs don't overlap. You do not want him nadiring from lantus and R at the same time. You could have shot it at PMPS tonight, as another example.

The way I draw a drop is I insert the syringe into the vial with the plunger pushed in and then release the plunger and the vacuum draws about a drop.

BTW, raising his dose as you are is going to cause some wonkiness. You can't get responses from lantus that you are looking for by being inconsistent with the dosing.

Again, I have to encourage you to discuss the R with the vet and get him on board. He might want to even give you some numbers that he'd feel comfortable with you shooting. And please be sure one of us is online with you if you decide to shoot R. It can be a dangerous insulin to use if you don't know what you are doing and shoot the wrong amount or shoot it at the wrong time or in the wrong spot.
 
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thanks., I should have raised him to 5u this am but didnt. When you say raising the dose as I did - do you mean tonite going up to 5? It was suggested earlier that I raise to 5 this morning but I tried going slow then the Vet came over today and we gave some fluids (not much needed) and urged me up. The osmotic state is caused by either high numbers unregulated,heart disease or renal failure. His only symptoms so far have been one day of not starving, and heavy breathing. He did start getting dehydrated a week ago and we have given him fluids constantly. He was a little slower in pace today but eating fine so Im hoping we caught it in time. Fatality rate is really high. Going to get a 2nd opinion from a vet tomorrow on the heart and kidneys and R dosing. Youre right, I could have done the R tonight but vet wasnt totally on board and i need him to be.
 
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Tell us when you plan on giving R and one of us will guide you. We can make a date for your next shot if you want. Or tomorrow evening after you've had a chance to consult with vet #2?

What time do you shoot and in what time zone? You must test hourly for 4 hours after using R in the beginning, and if it reduces his blood sugar enough you need to be able to keep testing if needed.

I would give the 4.75u at least 4 more likely 6 cycles total before raising it again. Some cats respond to a dose increase with higher numbers, New Dose Wonkiness, and you need enough time on the increased dose to see what it can do.
 
It should be fairly simple to tell if it's renal failure. Has your vet not run labs? If so, if you post them on the lab tab on Otto's SS, we can look at them. We're pretty good with labs :)
 
Looks like Julie tagged me yesterday, but I've been away from the board the last few days. How is Otto doing today?

As far as I know there has been only one other kitty on this board with Nonketotic Hyperosmolar Syndrome. Linda and Mandy's kitty, Snickers, was diagnosed with hyperosmolar syndrome in November 2010 as Mandy mentions here. In that same thread, Jess & Earl, a highly respected vet tech describes hyperosmolar syndrome in layman's terms:

"Sounds like the vet is talking about hyperosmolar syndrome. It is a potentially serious complication of diabetes ... it is difficult to explain, but basically means that the cells themselves have become dehydrated -- it is a sort of deep dehydration that occurs because the body tries to compensate for thick, sugary blood by putting more fluid into the blood. The fluid comes from the cells, which then are too dehydrated themselves. Does that make some kind of sense? The body always tries to balance things out, so if the blood has too little X or too much Z, the body tries to push more X into the blood, or suck out or dilute out Z. Hyperosmolar syndrome happens over time because of uncontrolled diabetes *usually* plus some other complication like pancreatitis, infection, etc."

As I recall, Snickers spent a lot of time in the ER and at his vet's office getting IV fluids or being on an R insulin drip to pull his numbers down. I don't recall getting involved with helping Mandy use basal and bolus insulin insulin combo to treat Snickers. I believe her vet felt it was better to administer R via an IV drip because I *think* (I'm going on memory) you're not supposed to pull the numbers down too fast. I'd be interested in knowing if you vet feels the same or if your vet thinks it would be ok to use tiny doses of R as a bolus along with Lantus as a basal insulin at home. Have you had a chance to discuss home use of R insulin as a bolus along with Lantus as the basal insulin?

I think this article lists some valid points to discuss your vet:

Treatment
  • IV 0.9% saline
  • Correction of any hypokalemia
  • IV insulin (as long as serum K is ≥ 3.3 mEq/L)


Key Points
  • Infections, nonadherence, and certain drugs can trigger marked glucose elevation, dehydration, and altered consciousness in patients with type 2 diabetes.
  • Patients have adequate insulin present to prevent ketoacidosis.
  • The average fluid deficit is 10 L; treatment is 0.9% saline solution IV plus insulin infusion beginning after the first liter is given.
  • Target plasma glucose in acute treatment is between 250 and 300 mg/dL (13.9 to 16.7 mmol/L).
  • Give K replacement depending on serum K levels.

As other members have mentioned, we can help you with using R insulin in addition to Lantus at home if your vet approves. If he doesn't approve, I'm curious what he suggests or recommends.

Most of us are aware this is a very serious condition. Because of the seriousness of this condition, it's best if your vet takes the lead. We can assist, but for Otto's sake and safety, we do need direction from your vet. Please let us know how or if we can help...

:bighug::bighug::bighug:
 
thanks for your interest... I think we caught it in time as I took him to the vet b/c he was breathing heavy and not eating. I know my cat and food is his biggest priority. They are usually presented to vet in an almost comatose state hence the poor survival rate. We increased his dose to 5u and his amps and pmps have come down which vet thinks was the root cause.(He was in the 5-600's constantly) No other indications of renal, heart, infection etc. and the main cause is high glucose for too long. He was in the 300's this morning and feeling great. Im taking him for an ultrasound today just in case we missed anything. It was a really rough weekend thinking this was it but he got better each day as the higher dose kicked in.
 
You might want to ask your vet to teach you to give fluids at home, it isn't very hard and the cat (and you) gets used to it very quickly. After Tess's DKA we started 75ml of fluids every day. Perhaps part of her problem was chronic dehydration like Otto that just wasn't diagnosed as such. The difference in a month is amazing. She's perkier, eating well and telling us in the mornings that it's time to get up and give her some fuds even! Yes, there is a lot more pee, but that's great for flushing out the toxins that were building up.

ECID , for the R we try to do as Marje does and catch rising numbers. Before we got the hang of it we were seeing an awful lot of reds and blacks. We're still fine tuning it, but you obviously know your cat. It's a lot of testing, but when you see numbers start to rise earlier than normal or faster than normal, that's when we give Tess R. If you catch the rise early you can use less, it's safer and the Lantus will be more effective at keeping things even. I know what you are going through, but things do get better!:bighug::bighug::bighug:
 
do you sleep at all? I dont understand how much you're dosing as its in mm and .6. What a range!!!!! I looked at your ss and I dont know how you do it! Im having issues with my test strips - great blood today and 3 test strips wouldnt read it. Happened yesterday too. Today (but not yesterday) I put neosporin on 1st to get the blood to bead up - maybe that spoiled the test although it hasnt before. I learned how to do fluids and I think that makes a big dif but vet doesnt think thats it. This new dose will be key.
 
If you got just a little too much neosporin on that could clog up the strip. Try wiping it off right away, there will still be enough to bead up the blood.

I'm lucky DH and I take turns staying up. We use a digital caliper to measure the dose, that's the mm , the units are above that on the SS. Right now we are at .5u. The markings on the syringes are often not stamped in the right place and for tiny doses we measure from the plunger to the inside of the end of the barrel, much more accurate. You need a good magnifier though. There is a link in the stickies showing how to do it.
 
I'd put the neosporin on when we were done for the night, then wipe off any excess in the morning. You don't want to leave on enough to goo up the strip.
 
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