? 5/1 Silver - still in hospital - Vet Dosing Question

Status
Not open for further replies.
J

Juliet

Member Since 2017
http://www.felinediabetes.com/FDMB/threads/4-30-silver-in-the-hospital.194902/


Ok so I am really worried about Silver. The vet called. Silver has still not eaten yet has been given 7 units of insulin last night and 7 again today. On top of the 5.25 (usual dose) yesterday at 10am. I thought no food=no insulin? He's gonna cause some serious bouncing with a dose so high. I'm scared to leave him in this guy's hands now. Does he know what he's doing? But I can't take Silver home until he is eating.

He's gonna tube feed him today and continue with the IV drip. His numbers were 199 this am so blue and that's on the pet meter so to me - that's a good number. Please somebody reassure me. I'm at work and now a complete mess.
 
Last edited:
Breathe Juliet, Idjit won t eat or pee at vet for the longest time, it's strange and definitely not home. Hopefully the tube feeding will help. Hoping for excellent outcome.
 
If they are giving him food via feeding tube, hopefully that will keep his numbers from going too low. Are they checking his BG during the day? Sending prayers.
 
carfurby said:
If they are giving him food via feeding tube, hopefully that will keep his numbers from going too low. Are they checking his BG during the day? Sending prayers.
Click to expand...
I don't know. I hope so. They are only starting feeding tube today. So he's had no food since Sunday.
 
Is this rapid insulin or more Lantus? He’s monitoring him, so he can compensate if it ends up being too much, it’s okay.

I’m glad he’s going to tube feed him and keep him on an IV, it should make a world of difference. It sounds like he has a good handle on things, breathe and trust that he is doing all he can for your boy. :bighug::bighug::bighug::bighug:
 
Stacy & Asia said:
Is this rapid insulin or more Lantus? He’s monitoring him, so he can compensate if it ends up being too much, it’s okay.

I’m glad he’s going to tube feed him and keep him on an IV, it should make a world of difference. It sounds like he has a good handle on things, breathe and trust that he is doing all he can for your boy. :bighug::bighug::bighug::bighug:
Click to expand...
It's Lantus. I had to drop off the vial.

I'll try to breathe. I'm scared he won't eat. I can't take him home til he eats.
 
I think as long as he is getting something via the feeding tube he will be okay. Since he hasn't had food since Sunday, that is probably why they are doing the feeding tube. Hopefully once the AB starts working, he will feel like eating. :bighug::bighug::bighug:
 
Sending lots of hugs to you and Silver, I’m sure he’s in good hands. Sending lots of
DCDFEAF4-5540-4E97-9239-76DF1FA97A69.jpeg
 
Sending lots of hugs for you today and some big healing vines for Silver.

ETA: if he is with the vet then I would assume he would be watching. Does Silver have anything that smells like you and Sasha? A blanket or something you can take to him.
 
Silver is where he should be while you're at work and while he needs more intensive care than you could provide at home. I know the label of DKA has been skirted around but if that's the issue the usual treatment involves:
  • fluids, electrolytes to rebalance him
  • doses of faster acting insulin to grab onto BG more aggressively
  • other meds to address infection, nausea, etc.
He needs to be eating on his own reliably, be well hydrated and showing a decent response to insulin before it's safe for him to go home. It can't be rushed.
 
Kris & Teasel said:
Silver is where he should be while you're at work and while he needs more intensive care than you could provide at home. I know the label of DKA has been skirted around but if that's the issue the usual treatment involves:
  • fluids, electrolytes to rebalance him
  • doses of faster acting insulin to grab onto BG more aggressively
  • other meds to address infection, nausea, etc.
He needs to be eating on his own reliably, be well hydrated and showing a decent response to insulin before it's safe for him to go home. It can't be rushed.
Click to expand...
They're not doing faster acting insulin. Just Lantus.

@Tracey&Jones he has a blanket in his carrier. Whether they use it I don't know.

@Kris & Teasel no clue re feeding tube
 
Stacy & Asia said:
Is this rapid insulin or more Lantus? He’s monitoring him, so he can compensate if it ends up being too much, it’s okay.

I’m glad he’s going to tube feed him and keep him on an IV, it should make a world of difference. It sounds like he has a good handle on things, breathe and trust that he is doing all he can for your boy. :bighug::bighug::bighug::bighug:
Click to expand...
I'm concerned about bouncing with such a jump in dose.
 
Kris & Teasel said:
Silver is where he should be while you're at work and while he needs more intensive care than you could provide at home. I know the label of DKA has been skirted around but if that's the issue the usual treatment involves:
  • fluids, electrolytes to rebalance him
  • doses of faster acting insulin to grab onto BG more aggressively
  • other meds to address infection, nausea, etc.
He needs to be eating on his own reliably, be well hydrated and showing a decent response to insulin before it's safe for him to go home. It can't be rushed.
Click to expand...
Thanks. I just read the last line of your post.
 
I’ve never had a cat with a feeding tube but have read of many that have. The purpose is usually to get food into the cat while he can’t eat for whatever reason so it makes no sense to me that he can’t come home until he is eating on his own. He should be able to come home once stable and be fed by you via the tube until he eats on his own. It was suggested at one point that my Tiffany might need a feeding tube but I elected to syringe feed her. When home she was mostly eating on her own. Very often cats won’t eat at the vet. :bighug:
 
tiffmaxee said:
I’ve never had a cat with a feeding tube but have read of many that have. The purpose is usually to get food into the cat while he can’t eat for whatever reason so it makes no sense to me that he can’t come home until he is eating on his own. He should be able to come home once stable and be fed by you via the tube until he eats on his own. It was suggested at one point that my Tiffany might need a feeding tube but I elected to syringe feed her. When home she was mostly eating on her own. Very often cats won’t eat at the vet. :bighug:
Click to expand...

I am assuming Silver does not have a surgically placed feeding tube that he can come home with (it requires surgery and your vet would tell you), I’m going to guess this is the more temporary variety I.e. through the nose, and usually not something they would send a cat home with.

I hope he perks up with some food and the numbers and ketones come down. Speedy recovery vines for Silver and try not to worry vines to you at work, Juliet. :bighug::bighug::bighug:
 
Stacy & Asia said:
I am assuming Silver does not have a surgically placed feeding tube that he can come home with (it requires surgery and your vet would tell you), I’m going to guess this is the more temporary variety I.e. through the nose, and usually not something they would send a cat home with.

I hope he perks up with some food and the numbers and ketones come down. Speedy recovery vines for Silver and try not to worry vines to you at work, Juliet. :bighug::bighug::bighug:
Click to expand...
Thanks for clarifying. In that case I would see if I could visit him and try syringing food. I’d also try finger feeding baby food. When Max had surgery he had to eat to come home. They told me to bring something special and try to get him to eat. He’d never had anywhere BG but cat food so I came with 3 kinds of baby food and tuna. The gerber’s 2nd ham and lamb were his get home free ticket.
 
tiffmaxee said:
I’ve never had a cat with a feeding tube but have read of many that have. The purpose is usually to get food into the cat while he can’t eat for whatever reason so it makes no sense to me that he can’t come home until he is eating on his own. He should be able to come home once stable and be fed by you via the tube until he eats on his own. It was suggested at one point that my Tiffany might need a feeding tube but I elected to syringe feed her. When home she was mostly eating on her own. Very often cats won’t eat at the vet. :bighug:
Click to expand...
I don't want him home until he is eating on his own. I am gone 12 hrs a day and he needs to be able to be healthy enough to be left. I am also at the end of my coping ability.
 
tiffmaxee said:
Thanks for clarifying. In that case I would see if I could visit him and try syringing food. I’d also try finger feeding baby food. When Max had surgery he had to eat to come home. They told me to bring something special and try to get him to eat. He’d never had anywhere BG but cat food so I came with 3 kinds of baby food and tuna. The gerber’s 2nd ham and lamb were his get home free ticket.
Click to expand...
Please see above. I am having to trust the vet. They close before I get home from work. The vet has been taking Silver home. I must trust the vet to do what's best for him without my involvement.
 
Sandy and Black Kitty said:
Juliet,

Find your breath-nice and steady- and repeat to yourself:
“I’m breathing in, I’m breathing out, I’m breathing in...”

Do your best to stay in the moment and focus on what’s in front of you at work.

Remember, time will pass with no effort required on your part.
Click to expand...
Thank you! :bighug:
 
Ok so I'm stranded in Toronto as there's a fatality on my line so I guess it's a blessing I don't have to rush home for Silver's shot.

Called vet. He said Silver's potassium levels are slowly coming up but he can't understand why his BG isn't coming down so he upped his dose AGAIN! I don't know how many times he is dosing but it's scaring me. Too aggressive. He's now finally talking of adding a short acting insulin to the mix. Dunno why he waited so long. So he is keeping him another night. Still not eaten. Tried to find out what his priority is and he was really vague. Got him to finally say getting potassium up is first then BG down. Didn't mention eating. That is my priority. I want him home so I can control the dosing. He's now saying maybe insulin not good. That's crap. I have been using it and its brought his numbers down. Silver takes a few days to adjust to a new dose. Vet no clue about NDW or bouncing. I mentioned bouncing he said Symogi. Different things entirely.

So once again I have left Silver in vet hands and I'm not happy. I want him to be able to eat on his own and get potassium up. Then I want him home. We can fix the dosing here with advice.

Vet said he gave him 7 units last night; 7 units this morning and today said he's upped his dose to 7.5. So he is clearly not giving it every 12 hrs. Sooo scared he may kill Silver.
 
Last edited:
I would insist that he keep the dose at 7 (or 7.5 since he already increased it) and not increase anymore. It takes more than a day for insulin to take effect as we know but he doesn't seem to realize that. Is he testing Silver throughout the day and not just preshot? Tell him not to increase anymore and that your priority is to get Silver eating so he can come home & then you will increase his dose as needed. It's your call, Silver is your baby. Hopefully he'll respect your wishes.
 
LuanneP said:
I would insist that he keep the dose at 7 (or 7.5 since he already increased it) and not increase anymore. It takes more than a day for insulin to take effect as we know but he doesn't seem to realize that. Is he testing Silver throughout the day and not just preshot? Tell him not to increase anymore and that your priority is to get Silver eating so he can come home & then you will increase his dose as needed. It's your call, Silver is your baby. Hopefully he'll respect your wishes.
Click to expand...
I can't insist anything. This vet is doing his thing.
 
My note to the vet - is this a good suggestion or am I wrong?

Hi

I'd rather we didn't keep increasing the Lantus and keep the dose at the 7.5 units you've now increased to and dose is only every 12 hours as he is used to. Silver takes several days to adjust to a new dose and I'm uncomfortable with the rapid increases. If you need to add short acting insulin to the mix that is okay.

Can we focus on getting the potassium up and him eating. I'm not so worried about the BG as that will always be higher under stressful situations anyway as time and experience with looking after Silver has proven to me. I've been dealing with his diabetes for over four years.

Can you try feeding him Royal Canin Recovery. That is what he ate at the emergency vet when he was reluctant to eat. Once he is eating and potassium levels are good I can give subq fluids and insulin at home. Can you confirm that it's the potassium you are most concerned about, followed by the BG and lack of appetite or is there another issue?
 
Juliet, do you know when/how often he is doing BG checks?

I'm just wondering if he is basing dosing on ps values alone. That's the way oldfasold-fas insulin is doses, but, as you know not the way lantus/depot insulin is dosed. It's not uncommon to find vets suggest dosing based on a sliding scale, though that's not the way we dose.


I sure hope he is getting some midcycle checks in. Perhaps you can plant that idea in his head by asking him?


Are Silvers ketones back to normal? I would want that to be in check too (sorry ifi you have already said, I've been away today, it's gone midnight and was quickly vhecchec in on silver)

:bighug::bighug:
 
Gill & George said:
Juliet, do you know when/how often he is doing BG checks?

I'm just wondering if he is basing dosing on ps values alone. That's the way oldfasold-fas insulin is doses, but, as you know not the way lantus/depot insulin is dosed. It's not uncommon to find vets suggest dosing based on a sliding scale, though that's not the way we dose.


I sure hope he is getting some midcycle checks in. Perhaps you can plant that idea in his head by asking him?


Are Silvers ketones back to normal? I would want that to be in check too (sorry ifi you have already said, I've been away today, it's gone midnight and was quickly vhecchec in on silver)

:bighug::bighug:
Click to expand...
I don't know those answers. He's not open to me interfering. He keeps talking over me. I don't want him messing with his dosing. Yeah I forgot about the keytones but last time they didn't come down until he was out of the hospital.
 
Gill & George said:
Juliet, do you know when/how often he is doing BG checks?

I'm just wondering if he is basing dosing on ps values alone. That's the way oldfasold-fas insulin is doses, but, as you know not the way lantus/depot insulin is dosed. It's not uncommon to find vets suggest dosing based on a sliding scale, though that's not the way we dose.


I sure hope he is getting some midcycle checks in. Perhaps you can plant that idea in his head by asking him?


Are Silvers ketones back to normal? I would want that to be in check too (sorry ifi you have already said, I've been away today, it's gone midnight and was quickly vhecchec in on silver)

:bighug::bighug:
Click to expand...
I just emailed back re the ketones. Re testing at the preshot only - if he is - I'm okay with that as the last several months Silver's nadir has been his preshot. So not too worried is that is the only testing.
 
((( Juliet )))

I understand everyone's apprehension with your vet's dosing methods, but something we all have to remember is this is not a "normal" situation... all the guidelines/rules we follow on the forum go out the widow when we're talking ketones/DKA. More insulin is required to get rid of ketones.

For example: In Australia, the renowned feline diabetes specialist, Rhett Marshall (a contemporary of Jacquie Rand and co-author of the very first TR Protocol using Lantus) uses Lantus just like one would use R insulin to treat DKA:

"Glargine can be administered to ketoacidotic cats by:
  • infusing intravenously at a rate of 0.05-0.1 U/kg/hr and rate adjusted to maintain blood glucose between 10-14mmol/L or
  • injected s/c at the normal dose rate (0.25-0.5U/kg) as well as 0.5-1U of glargine injected IM or IV

As soon as I have a diagnosis of DKA, I immediately administer 0.5U/kg subcutanI eously as well as 1U into the quadriceps muscles. I often administer glargine before I have discussed the diagnosis and treatment plan with owners. If they decide not to treat the cat, little has been lost as the syringes and insulin probably cost the clinic less than $1. I have found most cats require 1U of glargine given IM every 2-4hrs based on glucose concentration. The dosing of glargine IM or IV is continued until hydration is restored and appetite returns, which usually occurs in 1-3 days. Glargine is then injected s/c and dosed as for an uncomplicated cat (see Table 1)."
http://www.thecatclinic.com.au/info-for-vets/using-glargine-for-diabetic-ketoacidosis

This isn't what your vet is doing. However, my point in bringing up another dosing method is... there are other methods out there for vets to use. They are equipped to bring up numbers quickly if they have to. Don't get too bothered by your vet's dosing methods. A vet's methods won't be the same as what we do here. Your vet is dealing with a cat in crisis. We deal with diabetes in general. Complicated cases often require extraordinary measures.

Will the vet be taking Silver home with him again tonight?
 
Juliet said:
I just emailed back re the ketones. Re testing at the preshot only - if he is - I'm okay with that as the last several months Silver's nadir has been his preshot. So not too worried is that is the only testing.
Click to expand...
Great for asking.

Be open to the possibility that Silvers patterns may change after this crisis. I've often seen that to be a the case.
 
He seems a kind and caring vet Juliet. He is willing to keep Silver with him 24/7.

Perhaps what he is doing seems odd to us as we are used to here but at the end of the day he is a highly trained doctor. He is committed to do no harm , to do his utmost & he will.

This is very much an E.R. crisis situation . Not a maintenance & first responder situation. The rules change.

The question for everyone is , if this were a person in an ICU unit - which is what this is for Silver - would anyone be trying to tell those specialists what they should be doing. Or would we stand back and give them the space they need.
 
Can I just add to Juliet.

He may not be talking over you as such. He may be talking right at you because he wants to make sure you are hearing what he is telling you.

When we are in emotional turbulence , it is so hard to keep the mind still and simply to listen . We just want to jump on in as that is a part of our protective survival coping mechanism. Vets/Doctors know this. They need to remain away from that to do their work calmly and clearly.

I have everything in my heart held to you that Silver comes out the other end and slowly improves.

Big hugs love. Big huge hugs.
 
Jill & Alex (GA) said:
((( Juliet )))

I understand everyone's apprehension with your vet's dosing methods, but something we all have to remember is this is not a "normal" situation... all the guidelines/rules we follow on the forum go out the widow when we're talking ketones/DKA. More insulin is required to get rid of ketones.

For example: In Australia, the renowned feline diabetes specialist, Rhett Marshall (a contemporary of Jacquie Rand and co-author of the very first TR Protocol using Lantus) uses Lantus just like one would use R insulin to treat DKA:

"Glargine can be administered to ketoacidotic cats by:
  • infusing intravenously at a rate of 0.05-0.1 U/kg/hr and rate adjusted to maintain blood glucose between 10-14mmol/L or
  • injected s/c at the normal dose rate (0.25-0.5U/kg) as well as 0.5-1U of glargine injected IM or IV

As soon as I have a diagnosis of DKA, I immediately administer 0.5U/kg subcutanI eously as well as 1U into the quadriceps muscles. I often administer glargine before I have discussed the diagnosis and treatment plan with owners. If they decide not to treat the cat, little has been lost as the syringes and insulin probably cost the clinic less than $1. I have found most cats require 1U of glargine given IM every 2-4hrs based on glucose concentration. The dosing of glargine IM or IV is continued until hydration is restored and appetite returns, which usually occurs in 1-3 days. Glargine is then injected s/c and dosed as for an uncomplicated cat (see Table 1)."
http://www.thecatclinic.com.au/info-for-vets/using-glargine-for-diabetic-ketoacidosis

This isn't what your vet is doing. However, my point in bringing up another dosing method is... there are other methods out there for vets to use. They are equipped to bring up numbers quickly if they have to. Don't get too bothered by your vet's dosing methods. A vet's methods won't be the same as what we do here. Your vet is dealing with a cat in crisis. We deal with diabetes in general. Complicated cases often require extraordinary measures.

Will the vet be taking Silver home with him again tonight?
Click to expand...
Oh thanks for this @Jill & Alex (GA) i feel better now. The dose increases were scaring me. So I was wrong in my email to the vet then. Dunno how to backtrack from that. Don't find it easy to trust vets with my cat. He didn't say if he was taking him home but I imagine he will. No one is at the clinic overnight and he does seem to care.
 
Should vet administer short acting insulin do you have any idea how much he is thinking of? That could be a real concern since he seems to be upping the lantus freewilly.
 
PussCatPrince said:
Can I just add to Juliet.

He may not be talking over you as such. He may be talking right at you because he wants to make sure you are hearing what he is telling you.

When we are in emotional turbulence , it is so hard to keep the mind still and simply to listen . We just want to jump on in as that is a part of our protective survival coping mechanism. Vets/Doctors know this. They need to remain away from that to do their work calmly and clearly.

I have everything in my heart held to you that Silver comes out the other end and slowly improves.

Big hugs love. Big huge hugs.
Click to expand...
I hear you. And thanks. I'm a bit of an emotional wreck with little sleep so probably am coming across too aggressive. I'm trying hard to work with him.
 
Status
Not open for further replies.
Back
Top