6/13 Topper PM Dose Question & Call From Vet

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J

Jan and Topper

Member Since 2013
http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=97487

I didn't take Topper to the ER last night but am leaving in a little while to take to vet.

He did eat some baby food last night at shot time, but threw up two hours later. He has been eating baby food through the night, has not thrown up again.

I gave a reduced dose of insulin last night. Half his usual dose.
I don't have time to fill in the SS right now but his bg has been:
PS 300
+2 300
+4 307
+6 326
Have not tested since.

He seems to feel a little better, seems more alert. But is still meatloafed and looks miserable.
I think he needs to come down out of these numbers but of course don't want him to hypo.
If things stay the same this morning, how much insulin should I shoot next shot? I should get him home from the vet at about shot time. I have no idea what to do, please help!

Checked for ketones in night, was negative. I'm really worried with the high numbers, not eating much and the inflammation he's set up for ketones.
Thank you
 
Re: 6/13 Topper Dose Question Urgent

It may take Topper's body more time to get used to the new dose. Just remember that with each new increase, it takes time to fill the shed in order to be utilized properly. He may be going through a bounce of sorts at this time due to the increase. As you go along, the #s will get better, and he'll be more perky over time. Hang in there. You're both doing an excellent job. It WILL get better. :-D Good luck at the vet's today. Let us know what he/she says.
 
Re: 6/13 Topper Dose Question Urgent

Good morning, Jan. That's great that he hasn't thrown up since last night and you're taking him to the vet. Good job on the ketone test too. What dose did you give him last night? Get a test when you get back from the vet and post for dosing advice. He may be higher because of vet stress so lets see what the number is.
Liz
 
Re: 6/13 Topper Dose Question Urgent

Hi Jan-

I'm glad to hear that Topper seems to be feeling better, that ketones are negative, and you're able to take him to the vet this morning. I agree with Liz; it will be easier to determine what to shoot next after the vetty visit, since you'll hopefully have some answers about how he's feeling, plus you'll have a current number.

Sending tons of prayers your way...please keep us posted!

Amy
 
Re: 6/13 Topper Dose Question Urgent

First, get input from your vet and factor that in unless you think the vet's input re. insulin dose is off the mark.

Some of the numbers you're seeing are a bounce off of the green at PM +4. Topper may not be feeling well and that''s contributing to where the numbers are, too.

If the vet is thinking pancreatitis, please push to get an fPLI -- either one that can be done in the office or that needs to be sent out.

I'd continue to give Topper baby food since it's staying down. (FYI - Gerber Stage 2 does contain cornstarch but it's about 7% carb so it's an option.) If the food is staying down, I'd stick with your current dose. But, as the others noted, evaluate the dose at shot time and post if you need inputs.
 
Re: 6/13 Topper Dose Question Urgent

Jan

Lantus land emergency fund is going to pay for the vet visit. Please see my PM to you before you go!
 
Re: 6/13 Topper Dose Question Urgent

Morning, I glad Topper is doing a little better ad will be looking for your post on him.
 
Re: 6/13 Topper Dose Question Urgent

Sending good vet visit vines. I hope Topper feels much better, soon.
Please keep us posted (((hugs))).
 
Re: 6/13 Topper Dose Question Urgent

Thanks everyone.

Vet suspects Pancreatitis, drew blood for that test.
Topper's temperature was 103.7. Vet gave an antibiotic injection called Crystiben. I hope that is a safe drug.
Gave subq fluids and I'm supposed to give 100ml every day for the next five days.
Prescribed Buprenorphine and Cerenia.
He tested Topper's bg and it was 487. On my Contour it was 322, my Relion 279. This of course is very upsetting to me.

Vet said to give Topper his regular dose of insulin based on the 487.
I had NO idea what to do. I was not able to get online for advice. His PSBG on my meter was 263. I shot the reduced dose again and I'm feeling like that is just wrong. No I do not want him to hypo, but I don't want him to go into DKA because he is sick and not getting enough insulin. I'm very frustrated as to what number is correct.

Topper ate some FF Beef Feast when we got home, and about an hour after his insulin shot he ate more. About 1oz and he has held it down.
I think he's feeling better with his meds, and his breathing isn't as rapid as it was. He's still sleeping with his face in the water bowl, but is shifting between meatloafed and stretched out on his side.

I'll get back on tonight for dose advice. I'm wondering if he continues to eat and hold it down if we can increase the dose.

I'm hoping to sleep for awhile now, I'm completely exhausted. Had to wait over an hour for a taxi, by the time we got to the clinic, the vet who was working us in on surgery day, had started a complicated surgery so we had to wait another hour, then when he came in he and the techs all seemed to be operating in slow motion - everything took forever. Had to wait 20 minutes just to get the take home meds.
Had to give insulin as soon as we were home and I was so upset about that, couldn't sleep afterwards!
 
Re: 6/13 Topper Vet Update

Jan

Do you know what test he ran for pancreatitis? Was it the specfPL?

I'm not familiar with crystiben. Normally an antibiotic is not needed for pancreatitis but if it was just one shot, it's probably fine. I did google it and it doesn't seem to be an a/b like Convenia which stays in the system over 3 weeks (which you DO NOT want). It is contraindicated in animals who have reactions to penicillin as it is a generic penicillen. It might also cause diarrhea.

I'm glad he gave you buprenorphine. The cerenia is for vomiting, not so much nausea...not sure why vets always reach for it in the case of nausea but it works better for vomiting so it might really help Topper.

Here is the video Mike and I made on giving subq fluids at home:
[youtube]TtSzMuDgx78[/youtube]

I probably would have given him a full dose but you're OK with giving him a half dose. See how he does today and if he feels better and is eating, then you can start with a full dose next shot.

I hope you get some rest. I'm sorry it was a tough day. Still need you to contact me via PM ASAP. :YMHUG: :YMHUG:
 
Re: 6/13 Topper Vet Update

Marje, I sent you a PM.
Yes the test was a specfPL.

Well, I'm really upset that I didn't give Topper the full dose. I just wasn't sure since he's had so much less food than usual and I had no idea if he was going to start throwing up what I'm getting into him.

Thank you for including the video!
Does it matter when the fluids are given in relation to when the insulin shot is given?
 
Re: 6/13 Topper Vet Update

What an exhausting day! You did a super job, Jan. :-D :-D I think the dose is fine. You made an excellent choice. Don't beat yourself up, there's no reason. Sending tons of vines to Topper. I hope he's feeling better soon.
Liz
 
Re: 6/13 Topper Vet Update

Marje, or one of the other members here who use fluids can better answer your question about when to give fluids better than I can. What I can tell you is that you don't want to give fluids and insulin in the same location. Also, for some cats, fluids can lower BG -- essentially you're "diluting" the glucose that's in the blood. It's probably best to not give fluids around nadir.

Marje put together an excellent primer on pancreatitis.

Actually, while Cerenia is effective for treating vomiting, it was developed to treat motion sickness. I've come across a couple of references to it's use in treating nausea, as well.

It sounds like Topper's temperature was a little elevated. Hopefully, if it's due to an infection, the penicillin will deal with it.

As far as the numbers at the vet, chances are Topper's numbers were elevated due to stress. You have to base your dosing on your meter. Given all that's going on, I would get a ketone test at every opportunity just so you have peace of mind on that front. The fluids and antibiotic will help to prevent ketones. I'd also feed Topper anything he will eat.
 
Re: 6/13 Topper Vet Update

I'd give it a few hours at least between insulin and fluid.. fluids perhaps after nadir? And, as Sienne pointed out, I'd be sure and give them at different locations.

Also...keep in mind that fluids "might" drop the BG a bit. It's an ECID. When we first started insulin, I was giving Gracie fluids and I didn't see any change in her BG but some cats do.

And please do not worry about having given a reduced dose! It's OK...really it is. You can give him a full dose next shot depending on how his numbers are. You are doing SUPER!!!!
 
Re: 6/13 Topper Vet Update

I'm so glad you got Topper to the vet and have a plan in action...I am so sorry about the p-titis, and the long and exhausting day you've had. You really are an awesome, fabulous bean, and you are doing a great, great job...do not doubt yourself!!! Get yourself some rest...be sure to take care of yourself, too!
 
Re: 6/13 Topper Vet Update

I'm not sure if I'm supposed to just keep adding to this condo or start a new one, I think I read somewhere on the board that you are supposed to keep adding to the one daily condo!

Well, I don't know how much to shoot tonight. Any advice?

I offered Topper some FF Beef Feast at +6 and he licked at it, wouldn't eat, but then let me put bites in his mouth which he swallowed, I kept putting until he said stop and in all he got 1/4 can. Has held it down. His +6 was 167. +10 211.

The vet called, he had gotten some of the results back, the white count is elevated so he says Topper has an infection. A couple of the liver enzymes are off, he said could be due to the vomiting, but he wants to recheck in a couple weeks. Also the bg at the lab was 389, which is at least close to my Contour 322, I think with the varience it's about the same. Makes me feel better than that 468 in house. Will talk to the vet again in the morning.

Thank you for the information on the fluids. And thank you for all of the support!
 
I would keep with the 1.90u. His numbers are pretty good and he's not eating all that great. Sending tons of vines to Topper.
Liz
 
I think the blue numbers are likely depot from the higher dose.

What would make you most comfortable, Jan? If you'd feel better just giving him a half dose in case he doesn't eat, that's fine. I think you are likely tired and it might be better to wait and shoot the full dose in the morning so you can rest tonight.
 
I don't know what I want to do. I really don't know anything at this point :smile:

I don't want to wait too long to bring the dose up and have him jump up really high, but I don't want him dropping too low, especially since I know if I ever really konk out I'm not going to wake up for awhile.

Maybe I'll just stay with the reduced dose tonight then see how he's doing in the morning. He sure looks awful tonight, is the Bupe supposed to knock him out? I can wake him up but he just lies there looking like a beached whale.
 
Yes, the bupe can knock them out. You can try giving less next time and see if he's less dopey but still gets enough to take care of the pain. Dosing is a hard decision sometimes. I wish my crystal ball would work!
Liz
 
((((Jan))))

You need to be sure and take care of yourself and rest. It's ok to give him a half dose of insulin and start over tomorrow.

The bupe usually has a wide dosing range and I find vets often start at the upper end of the range instead of the lower. So you could cut it back a bit and see how he does.

More healing vines for Topper.
 
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