6/21 Henry's home! PMPS 474 +2 498

[John & Henry]

Is his appetite good?

Yeah, it's been great, but I've been waiting to feed him til his BG drops some, but 498 at +2?!?! I'm so frustrated. I hope I didn't shoot through his skin or something. I try so hard not to do that

We'd need to line up some experienced people to help you with R if you do it, to "sit" with you the first few times you give it. There are a lot of things to learn about giving R, and even more to learn about when not to give it.

Hmmm... Not sure where I'd find someone like that around portland, unless you mean sit online? Is there tutorials or a FAQ or something about giving it to cats? Not that I would without getting guidance from here first, but I'd like to read about it. Is it as "strong" as Lantus (Ie, more dilute, so it's easier to dose in small quantities?)

Here you go.

Thank you

 

[Bron and Sheba (GA)]

Ugh!!! I just tested him PMPS +2 and he's 498!!! HOW!?!?!?

John, Henry is probably bouncing from the long run of low green BGs and then a green preshot. I would continue to check for ketones and let us know how they are going

• Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).

 

[Bron and Sheba (GA)]

eah, it's been great, but I've been waiting to feed him til his BG drops some, but 498 at +2?!?! I'm so frustrated. I hope I didn't shoot through his skin or something. I try so hard not to do that

Please don't wait to feed him.....he needs food every couple of hours regardless what the BG is.... and fluids
I'm sure you didn't shoot through the skin. I think he is bouncing

 

[John & Henry]

John, Henry is probably bouncing from the long run of low green BGs and then a green preshot. I would continue to check for ketones and let us know how they are going

• Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).

That 67 AMPS on the SS is a little misleading since he didn't actually get the shot, but I wasn't sure how to put it on there so I just put 0 under the units. I guess what the vet was trying to explain to me earlier with her hypo fears was "bouncing" without using that word. If this goes on for 6 cycles he's probably going to go ketogenic again? /sigh I'll check the ketones shortly, but I'm kind of afraid

 

[John & Henry]

The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low.

Am I correct guessing that the source of this sugar has something to do with ketone production?

 

[John & Henry]

Please don't wait to feed him.....he needs food every couple of hours regardless what the BG is.... and fluids
I'm sure you didn't shoot through the skin. I think he is bouncing

He actually still has been he hasn't eaten he keeps picking at. I guess I meant I was waiting to open a new can of food. He's pretty much had non-stop food available since he's been home. He just drank a whole bunch of water, although he hasn't touched his new cat fountain since he's been home

 

[Bron and Sheba (GA)]

That 67 AMPS on the SS is a little misleading since he didn't actually get the shot, but I wasn't sure how to put it on there so I just put 0 under the units. I guess what the vet was trying to explain to me earlier with her hypo fears was "bouncing" without using that word. If this goes on for 6 cycles he's probably going to go ketogenic again? /sigh I'll check the ketones shortly, but I'm kind of afraid

I would put 'skip' in the U column for this morning.
As long as he is getting enough insulin, enough food and the infection is being treated, he should be OK. And bouncing doesn't always last 6 cycles...its up to 6 cycles.

Am I correct guessing that the source of this sugar has something to do with ketone production?

NO. Nothing to do with ketones.
Lots of cats bounce. My Sheba bounced but she never had ketones.

He actually still has been he hasn't eaten he keeps picking at. I guess I meant I was waiting to open a new can of food. He's pretty much had non-stop food available since he's been home. He just drank a whole bunch of water, although he hasn't touched his new cat fountain since he's been home

Do you think he is nauseated?

 

[John & Henry]

Do you think he is nauseated?

It's hard to tell. He begs for food anytime I walk out into the kitchen, but I think he's just "programmed" to do that. It probably couldn't hurt to give him some cerenia anyway. Thank for answering my other questions. BG still through the roof 492 @ PMPS +3 and ketones are up to 1.9

 

[Bron and Sheba (GA)]

It's hard to tell. He begs for food anytime I walk out into the kitchen, but I think he's just "programmed" to do that. It probably couldn't hurt to give him some cerenia anyway. Thank for answering my other questions. BG still through the roof 492 @ PMPS +3 and ketones are up to 1.9

Yes I would give him some cerenia. We want him to eat well.
I hope the ketones go down soon. Are they showing in the urine?

 

[Wendy&Neko]

Hmmm... Not sure where I'd find someone like that around portland, unless you mean sit online? Is there tutorials or a FAQ or something about giving it to cats? Not that I would without getting guidance from here first, but I'd like to read about it. Is it as "strong" as Lantus (Ie, more dilute, so it's easier to dose in small quantities?)

I mean one of us on FDMB, preferably in your time zone and awake and online for your PS times and 4 hours after that. No tutorials or FAQ. R use is discouraged without someone to help you. We don't want anyone grabbing the information and thinking they can "wing it" on their own. R is a LOT stronger than Lantus and potentially more dangerous. Initial dose is usually 0.1 units. At times I used a drop of R with Neko.

 

[Bron and Sheba (GA)]

How is it going John?

 

[John & Henry]

BG is still high 440 @ PMPS +6.

R is a LOT stronger than Lantus and potentially more dangerous. Initial dose is usually 0.1 units. At times I used a drop of R with Neko.

That's unfortunate. I can't believe there isn't a more dilute insulin (of any kind) so the dose can be more finely dialed in without calipers. Or at least smaller syringes.

Yes I would give him some cerenia. We want him to eat well.
I hope the ketones go down soon. Are they showing in the urine?

I've given Cerenia, but he's just not interested in food He hasn't eaten since earlier this evening, despite me opening a new can (which really gets him excited), but just a sniff and "no thanks". He has been drinking plenty of water tho. Do BGs this high make them less apt to want to eat? He hasn't used the LB in awhile either, so I haven't been able to check ketones there. While I did stock up on blood ketone strips, I still only have a fairly limited amount since they only come in like 5 packs, so I figured I'd wait to check his blood ketones until I get to bed in a few hours. Last check was 1.9 @ PMPS +3. With all his drinking I figure he'll have to go soon.

 

[Bron and Sheba (GA)]

BG is still high 440 @ PMPS +6.

That's unfortunate. I can't believe there isn't a more dilute insulin (of any kind) so the dose can be more finely dialed in without calipers. Or at least smaller syringes.

I've given Cerenia, but he's just not interested in food He hasn't eaten since earlier this evening, despite me opening a new can (which really gets him excited), but just a sniff and "no thanks". He has been drinking plenty of water tho. Do BGs this high make them less apt to want to eat? He hasn't used the LB in awhile either, so I haven't been able to check ketones there. While I did stock up on blood ketone strips, I still only have a fairly limited amount since they only come in like 5 packs, so I figured I'd wait to check his blood ketones until I get to bed in a few hours. Last check was 1.9 @ PMPS +3. With all his drinking I figure he'll have to go soon.

I am really concerned he’s not eating.
Is there anything else he will eat…..anything at this point? He is usually such a good eater. He must be nauseated
tomorrow morning I would try and get some ondansetron first thing and give him some. It can be given 3 times a day. It is really good go for nausea. Better than cerenia.
Have a look at this link
HOW TO STIMULATE A KITTYS APPETITE

If he won’t eat you might have to syringe feed him…..he has to eat.
SYRINGE FEEDING LINK

 

[John & Henry]

I am really concerned he’s not eating.
Is there anything else he will eat…..anything at this point? He is usually such a good eater. He must be nauseated
tomorrow morning I would try and get some ondansetron first thing and give him some. It can be given 3 times a day. It is really good go for nausea. Better than cerenia.
Have a look at this link
HOW TO STIMULATE A KITTYS APPETITE

If he won’t eat you might have to syringe feed him…..he has to eat.
SYRINGE FEEDING LINK

Yeah, it's not very encouraging he's not eating He has had 2 cans of fancy feast today, but hasn't touched the third one. I'll ask about the ondansetron when I call her in the morning. Do the really high BGs make them not feel hungry sometimes? Is it possible its because he's in pain? I still have some buprenorphine, but I'm afraid that just might make him more nauseous? I've already read the first link, and I did buy some of the baby food suggested in that link, so I'll try that. I'll read that second link on syringe feeding right now.

 

[Bron and Sheba (GA)]

Yeah, it's not very encouraging he's not eating He has had 2 cans of fancy feast today, but hasn't touched the third one. I'll ask about the ondansetron when I call her in the morning. Do the really high BGs make them not feel hungry sometimes? Is it possible its because he's in pain? I still have some buprenorphine, but I'm afraid that just might make him more nauseous? I've already read the first link, and I did buy some of the baby food suggested in that link, so I'll try that. I'll read that second link on syringe feeding right now.

I think he is most likely not eating because of nausea rather than pain or higher BGs.
Do you have any Parmesan cheese? Cats love that. Maybe try sprinkling some on top of some food….not food he’s been refusing but something else.
The baby food is a good idea.
Even dry food is ok at the moment. Eating anything trumps everything.

 

[John & Henry]

I think he is most likely not eating because of nausea rather than pain or higher BGs.
Do you have any Parmesan cheese? Cats love that. Maybe try sprinkling some on top of some food….not food he’s been refusing but something else.
The baby food is a good idea.
Even dry food is ok at the moment. Eating anything trumps everything.

So he's acting super lethargic right now. Maybe he's just tried, but I don't think so, he's also not purring when I pet him which is another give away that something is wrong. There must be something else going other than the ketones / BG issue.

edit: I just read cerenia can cause lethargy, and they give you small pills to begin with and expect you to cut them into quarters which is almost impossible. I did give him the largest quarter, so maybe too much cerenia? I'm so frustrated. I think i'm just going to go lay next to him and cuddle him for awhile

 

[Bron and Sheba (GA)]

So he's acting super lethargic right now. Maybe he's just tried, but I don't think so, he's also not purring when I pet him which is another give away that something is wrong. There must be something else going other than the ketones / BG issue.

edit: I just read cerenia can cause lethargy, and they give you small pills to begin with and expect you to cut them into quarters which is almost impossible. I did give him the largest quarter, so maybe too much cerenia? I'm so frustrated. I think i'm just going to go lay next to him and cuddle him for awhile

I think you might have to take him back to the ER John. I don’t like the sound of the lethargy at all. I think he just hasn’t got over the ketones and that skip of the dose did I not do him any favours at all.
Can you take the BG again and get a ketones test please?

 

[John & Henry]

I think you might have to take him back to the ER John. I don’t like the sound of the lethargy at all. I think he just hasn’t got over the ketones and that skip of the dose did I not do him any favours at all.
Can you take the BG again and get a ketones test please?

So he just got up when he heard the water tap turn on, and acted like he wanted a drink even though he didn't drink much. He keeps going to his water bowl too, but then barely drinks at all and just lays down next to it. I just tested his urine ketones and it was the same as before (trace, barely changed color at all). I offered him some baby food, and he's eating it! He's still acting really tried and dopey tho. I gave him the cerenia only about 2-3 hours ago, so if it's what is making him lethargic, the time would line up to when this started. The piece was bigger than a quarter because they're hard to properly cut. Is it not possible the cerenia is causing this sudden lethargy?

 

[Bron and Sheba (GA)]

That is good he is eating and that there is only a trace of ketones in the urine! Really good!
Yes, cerenia can cause lethargy. How much did you give him?
Was that a 1/4 of a 16 mg tablet?
And what is his weight?

 

[John & Henry]

That is good he is eating and that there is only a trace of ketones in the urine! Really good!
Yes, cerenia can cause lethargy. How much did you give him?
Was that a 1/4 of a 16 mg tablet?
And what is his weight?

Well, it was supposed to be 1/4 of a 16 mg tablet, but from the looks of what is left, it was likely closer to 1/3. He's on the low end of 7LBS

 

[Bron and Sheba (GA)]

Well, it was supposed to be 1/4 of a 16 mg tablet, but from the looks of what is left, it was likely closer to 1/3. He's on the low end of 7LBS

That should be fine.

How much food did he eat?
Did you try Parmesan cheese?

 

[John & Henry]

That should be fine.

How much food did he eat?
Did you try Parmesan cheese?

Not a ton. Maybe 1/5-1/6 of a jar? He keeps going back to it and taking a few licks every once in awhile. I propped it up to head level like it said in the FAQ and that seemed to help. He is really interested in water, he'll go over to take a drink pretty frequently, but its hard to tell how much he's actually drinking. 30-45 seconds worth of licking every 15 minutes or so? It's hard to gauge. He'll walk from his fountain, to the baby food, to his water bowl, back to the baby food, just now he finally ate some fancy feast (but only a couple bites) he's been doing this over and over, occasionally taking 10 minute breaks and then repeating the process. He's acting real tired and drunk. Don't have any Parmesan cheese unfortunately.

 

[Bron and Sheba (GA)]

Not a ton. Maybe 1/5-1/6 of a jar? He keeps going back to it and taking a few licks every once in awhile. I propped it up to head level like it said in the FAQ and that seemed to help. He is really interested in water, he'll go over to take a drink pretty frequently, but its hard to tell how much he's actually drinking. 30-45 seconds worth of licking every 15 minutes or so? It's hard to gauge. He'll walk from his fountain, to the baby food, to his water bowl, back to the baby food, just now he finally ate some fancy feast (but only a couple bites) he's been doing this over and over, occasionally taking 10 minute breaks and then repeating the process. He's acting real tired and drunk. Don't have any Parmesan cheese unfortunately.

Every little bit helps. Try and keep that up.
It’s good he is drinking as well.
You are doing an amazing job with him!
When you ring the vet in the morning about the ondansetron, also ask if you can have some Hills a/ d cans which is recovery food. It ks higher in carbs at 13% but that ok and it is fairly palatable as well. It is good for cats recovering from illness and can be syringed if needed.

 

[Bron and Sheba (GA)]

How are things going John?

 

[Suzanne & Darcy]

I’m checking in this morning. I just read through all of this stuff from last night. I’m worried (but hoping that I have nothing to worry about.)

 

[John & Henry]

How are things going John?

just emailed vet last night's curve and updated SS, gave 2 units of insulin at 6am. Told her about lethargy and lack of food intake in email. She said she'd call this AM last night. Will continue to monitor him and update.

Thank you everyone

 

[Bron and Sheba (GA)]

When the vet rings remember to ask for some ondansetron and an appetite stimulant and the Hills recovery a/d canned food.
Have you tested again for ketones.?
Is Henry eating much? If not you will have to look at syringe feeding him as he must get some food into him.

 

[Suzanne & Darcy]

Oh man, I hope he will eat. I wonder if the antibiotics have gotten him a little off of his food?

This is why my boy came home with a feeding tube (E-tube.) He didn't need it for too long, but it allowed us to get plenty of calories into him post-DKA.

 

[John & Henry]

Oh man, I hope he will eat. I wonder if the antibiotics have gotten him a little off of his food?

This is why my boy came home with a feeding tube (E-tube.) He didn't need it for too long, but it allowed us to get plenty of calories into him post-DKA.

I wondered that too about the antibiotics. Just got off the phone with the vet and she wants me to drop him off. Will keep you updated.

 

[Suzanne & Darcy]

Maybe just for some IV fluids for the day? A Cerenia injection? Ondansetron injection? They’re only good for 24 hours but….

I would push for an Rx for Ondansetron orally dissolving tablets (small tablets).

 

[Diane Tyler's Mom GA]

I've been following along, I hope Henry is going to be alright, that poor kitty, breaks my heart.♥

 

[Liz & Minnie]

Yes. Novolin R insulin is available at Walmart without a prescription. You just walk up to the pharmacy counter and ask for it. At least that’s how it’s done in Georgia. It’s less than $25.00.

Same in WA, I got mine at Walmart at the pharmacy counter.

I've just caught up on this. Hope they give fluids and get him feeling better. I second the vote for ondansetron tablets and - when he's back home again - keeping a super close eye on his blood ketones. I found they show an increase much sooner than the urine test.

And - though I'm not wishing this on you - don't be scared if they suggest the feeding tube (e-tube). I was really bothered by the idea before we had it, but now I know how well it works. I bought a nutribullet and the vet gave the 'recipe' for making a slurry out of a/d.

And for the vet - good for you, speaking up. If there's a specialist internist vet there, they will be much more familiar with diabetes and (in my experience) don't give advice like withholding insulin after a DKA. It was our internist who suggested the Novolin R insulin to fight ketones.

Wishing you well and looking forward to some improvement.

 

[Suzanne & Darcy]

keeping a super close eye on his blood ketones. I found they show an increase much sooner than the urine test.

So true. This is why my vet always just thought I was nuts! I would take Darcy in and say.... his ketones are really high... and they'd do the urine test... and say... he has no ketones... or it's only trace... I remember one time they came outside (was still curbside at that time) and showed me the dipstick. Anyway, I guess they knew I was determined (pushy?) and they'd just say... what do you want us to do... and I said.... put him on IV fluids... so they did. But the vet really was a little perplexed and said, "I wonder if those blood ketone meters are really very reliable," which frustrated me no end! Geesh! I was just trying to keep him out of the ER with another DKA. Fortunately, I think they actually like me (my vet does, anyway) and she humored me.

 

[John & Henry]

If there's a specialist internist vet there, they will be much more familiar with diabetes

He's with an internal medicine specialist. I'm guessing that's the same as an internist?

So true. This is why my vet always just thought I was nuts! I would take Darcy in and say.... his ketones are really high... and they'd do the urine test... and say... he has no ketones... or it's only trace... I remember one time they came outside (was still curbside at that time) and showed me the dipstick. Anyway, I guess they knew I was determined (pushy?) and they'd just say... what do you want us to do... and I said.... put him on IV fluids... so they did. But the vet really was a little perplexed and said, "I wonder if those blood ketone meters are really very reliable," which frustrated me no end! Geesh! I was just trying to keep him out of the ER with another DKA. Fortunately, I think they actually like me (my vet does, anyway) and she humored me.

Read what I posted in the next thread about how ketones over 2.4 can diagnose DKA with 87% accuracy.

don't be scared if they suggest the feeding tube (e-tube). I was really bothered by the idea before we had it, but now I know how well it works. I bought a nutribullet and the vet gave the 'recipe' for making a slurry out of a/d.

But he's been such a good eater. He ate up til a few hours before I took him to the hospital for DKA last time. Why he's not eating now when he's not in nearly as bad of condition IDK. I read that FAQ on syringe feeding, and I feel awful about the prospect of force feeding my boy. It breaks my heart. Maybe he's made his peace and just wants to cross the bridge and I'm just holding him back for my own selfishness :,(

new thread here: https://felinediabetes.com/FDMB/threads/6-22-henrys-back-in-the-hospital-already-3rd-time.264944/

 

[Suzanne & Darcy]

Quote: Maybe he's made his peace and just wants to cross the bridge and I'm just holding him back for my own selfishness :,(. Quote


No. He just feels really rotten for some reason. What did vet say? Are his electrolytes all whacked out again? Did they do fluids? A lot of times a cat feels badly just from not eating. When you syringe feed them or if he had an e tube he could feel a lot better. There is a solution for this. This is just an awful time for Henry that you will look back on and shudder… but you will be holding Henry close to your heart!

 

[Suzanne & Darcy]

I have oftentimes found that when I syringe feed a cat that they start to eat more on their own.