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

John & Henry

John & Henry

Member Since 2022
Hi everyone,

Just got Henry home tonight. Sorry I didn't post sooner, my laptop screen is having issues and is trying to give me a seizure so I gotta type this on a tablet. When they called yesterday (Sunday) they said he was off the IV, and all his electrolytes and blood pH were looking good. They thought I may had been able to pick him up later that day but they were trying to transition him back to Lantus first @ 3U. The second call said his BG was 47 and they didn't want to let him go for fear of him going hypo, I can't remember if it was last night or this morning they told me they had to use dextrose at some point (and they must have used too much) because his BG was in the 400s now. When I talked to them this afternoon they said they had cut back his Lantus back to 2U & they didn't mention what the BG was but said they wanted to keep him another night to run a curve. I said I was perfectly capable to charting the curve for him and wasn't thrilled about paying another 2 grand for them to keep him another night since the bill was already up to $7k. She said I could take him so long as I was really vigilant about watching for symptoms and checking BG for hypo. So I got him tonight. BG was 179 when I got him home (AMPS +7) and 139 @ amps +9.

He was acting quite tired and I just got a sense he didn't feel good, but he was eating and drinking real well. His walking is weird again (just like after I brought him home last time). I think its because he was stuck in a cage for several days? He had a hard time jumping up in my lap, but his jumping has seemed to get better throughout the evening. (He's constantly getting down to go eat and coming back every 20 minutes to half hour). He seems less tired and sickly now for whatever reason. Maybe some drugs they had given him? Not sure. I have oral clavamox and marbofoxacin for antibiotics and cerenia.

I think that's most of the information. I'm going to get up every 2 hours tonight to chart the curve for the Dr but it seems we're outta hypo territory luckily. Ketones were .4 when I got home. I'm going to try to update the SS on my tablet now. Hopefully the sheet isn't locked on here like it has been (sometimes I can only update it from the laptop)
 
It is so good to get an update of Henry, thank you John.
I’m sure he is very glad to be home with you.
You know the drill.
Lots of food and fluids, no skipping of insulin doses and testing for ketones.
I am sure he was a bit stiff after being in a cage for several days and not moving much. I am glad he is moving better now.
Looks like the BG has dropped to 93 so don’t leave it 2 hours before testing again.
Its good to see him on lower numbers again amd great he is wanting to eat.
 
Bron and Sheba (GA) said:
It is so good to get an update of Henry, thank you John.
I’m sure he is very glad to be home with you.
You know the drill.
Lots of food and fluids, no skipping of insulin doses and testing for ketones.
I am sure he was a bit stiff after being in a cage for several days and not moving much. I am glad he is moving better now.
Looks like the BG has dropped to 93 so don’t leave it 2 hours before testing again.
Its good to see him on lower numbers again amd great he is wanting to eat.
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Yep, he's been eating and drinking very well. I really hope to get some meat back on him because he feels like a skeleton cat with some skin. I got alarms set on my phone for BG checks and insulin. Very glad he's home.

Thank you everyone for all your thoughts and well wishes while we've been going through this difficult time. I sure hope I never have to repeat it.

Edit: Bron we're 9 minute till pmps +6... I probably should have taken a +5, but he was acting pretty well and I figured we were already past the pmps low at +4?
 
John & Henry said:
Edit: Bron we're 9 minute till pmps +6... I probably should have taken a +5, but he was acting pretty well and I figured we were already past the pmps low at +4?
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I think I would have taken a +5 as we don’t really know what he’s up to, but let’s see what the +6 is.
I’m sure he will put on some weight now that he is home with his loved ones and hopefully over the worst.
 
Bron and Sheba (GA) said:
I think I would have taken a +5 as we don’t really know what he’s up to, but let’s see what the +6 is.
I’m sure he will put on some weight now that he is home with his loved ones and hopefully over the worst.
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Oof, I should have been keeping closer track :( we're at 53 @ +6 ... should I check it every 30 minutes now? I'm going to give him some food with some carbs
 
Suzanne & Darcy said:
Wow. He’s at 53. I’m sure you are feeding him now. It’s so good to hear this update on Henry and how he’s eating and drinking well.
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Yep, I wrote a post that said I was feeding him but it didn't show up for some reason. He ate a bit but not much. Cat napping now
 
55 @ +6.5 so hopefully we're past the low. Should I check in another 30 minutes or you think I'm good til +8?
 
Sorry I missed you message Bron. I did do it again in an hour, and it's was very low right up til AMPS (67) time. Called vet and she said to not give the shot and take BG every 3-4 hours and we'd talk about what to do at 5pm. At 1pm it was back up to 290. I emailed her asking if I should give the shot now and she said to "let him ride it out til 5". At 3pm it was up to 419, so a little worrying. Little over an hour to 5... not thrilled about waiting, but she's the vet I guess. He's walking weird... looks like his hinds really aren't moving right. This could be from high BG right? Updating SS now
 
How many hours until the next shot?…..I see it is under an hour.
Have you tested for ketones today? If not please test now.
The 3 unit depot probably influenced the am cycle yesterday.
Im not thrilled to see you skipping this cycle with a BG of +6 419.
I don’t think the odd walking is due to the current high BG
 
Bron and Sheba (GA) said:
How many hours until the next shot?…..I see it is under an hour.
Have you tested for ketones today? If not please test now.
The 3 unit depot probably influenced the am cycle yesterday.
Im not thrilled to see you skipping this cycle with a BG of +6 419.
I don’t think the odd walking is due to the current high BG
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His shot has been at 9 since I got him last night. I don't like waiting either. 45 minutes til our call. Just checked urine ketones and they were only trace so that's good. Glad to hear the odd walking probably isn't due to high BG.

I'm going to ask her about the possibility of adding the fast acting R insulin in addition to the Lantus. The ER doc I asked about this over the weekend said she'd never heard of that being done, but she's not IM. She said all the fast acting they give is via IV. How is R typically given at home? SC or IM? I'm not sure I could do IV, although my niece-in-law (is that a thing? Lol) gives her cat IV treatment everyday for his kidneys. And there isn't a port either. She's gotta hit that vein. Seems tough!

Edit bron- it's been 19 hours since his last shot :(
 
At home, R is given subcutaneously just like your Lantus. I used it in my high dose kitty to help the Lantus and then Levemir do it’s job. It lasts about 4 hours. I think you should let the Lantus do its work at this point though.
 
John & Henry said:
His shot has been at 9 since I got him last night. I don't like waiting either. 45 minutes til our call. Just checked urine ketones and they were only trace so that's good. Glad to hear the odd walking probably isn't due to high BG.

I'm going to ask her about the possibility of adding the fast acting R insulin in addition to the Lantus. The ER doc I asked about this over the weekend said she'd never heard of that being done, but she's not IM. She said all the fast acting they give is via IV. How is R typically given at home? SC or IM? I'm not sure I could do IV, although my niece-in-law (is that a thing? Lol) gives her cat IV treatment everyday for his kidneys. And there isn't a port either. She's gotta hit that vein. Seems tough!
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You don’t need to wait until 9 pm. I would give the pm dose at 5 pm after you talk to her. Please don’t wait until 9 pm.
I don’t like to see even that trace of ketones in the urine (I assume it is in the urine?)
At the moment you don’t need R as the BGs are low, except for the 415 and you would not give R with those very recent green BGs in the last cycle. The R is given just like the Lantus but you would not want to give that without @Wendy&Neko full supervision. And it’s not needed at the moment

I think you will find your niece gives subQ fluids to her kidney cat which is fluids into the tissues (subcutaneously). That is common.
Please let us know what the vet says before you go ahead and give any dose she says.
 
Bron and Sheba (GA) said:
You don’t need to wait until 9 pm. I would give the pm dose at 5 pm after you talk to her. Please don’t wait until 9 pm.
I don’t like to see even that trace of ketones in the urine (I assume it is in the urine?)
At the moment you don’t need R as the BGs are low, except for the 415 and you would not give R with those very recent green BGs in the last cycle. The R is given just like the Lantus but you would not want to give that without @Wendy&Neko full supervision. And it’s not needed at the moment

I think you will find your niece gives subQ fluids to her kidney cat which is fluids into the tissues (subcutaneously). That is common.
Please let us know what the vet says before you go ahead and give any dose she says.
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Yes. Please let us know! Bron is correct. This is what I was trying to say. You are getting some pretty good numbers with Lantus. You need to dose it consistently and let it do its work.
 
Suzanne & Darcy said:
Believe me, if Henry would benefit from adding in a little R insulin, we could guide and help you with that. @Wendy&Neko was so helpful to me when we needed it. It’s just not really warranted at this time.
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My thought on using the R goes like this... his last does increase only negligiblely lowered his BG, and he developed DKA when his numbers were in the low 300s, upper 200s, which doesn't seem that high to me compared to others SS which don't have problems with ketones. It seems some days (like when we first started and got those greens and blues) the insulin just worked better for whatever reason, but before this recent DKA it hardly moved his BG at all. Seems like it would be nice to have the fast acting (in addition to the normal Lantus does) to bring his BG into check on those days where it's not working well. I feel like this is a literall fight for his life at this point as I'm not sure I can really afford another hospitalization and I gotta do everything within my power to keep another DKA from happening.

I was on hold waiting for the vet for 15 minutes then they told me she'd call me back so I'm waiting for that right now. BG at 5pm was 460.
 
I just called again and told them this is getting urgent and I really need to talk to the vet.m I'm on hold again, right now
 
Because you skipped, the depot will have drained from the 3 units they gave him at the vets, so I think we need to stay with the 2 units and see how that goes.
That dose didn't drop him below 50

You will have to monitor the cycle closely though and may have to feed some higher carb food to keep the BG up higher but we need to get the insulin into him to keep the ketones away.
Thoughts @tiffmaxee
@Wendy&Neko
@Suzanne & Darcy
 
Just got off the phone with the vet. She wanted to just give him one unit, and I had to have a conversation with her about how I was way more afraid of another DKA (his ketones are currently 1.4 @ w/a 474 BG)/high BG than I am to deal with potential hypo which isn't deadly and can be managed and I'm always monitoring closely. She begrudgingly agreed to the 2 units so long as I watch him closely.

So I just gave it to him.
 
John & Henry said:
Just got off the phone with the vet. She wanted to just give him one unit, and I had to have a conversation with her about how I was way more afraid of another DKA (his ketones are currently 1.4 @ w/a 474 BG)/high BG than I am to deal with potential hypo which isn't deadly and can be managed and I'm always monitoring closely. She begrudgingly agreed to the 2 units so long as I watch him closely.

So I just gave it to him.
Click to expand...
I'm very relieved you gave the 2 units.
You will need to monitor closely the whole cycle. Its possible he will bounce from the greens but that 460 could just be from no insulin.
With DKA kitties, we sometimes have to give them some higher carb foods so we can give a higher dose of insulin to keep the ketones at bay.
What carbs are you feeding now?
Keep up lots of food and fluids.
 
She explained the consequences of prolonged hypo including brain damage and that their body will produce hormones that end up boosting the BG even higher. I explained the consequences of him going back into DKA includes me not being able to afford paying for it and his passing. Hey Dr. <censored> if you happen to find this thread: "Try to talk to people without sounding utterly annoyed, it doesn't help your cause" ... I didn't get any of the attitude with the weekend ER vet who explained things very well and answered my questions without attitude even if they didn't think it was the correct way foward or had heard of such and such. /end rant

Edit: Do they not teach cage side manner in vet school?
 
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John & Henry said:
Apparently his favorite Friskies is 18% so I got that. His normal food is the fancy feast pate which are under 3% so that probably isn't a great one for hypo. I also have that food sampler he loves which is a whopping 30+%
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I would feed him the normal low carb food unless he drops into lower numbers and then we can see if he might need some higher carb food. He may not.
Is his appetite good?
 
Here you go.
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John & Henry said:
The ER doc I asked about this over the weekend said she'd never heard of that being done, but she's not IM. She said all the fast acting they give is via IV. How is R typically given at home?
Click to expand...
It's given SC, same as Lantus, using the same syringes. Don't quote me, but I think you don't need the vet's prescription to get Humulin R at Walmart. Let's keep an eye on his ketones to see if you need to start R before buying it. R can also be used for skipped shots (like this morning), taking the edge off bounces in a ketone prone cat. See what this Lantus does does and how his ketones are trending and we'll decide. I've seen a cat in yellows also get worrying ketones. ECID.

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.
 
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.
 
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