6/23 Henry's home from the hospital. AMPS +11 67

Henry's home (again)


First, I know it isn't recommended for cats to ride in the car without a carrier, although I didn't learn that til fairly recently. He's been a "car kitty" since he's been a kitten. He's done 4 coast to coast treks. He'll only tolerate being in his carrier for about 15-30 minutes before he starts meowing non-stop.

Here's his previous thread. He's so much more energetic and bright than when he came home last time (3 days ago). His appetite is back in full force. He inhaled a whole can of fancy feast as soon as we got home. The vet wanted him to wear a libre, so she installed that and it doesn't seem to bother him one bit. The first scan showed a BG of only 67 @ AMPS +11. She told me on the phone that she had given him some R before I picked him up. I'm guessing it was .5U since that's what she wants me to give him. His next shot of Lantus is due in 15 minutes at 9pm, which obviously isn't going to happen with a BG of only 67. I gave him 2 "little soupers" (not sure what the carb count is on these) since he was still begging after the fancy feast in an effort to try and up his BG for the PM shot.

I understand the libre might not be totally accurate and I'll still need to do occasional manual BG readings. She sent him with subQ fluids (60ml/day) but she wasn't sure if the subQ fluids would effect the libre reading, so she put the libre closer to his hind end. She prescribed him the R insulin with the instructions "Give .5U SC 6 hours after Lantus ONLY if BG >300". I know that I need to start at .1U thanks to @Wendy&Neko. Just scanned the libre for the second time (@ almost 9pm) and we're still only up to 68. I'm guessing I should just hold on the Lantus till we're @ or near 200? She still has the Lantus @ 2U

I'm probably missing things, I'll add as I remember. Curious on how long I should wait to give the Lantus?

 

So I just did a manual check of the libre (78) against the meter and the meter is reading 49 That's after all the eating he's done. Should I try and give some karo syrup?

 

Lovely photo of Henry. He looks better than in the last photo.
Oh, I am really very surprised she gave 0.5u of R and then discharged him. Did she say what the BG was when she gave the R and do you know what time that was?
No don’t give any Lantus at the moment. We need to figure what the R is doing. Keep a close eye on the BG. The sensor can be unreliable when the BG is under about 80 so I would be doing a manual check for any BG under that. Please wait u til Wendy says you can give the Lantus
I would follow @Wendy&Neko instructions for the R not the vets.

 

I think the 78 on the manual check is the correct one. I would check again in 20 mins just to be sure. I would just feed some maybe higher low carb food. How many hours do you think it is since the R was given.?

 

No, you got the backwards. The manual is showing 49

edit: not sure when the R was given other than she mentioned that she had given him some when I talked to her around 5pm

 

Sorry, Yes give some high carb food and test in 20

 

If it is under 4 or 5 hours since the R was given, he could keep dropping so you may need to add honey or Karo to that is it drops lower.

 

So he wasn't interested in licking the syrup, so I just slowly put .5ml in this mouth. I then mixed 1.5ml into his friskies and he wouldn't touch it Gave another little souper and he ate most of it. He's acting a little weird. getting a bit worried.

 

What is the BG now?

 

Meter is reading 44!! How much syrup should I give him 2ml 3ml??

 

Rub some honey on his gums with your finger.

 

I don’t know how many hours since the R was given but if it is under 4, then the BG could drop lower.
Is anyone else at home with you in case you need to drive back to the ER? You would need someone to drive while you looked after Henry.
Not saying this will happen but you need to be prepared that it could.

 

@Bandit's Mom
@tiffmaxee
Are you around? I have to leave in 5 minutes for school pickup

 

I just gave him another ml. So that's 1.5ml given so far. Damn it this is going to make him bounce like crazy! God, this vet!

 

Yes, I am around.

 

I'm guessing she gave that R not long before I picked him up and now he's getting the full effect of it. At what point should I head to the local ER for dextrose? The libre reading went from 79 to 53 just now, and the last meter reading was 44

 

Thank you Bhooma. Are you able to stay here?
my concern is that we don’t know how long ago that the R was given and we don’t know how much longer it will lower the BG. I have told John he needs to be aware if it keeps dropping and we can’t stop the drop, he will have to go back to the ER.

 

Did you rub some honey on the gums. Test again in 15 from then and post, how many hours since you picked him up?
I have to leave but Bhooma is here and I’ll be back. She is great!
Keep testing and rubbing honey on gums if he won’t eat.
You have got this!

 

How long does it take to get an effect from the syrup?

 

Hi Bron, I am around. Will stay with John & Henry

John, 40s is low but not too bad. Please test 15-20 mins after the honey?

 

Whew... 15 minutes after the last reading we're at 55 yay.

 

Phew! 55 on the meter? This would be +13? Later?

Did the vet even test his BG before giving the R??!!

 

I got him a little after 7pm and it's 10pm here now. She said she had given it when I talked to her at 5pm, so hopefully its effects are almost over with

 

I would assume so, but who knows? If I'd just straight up followed her instructs as written I would have just given him his Lantus shot when he was in the 40s!

edit: Yes, the 55 was on the nova and yeah +13

 

Don't feed any higher carbs or honey for now and keep scanning his BG every 15-20 mins.

What time do you shoot (Lantus)? Considering his low numbers thanks to the R and the fact that it's 10pm, I'm not sure about whether to give Lantus or how much. But there's also the multiple DKAs.

Let's wait for @Wendy&Neko and @Bron and Sheba (GA) advice.

 

Was supposed to be 9pm, but it's changed so frequently lately I'm not sure it really matters. I'm guessing he got his AM shot at 9am tho. So, yeah we're at +13 right now. Thank you for the help

 

Let's keep an eye on his BG. If it starts rising sharply, it might me good to give his shot. He is going to bounce.

How is he doing? I guess he's not hungry after inhaling a whole can of food a couple of hours back?

 

No, probably not after a whole can and almost 3 "lil supers", but I bet he'd still beg if I went out in the kitchen right now. He just looks kinda tired. Not sick tired. He usually lays his head down when he's sick tired. I think this is just normal cat tiredness. He seems alert. The nova just read 46 20 minutes after the 55 so we're not outta the woods yet I guess

 

Will he eat a little HC/MC? If not, some more honey and test in 20!

 

Back up to 53 on the nova 15 minutes after that 46, so hopefully it won't go down again. libre is reading 74

 

Did he eat anything when you got the 46 or is this just flat with meter variance?

 

No, he hasn't eaten since the last lil souper about an hour ago. I tried to give him some friskies which is about 18%, but I mixed about 1.5ml of karo with it and he wouldn't touch it. Not sure if it was because of the karo or he's just full. Next reading in 4 minutes. fingers crossed

 

Alright, we're now at 66 on the nova! Yay! 78 on the libre.

 

So just to reconfirm:

• AM shot of Lantus (2U) was given at 9am?
• 0.5U of R assumed to be given at 5pm?
• Last meal / honey was 1 hour back?
• It is 11pm now for you?

Don't feed unless he dips below 50. Let's get a clear number without the food influence of food when taking a decision to give Lantus.

 

That's all correct. The R may have been given a bit before 5, I'm not exactly sure when, but she told me a little after 5 she had given it. Been about an hour and a half since food/syrup. Yes it's 11:09pm

edit: yes, lantus shot was supposed to be given at 9pm

 

One more question! Do you want to stay with the 9am/9pm shot time or move it up? Shooting at 9pm means staying up pretty late if it is an active cycle - unless you are a night bird and that's easier than waking up at 6am or 7am to give the shot.

 

Yep, total night bird. I was on 1am/pm for awhile

 

Looks like he is still wobbling up and down a bit but at least he hasn’t dropped below 44 again. So if the R was given around 5pm, it’s effects have lasted longer than 4 /5 hours.
Don’t suppose you have had a chance to test for ketones since you have been home?

 

Let's see where he is 2 hours after the honey/syrup. That would be in another 20-30 mins? We can take a call on the Lantus shot then.
Hopefully we will hear from @Wendy&Neko or @Bron and Sheba (GA) by then.

 

Sorry, but can't stay on long. Morning alarm goes off in 5.5 hours so I have to sleep soon.

The R should be wearing off soon. Note I said "should". In most cats it lasts 4 hours. Neko was not "most cats", it both onset later and lasted longer with her. We know nothing about how Henry uses R, nor what his BG was when he got it, or even if he got R more than once today. Since Henry needs his Lantus, I think the best option is to see if you can wait a little longer until he's closer to 100 then shoot and feed higher carb food if need be. As Henry so recently proved, skipping the Lantus shot isn't a great idea.

Good to hear you are a night bird and Bron and Bhooma are on the case.

 

Wendy, if Henry doesn't hit the 100 mark soon - say after 2 hours of honey - is a token dose (1U) advisable? Or do we stall till he hits 100 and give the full dose - however late that is?

 

We're now to 77 on the nova at +14.25

 

I haven't but I'll do it at next poke in 10 minutes

 

Hi John I know you are very busy trying to get Henry's numbers up, just wanted to say I'm glad he's home , he looks much better in that pic. I hope he keeps going up.
Jesus you and Henry need a dam brake
Give him kisses for me ♥

 

We're at exactly 2 hours from the syrup/food

 

I know it, right? I'm counting 3 major errors on this vet now. I know she's trying and handling other animals too, but

Thank you

 

You are right ,she could have kept him there to see how the R was going to effect him. Makes be so freaking mad !

 

At +14.5 we're at 80 on the nova. 108 on the libre and .3 ketones. So looking better and ketones are low

 

She said (and I quote) "Henry can't live at the hospital" ... Like, WHAT? passive aggressiveness. When I talked to the weekend ER doc I asked her if she has ever seen fast acting insulin given SC and she said she had not and only ever given it IV with those continuous infusion pumps before. No idea how much (if any) experience his IM attending has using R SC.

 

Hallelujah, John when you have time , don't forget to fill in your spreadsheet
Keep going up Henry ♥♥

 

I think we should stall don’t feed and wait a bit longer to see if he will rise higher before giving the dose.
Are you ok with that John? You will need to monitor the whole cycle though unless he bounces?
@Bandit's Mom what do you think?
Glad to see the ketones at 0.3
Do you think he will eat ok this cycle?

 

I've been doing it, but everything after +12 is in the comments section because I'm not sure where else to put it

Sounds good to me. Will keep a close eye on it.

edit:

I'm quite sure of it. He was just begging me for my pizza and I gave him a (very very little) piece of peperoni he gladly ate.

 

You can put all those BGs stacked up on each other into the +11 and +12 of the SS

 

I can help you with that once we have all the numbers.

 

Just got a 76 at +15 on the nova. Not sure why it's went down slightly from that 80, maybe just meter variation? libre reading 134 at +15

 

That’s quite a difference. Usually the libre and the human meter are closer than that when over 100. And the libre is going up and the nova going down. Strange.
I think we need to stall a bit longer

 

Another member here has been finding that the Libre reads higher I.e. she has been getting low blues on the Libre and higher greens on the meter. As much difference as John is seeing now. It's pretty strange.

 

That is interesting. Doesn’t sound very consistent or reliable.

 

Just re-read with the libre and now its saying 108

 

How long since he’s eaten, it might be dropping because he needs food?

 

It's been almost 2h 50m hours since the syrup, 3 1/2ish since the food.

 

Bhooma and I are talking about the dose given that the BG isn’t rising much.
I think we are going to have to let him eat very soon.
Will get you to take another BG soon

 

OK. About 5 minutes to +15.5

 

Alright we're at 74 on the nova and 90 on the libre at +15.5

I'm guessing we're going back down maybe after the surge from the syrup? really not sure, but I'm afraid its going to start going up fast at some point.

 

I’m going to talk to Bhooma then brb

 

Forgot to add that @alio 's experience has been that the Libre takes 12 hours (or so?) to start giving proper reads. The first X hours can be more wonky than usual.

 

I was actually going to just mention that. Another forum of diabetic humans claim the first 24 hours and last 24 hours the accuracy is off. It generally runs a bit higher than finger stick meters (up to 30 points) although some users claimed it ran lower for them. the FDA allows for up to 20% variation from lab quality tests. The nova's accuracy is supposedly the most accurate at-home test meter with only 9.5% variation from a study I read.

 

Ok, I’ve talked to Bhooma. The dropping number is more likely to be from not eating for so long and he is hungry.
What we have to keep in mind is……is the R still in play, and we need to give him a dose that does not drop him too much and does not let the ketones back in.
So we think that given that the preshot is only 74 we should give 1 unit of Lantus and then go back to the 2 units at AMPS providing the BG is high enough. It will take up to 2 hours for the onset to come in, so if we give him some higher carb food for the preshot meal and the first snack that will hopefully bring the BG up a bit higher. At the moment we don’t have any data as to how he goes with a low preshot BG, so we have to find a balance.
Are you happy with that plan?

 

There is a 10 minute delay in the sensor readings when comparing them with a blood glucose reading because one is blood and the other is interstitial fluid.

 

I am, I totally trust your judgement and I also know there are so many variations between cats, its very difficult to gauge. 1 problem is I don't really have any high carb food (I know, I should have already bought some). I guess the friskies is the highest I have supposedly at 18%, although he turned his nose up at it before (but it was mixed with the karo which I think is why he didn't want it). Maybe the DM? not sure what carbs are in the DM, but I know the fancy feast is less than 3%. I can't find the carb info for the little soupers anywhere, but they're mostly liquid so I'm guessing it's pretty high. Next reading in a few minutes

 

The 18% carb is plenty high enough. I was thinking of something around 12% for the preshot meal.
Can you mix some 18% and some of the FF….would he eat that?
What is the DM….canned or dry?
Can you feed him now and then give the dose. We need to get it started.

 

DM canned is 6%, DM Savory Selects is 10%.

 

DM canned is not high carb. It is low carb

 

Do you have anyone at home who could go out and buy some higher carb canned foods tonight it is it too late?

 

Hard to say, but I can try to mix them. Bad news tho: BG is continuing to drop slightly. we're at 71 now on the nova and 87 on the libre Think I should go ahead?

 

Yes feed him, then shoot.
Give him one then the other if you don’t think he will eat it together.
Make sure he eats well though

 

Yes, Christy is here. I can go. Only one grocery store is open near me. Not sure what their selection is, but I can research on my phone. Multiple convivence stores, but they'll likely only have 1 brand (probably friskes) if they have anything at all.

 

OK, I'll try mixing some friskies and FF

 

Ok but you need to get him fed and shot first. Then we don’t want you away from the house for long!

 

The most common MC and HC foods used here are:

FANCY FEAST - Gravy Lovers - Gourmet Beef Feast in Gravy is 20%
(The other gravy lovers are 15%)

Most of the FANCY FEAST - Grilled in Gravy are MC - 12-13%


This list is a little old but is a good reference point:
https://catinfo.org/chart/index.php

 

So glad I saw this comment. He's acting super hungry and meowing/begging. First can I picked up I thought was friskies, but it was actually DM and he wouldn't touch it. Then tried the friskies by itself and he would only take a couple licks, but kept begging. Tried some freeze dried cubes on top, he ate a bit more and started begging again. Then I mixed the FF and friskies and he ate a bit more trying to get to the FF, then started begging again. This post reminded me I had some FF grilled in gravy cans still, and he ate that one pretty well. About half the can. I'd say in total he's had close to a full can. Maybe 3/4 of a fancy feast can total. He's hungry and acting bright, he's just being picky now.

 

So shot time now? 1U lantus?

edit: +14.5 = 70 on the nova 77 on the libre

 

Yes

 

Don't fill him up. You want him to be willing to eat later in the cycle, if needed.

 

Did you get some ondansetron today? He sounds as if he could be nauseated to me.

 

I honestly thing he's just stuffed from eating 3 full can of food earlier when we got home. Before he got sick and started having his ravenous appetite, he would only eat 1/2 can 2 times per day, so only 1 can total all day for most of his life. 3 cans seems like a lot

edit: no didn't get the zofran yet. I can ask about it tomorrow.

 

Alright. 1U of Lantus has been given. First green shot for me. Fingers crossed. Will be monitoring closely.

edit: his belly feels HUGE, like a big old bloated belly on a skelleton cat. I think he over did the eating earlier after we got home.

 

Fantastic. Well done!
I’ll get you to get a +1 and a +2 to start with so we can see what he has in mind. Someone will stay with you if needed for the cycle. I’ll be here for 4 more hours and then Bhooma is around for several more hours as she lives in India.
Did you get the ondansetron?

 

So BG is continuing to drop libre alarm just went off on my phone and is reading 67 and nova is reading 63. In my layman opinion maybe this is happening because the karo has finally warn off, and he's still having effects from the R the vet gave? very confusing.

 

Great. Thank you guys so much! No, didn't get the ondansetron yet. Just gave some cerenia

 

The honey would have worn off within 2 hours. Hopefully the food will bump it up .just keep monitoring. Don’t go to the shops just yet

 

Let's give the food 20 mins to kick in. Karo/ honey wears off in 2 hours. It's been at least 9 hours since the R?

 

Yep

 

Do you have a +1?

 

Just took it. We're at 49 It's so strange! I don't understand why it would go back down unless she like gave him this shot of Lantus right before he left! I guess I would rather have it be low which can be dealt with than in the 300s or 400s where he produces ketones.

 

John I can see +1 is 49. You need to rub some honey on his gums if he won’t eat some high carb food..
And test again in 20 minutes

 

OK, just gave .5ml of karo

 

If he will eat I would give him some of the high carb friskies

 

Is this on the Libre or the Nova?

 

Can you test again please John?