7/07 Kozmo AMPS Hi, +2 Hi, +4 594, +6 446, +9 250, PMPS 216, 1wk post DKA not eating

Annie & Kozmo

Annie & Kozmo

Member Since 2020
Previous post: https://www.felinediabetes.com/FDMB...e-shooting-new-to-lantus.231958/#post-2593774

Kozmo nibbled at wet food through the night and showed signs of hunger at PM+8 488 but only ate about ¼ pouch of wet food and another ¼ at +10. After his AMPS HI reading he was interested in food but only managed to eat a couple of mouthfuls.

We were a little surprised at such a high reading because only an hour previous he had the energy to chase Neil down the stairs and trot through the kitchen in the hope of food (which we didn’t allow because it was in the 2 hour no feed zone). I suspected he was a little hyper because he was in ‘stare mode’ and wasn’t sleeping but apart from that he looks quite good and is purring in a happy way when stroked.

How often would you suggest we test today?

I’m going to start a new SS today - and re-enter all test results - as it appears I’ve done something wrong. Not all of my ‘world’ entries are showing on the ‘US’ chart, I have two extra sheets and some people can’t see my SS at all!

One more question: Our BG meter reads HI at >599.4 which happens to be a regular occurrence at the moment. I’ve been recording it as HI on our world SS but it’s showing as #VALUE! on the US side. What number should I be using?
 
Annie & Kozmo said:
Kozmo nibbled at wet food through the night and showed signs of hunger at PM+8 488 but only ate about ¼ pouch of wet food and another ¼ at +10. After his AMPS HI reading he was interested in food but only managed to eat a couple of mouthfuls.
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Are you still giving him the cerenia tablet each 24 hours? I would keep it going to ensure he eats.
How is his eating generally?
Have you managed a ketone test this morning yet?

Annie & Kozmo said:
We were a little surprised at such a high reading because only an hour previous he had the energy to chase Neil down the stairs and trot through the kitchen in the hope of food (which we didn’t allow because it was in the 2 hour no feed zone). I suspected he was a little hyper because he was in ‘stare mode’ and wasn’t sleeping but apart from that he looks quite good and is purring in a happy way when stroked.
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He's HI this morning because he's bouncing (a normal thing for cats to do, especially newly diagnosed cats) from those greens last night. He's not used to them any more and he thinks the higher numbers are the normal ones.....he has to get used to the lower numbers again and the only way to do that is to let him go into those lower numbers to get used to them. Also if he is dropping down fast, that will also cause a bounce. If you are testing, you can catch a drop before it goes too far by feeding.

Annie & Kozmo said:
How often would you suggest we test today?
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I would test at +2 and if he's dropped some, test at +4, then see after that. The things you need to look for are:
We don't know how long he'll bounce for. It might be 6 cycles or only one.
Looking at his SS he looks like he gets over bounces quickly.
If he is dropping quickly you need to feed the drop to help slow it down and stop a further bounce.
He is responding really well to the lantus so you need to be on the lookout for further lower numbers.

Annie & Kozmo said:
I’m going to start a new SS today - and re-enter all test results - as it appears I’ve done something wrong. Not all of my ‘world’ entries are showing on the ‘US’ chart, I have two extra sheets and some people can’t see my SS at all!
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Your SS is a bit strange...not quite right somehow.
If you write anything except the BG number in the world SS it will not transfer over to the US SS. You then need to do it manually.

Annie & Kozmo said:
One more question: Our BG meter reads HI at >599.4 which happens to be a regular occurrence at the moment. I’ve been recording it as HI on our world SS but it’s showing as #VALUE! on the US side. What number should I be using?
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Write Hi in the world SS then go over to the US SS and delete the #value and put in Hi.
 
Bron and Sheba (GA) said:
Are you still giving him the cerenia tablet each 24 hours? I would keep it going to ensure he eats.
How is his eating generally?
Have you managed a ketone test this morning yet?
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We’re still giving the cerenia every 24 hours. I tested negative ketones at +5 and Neil tested the same at AMPS (he was sleeping when I tested and I forgot to tell him ).
 
Bron and Sheba (GA) said:
Kozmo is sounding much better generally, you must be pleased!
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We are pleased with him in general, Bron .

He had a good day yesterday and we hope it’ll be the same again but are expecting some bouncing.

We’ve just tested at +2 Hi - do I need to add that to the subject on this thread?
 
Bron and Sheba (GA) said:
Your SS is a bit strange...not quite right somehow.
If you write anything except the BG number in the world SS it will not transfer over to the US SS. You then need to do it manually.
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Sue and Luci said:
Not sure if @Marje and Gracie is around - but she's great at sorting out SS issues.
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I've created a new SS with all the data we've gathered to date and have replaced the old link... hopefully it's successful and everyone can read it :)
 
Kozmo's not having a good day at all - completely opposite to yesterday. He's been refusing to eat since AMPS and it's due to his high numbers. They're finally starting to come down now and he's had cerenia at +6 (fourth day on it). He ate well yesterday, however it did taper off during the early hours after he reached high numbers again. We're not panicking, and we understand the bounces. Because he's refusing to eat and he spent a long time in the black and is now in the red and getting lower, to help slow it down and avoid a bounce I've put some honey on his tongue. Is that okay? I really have no idea if that's right or even how much I'd give him. Flying blind again haha.
 
I can’t see the BGs so can’t really comment on slowing the drop. Honey isn’t ideal if the numbers aren’t low. Has he eaten any food at all today?

Did you ask the vet about a ondansetron (zofran). It can be given 3 times a day And can be given at the same time as cerenia and often helps when cerenia doesn’t. I found it very good.
 
The rapid swings in BG are probably contributing to him feeling yucky today. The good news is he ate a ton yesterday :woot:, so he's not in imminent danger, but yes, I would definitely be ready for assist feeding if he doesn't start at least nibbling soon.

Tiptoeing down into red is good-- better than the black numbers anyway! Let's hope he's on his way down for real. More BG swings :confused:, but he'll hopefully feel better on the lower end than the higher (look how good he was feeling yesterday in greens!).
 
Nan & Amber (GA) said:
The good news is he ate a ton yesterday :woot:, so he's not in imminent danger, but yes, I would definitely be ready for assist feeding if he doesn't start at least nibbling soon.
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Hi Nan, Kozzie's AM+8 just now was 356.4 and officially in the pink. We've had to lighten up and laugh at the state of our kitchen! We have a smorgasbord of a dozen different offerings of food (disposed of and refreshed regularly), but unfortunately he's not interested in any of it. We've watched the video link Bron supplied re syringe feeding and we feel confident that we can do this if necessary. I slipped a couple of morsels of food into the side of his mouth just now and I'm surprised that he took it so well. He's been so tolerant of us poking and prodding him constantly.

My question is when should we consider syringe feeding him if he keeps refusing food and how much? I've stockpiled Liquivite to mix with pate.
 
When cats are nauseous and then start to feel better, they eat a lot at one time and then feel yucky. It’s best to resist the urge to get a lot of food into them at once and instead feed small amounts often, every hour if need be. I’ve had to syringe feed my cats and found it to be a messy but necessary option. Finger feeding sometimes works better. I would give ondansetron a try and an appetite stimulant too. I like cyproheptadine because it wears off and can be given twice a day. The only problem is sometimes when you feed a nauseous cat via an appy stimulant they can build a food aversion to that food. So if you go that route once the nausea is controlled you might have to switch food. I’ve never had that happen because I fed small amounts and got the nausea under control quickly.
 
tiffmaxee said:
I would give ondansetron a try and an appetite stimulant too.
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We were fighting an uphill battle just trying to get Cerenia from the vet and it was a miracle when they finally (begrudgingly) agreed to Lantus. They want to perform further invasive testing on him which would involve a general anaesthetic and they'll use our request for more anti-nausea medication as their justification. They were truly baffled when we asked for Cerenia... like they didn't know DKA cats become nauseous. I'm going to have approach them with a very convincing argument.

We have a supply of Prochlorperazine Maleate 5mg tablets here at home. It's anti-nausea medication used for humans and cats/dogs. I wonder if anyone has used it?
 
tiffmaxee said:
When cats are nauseous and then start to feel better, they eat a lot at one time and then feel yucky. It’s best to resist the urge to get a lot of food into them at once and instead feed small amounts often, every hour if need be. I’ve had to syringe feed my cats and found it to be a messy but necessary option. Finger feeding sometimes works better. I would give ondansetron a try and an appetite stimulant too. I like cyproheptadine because it wears off and can be given twice a day. The only problem is sometimes when you feed a nauseous cat via an appy stimulant they can build a food aversion to that food. So if you go that route once the nausea is controlled you might have to switch food. I’ve never had that happen because I fed small amounts and got the nausea under control quickly.
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Wonderful advice, thanks Tiff.
 
Annie & Kozmo said:
We have a supply of Prochlorperazine Maleate 5mg tablets here at home. It's anti-nausea medication used for humans and cats/dogs. I wonder if anyone has used it?
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Replying to myself here! I've done a FDMB search and didn't find anything so I think we'll stop looking into it further.
 
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tiffmaxee said:
I’ve never heard of that drug but just googled it. Here’s what I found.
https://www.petplace.com/article/dr...compazine-prochlorperazine-for-dogs-and-cats/
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That was the first one we pulled up too (among others), and there’re too many unknowns to risk giving this to Kozmo. He’s nauseous but not vomiting.

It’s AM+11 and he hasn’t eaten anything since pre-AMPS so I administered 15g (.530oz? not even sure how to type that) of pate & Liquavite at +10. It wasn’t much but it’s a start and I didn’t want to stress him, knowing it’s going to keep on happening tonight if he doesn’t get his act together! I’ll give him considerably more after we test his BG. To be honest, he was so limp it was like holding a wet lettuce leaf. No fight in him whatsoever. He just opened his mouth and swallowed.
 
I wish you could get ondansetron. It works really well for nausea fir many cats. It did for two of mine. One with cancer and Max with pancreatitis and diabetes.
 
tiffmaxee said:
I wish you could get ondansetron. It works really well for nausea fir many cats. It did for two of mine. One with cancer and Max with pancreatitis and diabetes.
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We will fight the fight for Kozmo and persist with our vet to get Ondansetron :)

Meanwhile, I just realised I shouldn’t syringe feed Kozmo at +11 due to looming PMPS. Or is it more important to get food into our floppy wet lettuce cat?
 
Thanks Nan. We’re just 15 minutes away from his PMPS anyway, so we’ll test now, then feed by syringe (it’ll take a while) and then shoot.

He’s so weak.
 
PMPS 216 (15 mins early) and I managed to syringe feed approx 30g pate&liquavite. He was weak but put up a teensy weensy fight this time (angry ears and dilated pupils and a poor attempt to push away) but I'll take what I can get! I'll do this every hour until he decides to ditch me and eat on his own.

Nan, I forgot to add on my SS that Neil tested keytones at +9 and they were negative. We'll catch and test every pee he does - fortunately he doesn't mind us shoving an empty BG test strip canister under him while he's in the litter box (the lid forms a convenient little handle).

It feels like he's given up on us, but we haven't given up on him.
 
Perclorphenazine is Compazine (in the US). In pets, it's used for acute vomiting. It's generally not recommended for anything except vomiting and if a cat's hospitalized.

You may also want to try finger feeding. I'd also raise Kosmo's bowl a bit. That may help, as well.

How much confidence do you have in this vet?
 
Sienne and Gabby (GA) said:
Perclorphenazine is Compazine (in the US). In pets, it's used for acute vomiting. It's generally not recommended for anything except vomiting and if a cat's hospitalized.
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Hi Sienne, thanks for that. From our research we realised it was for cases much worse than Kozzie is at the moment and we would never give him something of our own accord.
Sienne and Gabby (GA) said:
You may also want to try finger feeding. I'd also raise Kosmo's bowl a bit. That may help, as well.
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I tried finger feeding earlier but was more successful with syringe feeding at that time. To be honest, I can't believe Kozmo let me near his mouth in the first place. He's an absolute love boy but his mouth and tummy is usually strictly out of bounds!
Sienne and Gabby (GA) said:
How much confidence do you have in this vet?
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None. It's a large(ish) veterinary group and the vet we're dealing with admitted she has only ever had experience with one cat on prozinc, no DKA. She showed interest in Lantus but her colleagues convinced her that instead, she should run invasive tests under general anaesthetic because of the 'bouncing' he's experiencing, even though she had told us only days before that Kozzie's blood results were unremarkable, tummy palpitations felt normal and to continue with Caninsulin because she suspects the FD trigger was short-term steroids. When we insisted on trying Lantus first, she became nasty said that she'd prescribe it only because it'll make us feel better about his last days. The next day we phoned to ask for cerenia and she couldn't, wouldn't understand why on earth we'd need it. We pressed hard and got enough for seven days. On that basis, we feel the chances of her prescribing odanestron without us being armed with every bit of ammunition we can compile are slim, but not impossible.

Unfortunately, it appears there aren't many (any) vet practices in our area that have any experience with feline diabetes, let alone cats in general and it's sucky because in Australia, the cat specialist in Mt Gravatt Queensland was our family vet.

Meanwhile, Kozmo is allowing me to syringe feed him and we're making sure to offer him food first before continuing to do so on his behalf. Finding a platform to raise his food bowl too.
 
How are things going now? I’m just awake and checking in.
The vets at Mt Gravatt are great. I’ve spoken to Rhett Marshall and I know there’s another very good cat vet there too, whose name escapes me at the moment.
It might be worth while ringing around other vets to see if you can find a more experienced one.
I see you are syringe feeding him and his BG has come down into the low blues.
Sending lots of healing vines. You must be exhausted. :bighug:
 
Bron and Sheba (GA) said:
How are things going now? I’m just awake and checking in.
The vets at Mt Gravatt are great. I’ve spoken to Rhett Marshall and I know there’s another very good cat vet there too, whose name escapes me at the moment.
It might be worth while ringing around other vets to see if you can find a more experienced one.
I see you are syringe feeding him and his BG has come down into the low blues.
Sending lots of healing vines. You must be exhausted. :bighug:
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Morning Bron. It’s been a baffling day. It’s like Kozzie threw in towel and just gave up. He still has no legs. He’s had a gentle ride down to blue and we’re hoping he gets over this bounce, if that’s what it is. I’m so tired I might be delirious and am therefore not responsible for my own thread (can’t even find emojis! and I love them!).

:arghh::bighug::):banghead::coffee:;):blackeye::(:bookworm::mad: found them!

You caught me reminiscing about Australia. There are limited vets with 24hr hospital facilities in South West Devon, but we’ll keep plugging on.

How should we proceed with testing between now, PM+4.5 and AMPS? Kozzie seems to be perking up and I feel confident he’s not heading for a DKA.
 
You are a bit out of the way down in Devon. But I bet it’s lovely country.
When you say no legs, do you mean he can’t walk?
How is the eating going? Any luck yet?

With the testing because he’s dropping lower you need to be doing it more often. I’d get another test in now if it’s an hour after the last one to see what it is and if it’s still dropping I’d get on other one an hour later. If it’s a lowish green I’d get it 1/2 hour later. I’ll watch for it.
 
Bron and Sheba (GA) said:
I’d test 30 mins from when you last tested just because we need to catch any further drop.
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I managed to pop a little bit of food into Kozmo’s mouth (unbelievable) and he actually started to eat a tiny bit of food from his bowl. I’d promised him that if he tried to eat on his own that I wouldn’t use the syringe. I didn’t have the heart to break confidence!
But! Our + 5.5 was 5... wait, I have to go to the US SS to find out what that is... 90.
 
Bron and Sheba (GA) said:
When you say no legs, do you mean he can’t walk?
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He could walk, but barely. Kept falling over. In fact, we found him sitting in his kitty litter at one stage. He was a dead, limp weight when we picked him up, legs splayed everywhere. It seems to be better now that he’s been fed, or his numbers are lower... but still not normal legs. This is different to his past DKA’s I think.
 
Progress! And we’ll take any progress we can! well done Kozmo and well done Annie.
Looks like his nadir was @+5.
Let’s hope he doesn’t bounce again. The drop wasn’t as steep as yesterday. He clears bounces quickly which is good.

Maybe one more test in an hour just to see it’s still in the way up then get some sleep.

Have you tried sardines?
Sending a plane load of strong Aussie vines and hugs to Kozmo.
 
Annie & Kozmo said:
He could walk, but barely. Kept falling over. In fact, we found him sitting in his kitty litter at one stage. He was a dead, limp weight when we picked him up, legs splayed everywhere. It seems to be better now that he’s been fed, or his numbers are lower... but still not normal legs. This is different to his past DKA’s I think.
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Can he hold his head up ? I’m wondering if his potassium is low. That can cause muscle weakness, loss of appetite, depression and unable to hold head up.
 
Bron and Sheba (GA) said:
Looks like his nadir was @+5.
Let’s hope he doesn’t bounce again. The drop wasn’t as steep as yesterday. He clears bounces quickly which is good.
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Oh please let it be true! I studied his numbers and noticed his ride was slower today. Fingers crossed. I’ll test at +6 as you suggested and will take it from there.
Bron and Sheba (GA) said:
Can he hold his head up ? I’m wondering if his potassium is low. That can cause muscle weakness, loss of appetite, depression and unable to hold head up.
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It’s worth taking note. The vet tested potassium levels and they were okay, but they may have changed. Kozzie is now lifting his head perfectly but earlier he was completely limp. It’s like he woke up and decided to be the polar opposite of yesterday.
Bron and Sheba (GA) said:
Have you tried sardines?
Sending a plane load of strong Aussie vines and hugs to Kozmo.
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Although Kozzie is Sunshine Coast born and bred - and we lived on the waterfront - sadly, he detests fish of any kind. It’s chicken all the way and even that hasn’t worked today.

He was just grooming, oh happy days.
 
The lethargy could just be lack of food and high numbers. I remember when Sheba was chronically in high numbers years ago she was very lethargic.
If he is intermittently able to do things it is less likely to be low potassium but worth keeping in the back of our minds. Im glad to hear the tested the potassium levels.

Have you tried tinned sardines. My Harry does not like most fish (except salmon) ... he has gourmet tastes... but he loves canned sardines.

Before you syringe feed each time try offering food by hand or pop some in his mouth to get started.
 
Did you get the lab results from the vet when Kozmo was discharged? If not I would ask for them next time you are there. They are yours as you paid for them.
If you could post them in the lab section of the SS that would be helpful.They are also good to keep for any future reference
 
Since we seem to agree that your vet is lacking in the requisite knowledge to treat your kitty (I'm attempting to be politically correct), I'd offer a suggestion. Jacquie Rand, DVM is at University of Queensland. This is the vet that has done a huge volume of research on feline diabetes and published the Tight Regulation Protocol. I would call the vet school and ask if they could provide a referral to someone more local to you if their Companion Animal Health clinic is too far to travel. (Just an FYI -- I did a Google search for Jacquie Rand and she may have retired from the University -- she's now and emeritus professor. She's now the Executive Director and Chief Scientist of the Australian Pet Welfare Assn.)

If Dr. Rand is willing to consult, bring the information to your vet. Or, better yet, if the vet program can offer you referrals of someone who worked with Dr. Rand, interview the vet(s).
 
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