7/22 Tiger Amps 284 ER last night

Deb and Tiger

Very Active Member
https://felinediabetes.com/FDMB/threads/7-20-tiger-amps-400-47-6-dose-tonight.292339/

Another trip to the ER last night as I suspected he was dehydrated. He didn’t eat well yesterday and still not drinking water. Since he gets his water from being added to food, I suspected the dehydration.

Bg on arrival at ER was 389. By +5 he was at 94 on their meter, alpha trac. He was 120 on the Libre. They immediately gave him a dextrose med. This brought him up to 135 on the Libre before we left.
The ER, tho not particularly busy seemed very disorganized last nite not their normal state we have experienced before. Hubby called it like “twilight zone”. They took him to the back and ushered us to a room, which is normal, but that is where normal ended. They kept him back there for 3 hours without being examined. I finally had to demand they bring him in with us while he waited since his libre was out of range and I was worried about him dropping. When they finally brought him in he was at 118. I had been told all this time he was being monitored but when I asked the doctor, who Finally came in, what their last reading was, she said 389! She had no idea he had dropped! They were not “monitoring” as they said, obviously. We had to tell them that he had fallen 269 points and they needed to take a reading!
Anyway she had most of the facts on him and reason for visit wrong. Needless to say we had lost trust in them. We told them to give him the fluids, and measure his BG and we would take him home, after she suggested we leave him to run tests and “monitor” him.
Their second BG test showed him at 94 and they administered a glucose med immediately. He got his fluids and we left.
When we got home, we gave a Zolfran and food. He ate the whole bowl of food and we went to bed. He snuggled on my shoulder and slept like a baby. I monitored him until +8 (4am) and fell asleep.
This morning he was perky and active and his BG was at 272. He ate most of his food and is now hiding upstairs, sleeping.
I am overwhelmed with all this low drops and bounces, especially on 3 hours sleep.
I am confused on handling his insulin as it appears to me that when he is not bouncing, any amount of insulin is too much. The teeth are healing and it has a big effect on his insulin. They are also effecting his eating and drinking too. I am at wits end as to how to proceed with his FD treatments. I do feel he may be going into remission and needing less and less insulin. He is not eating right because of the teeth, which is effecting his tummy problems. This makes it hard to control the drops with food carbs. It a viscous circle of drops and bounces and tummy troubles.
This morning I just froze on making a decision on his dose. So bad that I decided to just skip it. I know he needed some but couldn’t decide how mush. I can’t take another drop, more syrup, making his tummy worse! I almost think maybe to skip any insulin until his stomach/ teeth issues are resolved might be best. Also see where he lands if / when he clears the bounce.
I think I’m just loosing it….

Any advice and guidance would be welcomed, my mind is putty. Tigers situation doesn’t seem to be the same as the other kittys here and I found no threads where this has happened to others after dental surgery, so I’m flying blind….
@Wendy&Neko @tiffmaxee and anyone else that may be able to help, thank you!
Sorry this is so long…..
 
I know it’s scary for you to to see the bg drops. It would be fur me too if he’s not eating. I think you need to add ondansetron for nausea. Is there a high carb canned food he loves that doesn’t bother his tummy or even a mc food? With ketones present he needs to have enough food, hydration and insulin as you know . I would have given 1.25 this morning but I guess stick with a fat 1.0 for now. Generally a .25 decrease is suggested especially with ketones. Once eating well you can adjust if needed.

It seems cerenia alone is not cutting it for nausea. All my cats responded to zofran and I now know they did not get the proper dose. Chai recently needed it every 6-8 hours and after a couple of days was eating. Do you have an appetite stimulant? Many do well with Mirataz which you apply to the ear. It didn’t work for Chai until the nausea was controlled and then I didn’t need it. I gave Max cyproheptadine for that but he too would respond to ondansetron. It is short acting. 3-4 hours I think so needs to be given often enough.

I am glad he’s eating this morning. Remind me how long since the dental and how many teeth did he lose? You must be exhausted from the stress and lack of sleep. I think you need to try zofran again and try and find food that doesn’t bother his tummy even if it means needing more insulin temporarily. See what Wendy has to say. I’ll tag another who might have ideas. @Bron and Sheba (GA)
 
Oh Deb, I don't know what to say because this really sounds like a nightmare what you have been through! And I am sorry that the ER was so disorganized. I can imagine, that you have trust issues because of that. I really hope you get some further helpful feedback how to deal with this situation. And I hope you can get some rest. I send some healing thoughts for Tiger and some hugs for you Deb! :bighug::bighug::bighug:
 
I know it’s scary for you to to see the bg drops. It would be fur me too if he’s not eating. I think you need to add ondansetron for nausea. Is there a high carb canned food he loves that doesn’t bother his tummy or even a mc food? With ketones present he needs to have enough food, hydration and insulin as you know . I would have given 1.25 this morning but I guess stick with a fat 1.0 for now. Generally a .25 decrease is suggested especially with ketones. Once eating well you can adjust if needed.

It seems cerenia alone is not cutting it for nausea. All my cats responded to zofran and I now know they did not get the proper dose. Chai recently needed it every 6-8 hours and after a couple of days was eating. Do you have an appetite stimulant? Many do well with Mirataz which you apply to the ear. It didn’t work for Chai until the nausea was controlled and then I didn’t need it. I gave Max cyproheptadine for that but he too would respond to ondansetron. It is short acting. 3-4 hours I think so needs to be given often enough.

I am glad he’s eating this morning. Remind me how long since the dental and how many teeth did he lose? You must be exhausted from the stress and lack of sleep. I think you need to try zofran again and try and find food that doesn’t bother his tummy even if it means needing more insulin temporarily. See what Wendy has to say. I’ll tag another who might have ideas. @Bron and Sheba (GA)
Thank you so much. I was afraid to shoot 1u as he got that yesterday and still dropped at the ER, even having a skip the night before. How do I allow for what it seems that the body is producing its own insulin again. At his highest he was at 3 unit, now 1. A drastic drop.
His ketones been at .2 which is good. Right?
I gave him another Zolfran about 2 hrs ago and also put a bit of Mirataz on his ear. He turned down his normal pate 30 mins after but I tried an old standby he likes of MC and he ate it up. I only gave a small portion, maybe 1.5 tsp to see how he does.

His surgery was 2 weeks ago today and they removed 6 teeth. They also saw where he had already lost 4 teeth naturally, so basically most his top teeth are gone.

yes I am exhausted, but mentally even more so than the physical. It will all be worth it if I can get Tiger better!
 
Can you syringe feed him if necessary? You cal also put Karo or his y on his gums if he drops into the 50’s.
 
He wasn’t in dangerous territory yesterday. Will he eat more? Is it staying down?
Can you syringe feed him if necessary? You cal also put Karo or his y on his gums if he drops into the 50’s.
The ER automatically give glucose when it goes under 100.. He more than likely would have gone down further, he hadn’t slowed down yet but who knows.
I’m sure we could syringe feed if necessary but his gums are still healing and could be tender. Same for karo put on gums, they are sensitive but we did give karo on Saturday when he hit 47.
So many things to consider with him, one effects the other…
Thanks Elise!
 
Sending you hugs and prayers for Tiger to feel much better quickly. I’m so sorry you all had to endure such a bad hospital visit last night.
Thank goodness you and your Hubby are such a strong team to take care of your sweet boy.
Sending you lots of good wishes :bighug::bighug::bighug:
 
That must have been distressing at the ER not feeling confident they were looking after Tiger.
You can give zofran 3 to 4 times a day if needed so I would think about giving it more often to see if that helps.

Making sure he eat something is more important than making sure it is low carb, so if he will eat a MC food, I would let him have that, just to make sure he eats. It’s only while he’s like this. When kitties are sick or recovering from an illness sometimes we have to let them eat food that is not strictly low carb as eating trumps everything and we can always go back to the low carb once they are improving…does that make sense?

I am assuming you are testing the ketones with a blood ketone meter…is that correct? A reading of 0.2 or 0.3 is nothing to be concerned about. That reading does not mean there are ketones present. But I would continue to monitor them daily while he is not eating so well
And I would not skip any doses of insulin unless the BG is really low. You can always give a reduced dose if necessary. Post and ask if you are unsure.
With so little sleep and the anxiety, it is no wonder you feel your mind is putty. Try and get some rest when he is resting and lean on us for help and support:bighug:
 
That must have been distressing at the ER not feeling confident they were looking after Tiger.
You can give zofran 3 to 4 times a day if needed so I would think about giving it more often to see if that helps.

Making sure he eat something is more important than making sure it is low carb, so if he will eat a MC food, I would let him have that, just to make sure he eats. It’s only while he’s like this. When kitties are sick or recovering from an illness sometimes we have to let them eat food that is not strictly low carb as eating trumps everything and we can always go back to the low carb once they are improving…does that make sense?

I am assuming you are testing the ketones with a blood ketone meter…is that correct? A reading of 0.2 or 0.3 is nothing to be concerned about. That reading does not mean there are ketones present. But I would continue to monitor them daily while he is not eating so well
And I would not skip any doses of insulin unless the BG is really low. You can always give a reduced dose if necessary. Post and ask if you are unsure.
With so little sleep and the anxiety, it is no wonder you feel your mind is putty. Try and get some rest when he is resting and lean on us for help and support:bighug:
Thank you so much for replying.
Yes I decided this morning I am going to concentrate on getting the appetite and tummy better. It has to come first.
Since his surgery I have given him any food he will eat, regardless of carb count. As for insulin I am going to stick with a lower dose that he stays safe at until the appetite comes around.
Thanks for the reminders, it always helps to hear them.
 
Sending you hugs and prayers for Tiger to feel much better quickly. I’m so sorry you all had to endure such a bad hospital visit last night.
Thank goodness you and your Hubby are such a strong team to take care of your sweet boy.
Sending you lots of good wishes :bighug::bighug::bighug:
Oh Deb, I don't know what to say because this really sounds like a nightmare what you have been through! And I am sorry that the ER was so disorganized. I can imagine, that you have trust issues because of that. I really hope you get some further helpful feedback how to deal with this situation. And I hope you can get some rest. I send some healing thoughts for Tiger and some hugs for you Deb! :bighug::bighug::bighug:
Thank you both for sending us good thoughts. It’s so sweet of you, when you both are dealing with problems with your babies. It means a lot! Please know that I am thinking of both of you! Hugs
 
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