? 7/26/24 New Member Lantus long lost-help needed

[Dbabz4]

Hello,

I am so thankful my friends told me about this community you all seem like a lovely bunch of dedicated cat parents. I have read a bunch of resources from the website and I have several questions.

Detailed Summary first: my cat Alfred has probably had uncontrolled diabetes for a while and I shamefully report that I missed the signs. I’m pregnant with my first child and was very sick first trimester and have regrettably been distracted since then. He is generally a chill/low energy cat.

Last weekend he became more lethargic than usual but I was out of town and only my husband noticed- Wednesday morning 7/24 he barely ate and was acting weird when I got home from work so that that night I took him to urgent care and found out he had hyperglycemia (455 BG) and elevated ketones (0.9). He hates car rides and vet visits so tachycardic and elevated RR that night. They did u/s and saw mild peritoneal effusion (ascites) so they recommended ER but on my way there I talked to another vet who thought it was pancreatitis and advised subq fluids and regular vet first thing to save on the bill so I did that since it was only 9 hours away. Regular vet Thursday 7/25: led us down CHF rabbit hole (and serious “E” Convos) because of his HR & RR when we got there. But then chest X-ray showed no CHF so they concurred with pancreatitis/diabetes and sent me to a VCA for hospitalization.
VCA- did more testing and definitively diagnosed diabetes (655 BG w/o eating) and DKA (1.1 ketones and blood gasses). They gave me a $5700-7200 quote for 24 hours with $3-4k/day after that. Then another serious “E” conversation. It may have been my hysterical sobbing that I couldn’t afford that bill because I was already $3100 down, or maybe they feared I was about to have a stillbirth in their office, but the DVM took pity on me and told me about a local vet clinic 40 min away who had lower pricing. They even arranged a referral.
4th vet in 24 hours 7/25 evening- he has diabetes, DKA, pancreatitis, mild ascites, mild pulmonary edema. they want to start insulin asap, hospitalize, manage fluids without aggravating heart, etc. 48 hour estimate $2500.

That brings us to today, 7/26. My eyes and teeth hurt from all the crying but my baby is stable and slowly recovering. With any luck he may come home tomorrow. They put a Freestyle Libre on him and are doing Lantus and everything else to help him recover. I am preparing for life with FDM. My cart has a ReliOn Premier Classic glucometer + strips + lance setup + ketone strips. I want to continue Lantus and got the savings card for $35.

My questions are:
-how do I get the Lantus Rx?
-any affordable syringe recommendations that work with whatever Lantus syringe is the $35 one?
-how am I supposed to use the ketone strips when he pees in a covered litter box w/ crystals?
-how on earth do I purchase another Freestyle Libre without a prescription I can’t figure it out. I have a pending FB message with their customer service.
-I work in healthcare and understand diabetes overall but have combed through a lot of resources here. Y’all are amazing! But searching the forum is tricky so if people would please give me your DKA, FDM, Lantus tips for beginners! He is a long hair boy and I am stressing out about finding good spots to do insulin injections with all the fur.
-I’m going to switch him to Fancy Feast classics and normally we would transition slowly but given his hospital stay can I make the switch when he comes home?
-FF is 3oz cans and they recommend 1 can/3-3.5lb of cat. Alfred is 20lb so should I really be feeding him almost 6 cans/day? Or do I base it on ideal weight (prob 14-15lb)?
-We were supposed to take our baby moon (last vacation as 2 before baby arrives) 8/10-16. I found a Rover cat boarder who will give him his injections and I planned to buy another Freestyle Libre so they could help me monitor his BG with ease. He’d have a quiet private room in their house and they would be able to check on him multiple times a day. But given this change in his health and tenuous recovery is this wildly irresponsible of us? I don’t know how intensely you have to monitor it in the first few weeks and I certainly don’t want him to deteriorate after spending almost $6k to save his life this week. I’m too new to FDM and could use a friendly slap of reality.


THANK YOU IN ADVANCE and please see my profile for details

*UPDATE 7/27*
Thank you all for getting me started!!! Great resources! Update 7/27: they are really happy with his progress overnight!!!!

-RR fine and he’s been off oxygen
-BG has gotten better. He’s on 2x/day glargine now. Still elevated but they are acclimating him slowly. 354 BG @ 6AM been hovering in 300s. Yesterday he was on 2U and they bumped him up to 3U overnight but I’ll probably taper down and chat with them for more specific guidance first
-EATING REALLY WELL!!!! His appetite has finally been coming back! It was meager up until last night
-Ketones resolved in urine
-Kidneys back to normal
-Rectal temp 101.8 now
-Current Meds: app stim and anti nausea and clavamox

He should be able to come home today!! I’m ordering the rest of his supplies to set up for home. The vet did very explicitly tell me that I needed the AlphaTrack monitor and not human— is that a liability thing?
they’ll also send me with the freestyle libre and a reader loaner, I confirmed they can give me anti nausea and more app stimulant supplies and insulin. I’ll also have a refill for the insulin but I’m not sure how much quantity it’ll be.

Does anyone have any tips for me for the next few hours? Other key things to ask the vet? Other supplies I need to acquire ASAP? Thank you all so much for your support here, I am crying with relief!

 

[Dbabz4]

 

[JL and Chip]

Hello and welcome to the FDMB. It’s the best place you never wanted to be.

I’m heading offline now but wanted to take time to welcome you. I’ll tag a couple of other members who have experience with DKA and might be able to start answering your questions.

@Bron and Sheba (GA)
@Sienne and Gabby (GA)

 

[Bron and Sheba (GA)]

Hi and welcome to the forum.
I’ll answer your questions the best I can first

how do I get the Lantus Rx?

The vet should give you a prescription for Lantus.

any affordable syringe recommendations that work with whatever Lantus syringe is the $35 one?

The syringes you need to use with Lantus is U 100, 3/10ml, 30 or 31 gauge, 6 or 8 mm insulin syringes with 1/2 unit markings.
You can buy them at Walmart or pharmacies.

how am I supposed to use the ketone strips when he pees in a covered litter box w/ crystals?

Here is a link to CATCHING URINE

how on earth do I purchase another Freestyle Libre without a prescription I can’t figure it out. I have a pending FB message with their customer service.

I think you can buy them from pharmacies. To be honest I am not sure but I will tag @Diane Tyler's Mom to see if she knows

in healthcare and understand diabetes overall but have combed through a lot of resources here. Y’all are amazing! But searching the forum is tricky so if people would please give me your DKA, FDM, Lantus tips for beginners! He is a long hair boy and I am stressing out about finding good spots to do insulin injections with all the fur.

If he is long haired it might be worth while clipping some of his hair so you can see where you are injecting. Here is a photo of where you can give the insulin

I’m going to switch him to Fancy Feast classics and normally we would transition slowly but given his hospital stay can I make the switch when he comes home?

You can make the switch when he comes home but make sure you do it slowly and monitor the blood glucose.

15lb)?
-We were supposed to take our baby moon 8/10-16. I found a Rover cat boarder who will give him his injections and I planned to buy another Freestyle Libre so they could help me monitor his BG with ease. He’d have a quiet private room in their house. But given this change in his health and tenuous recovery is this wildly irresponsible of us? I

I don’t know what a baby moon is so can't comment on this questions sorry.

I don’t know how intensely you have to monitor it in the first few weeks and I certainly don’t want him to deteriorate after spending almost $6k to save his life this week. I’m too new to FDM and could use a friendly slap of reality.

I will explain this in my next post.

 

[Bron and Sheba (GA)]

Here is what you need to be doing to get ready for Alfred coming home.

• Buy a bottle Ketostix for testing ketones. Can be bought from Walmart in the US or a pharmacy. I think you have this ordered.
• Ask the vet for antinausea medication such as cerenia or ondansetron. Ondansetron is better. Most post DKA kitties are nauseated for a time. Make sure you don’t leave the ER without them.
• May also need an appetite stimulant. Make sure you give the antinausea medication first before the appetite stimulant.
• Ask the vet about giving sub Q fluids at home. You need to check with the vet if there are any heart issues before giving any sub Q fluids.
• Get a range of low carb canned food for when he gets home including some higher carb foods. Look at the FOOD CHART. He will most likely be picky and may not want to eat once he comes home so have a variety of foods for him because it is really really important he eats well to keep the ketones away.
• Set up our spreadsheet and the signature before Alfred comes home. You will find the information in this link HELP US HELP YOU. If you have any trouble setting up the SS I Weill ask @Bandit's Mom to help you.
• If you don’t have a glucose meter I would buy one …preferably a human glucose meter over an alphatrak meter. I th8nk you have this organised.
  Get a copy of all the path results from the ER
• Try and get sleep before he comes home as you will be busy for a couple of weeks with her.

Once he gets home here is a list of things you need to be doing :

• you need to give one and a half times as many calories as he normally eats. Offer snacks every couple of hours during the day and evening as well as the 2 main meals. Food is like a medicine and helps keep ketones away. If Alfred won’t eat the low carb food, feed him whatever he will eat, as eating any food is better than not eating,
• Don’t skip any doses of insulin as insulin helps keep ketones away. If the BG is not high enough to give the dose…stall, dont feed and test again in 20 minutes and post and ask for help.
• Test daily for ketones. Put the results of the tests into the remarks column of the SS so we can see. Please report any trace ketones at all.
• Give antinausea medication if needed
• Give appetite stimulant if needed after the antinausea medication
• Give extra fluids. If kitty will tolerate warm water in the food, put a teaspoon into each snack.
• Hopefully you have set up the spreadsheet so we can see it and test the BG frequently
• Post daily with updates and ask for help as often as needed.

Here is a link to information about:
Ketones, Diabetic Ketoacidosis (DKA), and Blood Ketone Meters

[QUOTE="Dbabz4, post: 3195848, member: 41018"]don’t know how intensely you have to monitor it in the first few weeks and I certainly don’t want him to deteriorate after spending almost $6k to save his life this week. I’m too new to FDM and could use a friendly slap of reality.[/QUOTE]
Alfred will need constant care for a few weeks once he comes home. It would not be suitable to leave him with a career who only comes in twice a day.
Let me know if I have not answered anything.
Bron

 

[Sienne and Gabby (GA)]

Welcome to FDMB.

I'm so sorry you got such a run around with getting your cat diagnosed. I would think with the blood glucose reading (and a follow up fructosamine test -- it's like a hemoglobin A1c) it was a no brainer.

If you are concerned about a urine sample, I have a couple of thoughts. First, don't use a litter box with a cover. It's generally not recommended since the cover traps the urine smell which is not pleasant for your cat. (Think about it as the equivalent of our using a Port-o-Potty.) You can either stalk your cat to the box and swipe a ketostix in your cat's urine stream or put a piece of plastic wrap over the litter, use aquarium gravel, or there are other suggestions. Alternatively, I'd encourage you to learn how to home test with a glucometer. There are both glucose and ketone meters. The strips for the ketone meters are pricey (about $1.00 each) but may be easier than getting a urine sample but that depends on your cat.

The Freestyle Libre is a good option. Just be aware that it tends to give a falsely low reading when the blood glucose level is running in the lower end of normal range. Many of our members will use a glucometer if they are getting low readings to ensure accuracy. The other issue is that they can fail, which could be a problem if you have someone caring for your cat. And, of course, some cats are part Houdini and manage to remove the sensor. There is a Facebook group for pet owners who use the Freestyle Libre that may be a good resource.

You do not want to use the Lantus pen with the needle tip. Lantus comes in vials or pens -- not "needles". You can buy needle tips with the pens but you want to use a syringe to draw up the insulin. The pens will only dispense insulin in 1.0u increments which may be fine for a human but not so much for a cat. You need to dose in smaller (0.25u) amounts. Also, you need to prime the pen which means you lose a unit of insulin with every shot. I believe you can also get syringes from Amazon without a prescription. Most other places require a prescription but that can be a state-by-state issue. Re. your cat having long hair, you may want to use a syringe with a longer needle length.

I agree with Bron. Getting a cat that has had an episode of DKA stabilized is a critical period. Without good follow-up, and sometimes even with good follow-up, cats can relapse. As you've noted, veterinary hospitalization is a major expense. Unless you have experience with a cat sitter and know that the person is tuned in to your cat and has exceptionally good judgement, can give a shot, etc., I would change my plans. Just as an example, my diabetic cat was very stable when I moved to a new city. The first thing I did was find a vet and a cat sitter. The sitter agreed to make several visits to get to know my cat and make sure she would allow her to give a shot. This was prior to the Libre technology and my cat would not allow anyone (and I do mean anyone) to test her other than me. Shots weren't a problem because food was involved. During one of these "stop by and visit with the new client's cat" days, she wasn't sure how Gabby was doing. She came back a couple of hours later to check on my cat. She's been my sitter for 10 years now.

As for "tips":

• Primer on Ketones
• Primer on Pancreatitis
• All of the sticky notes at the top of the Lantus forum

There are also a lot of links to posts that are on the Health Links page. Unfortunately, I really do mean a lot of links. The good news is that your background in health care will serve you well. There are many similarities with treating DM in humans and in cats. The beginning of this process is completely overwhelming so please don't feel like you're being slow on the uptake. We've had MDs, nurses, vets, vet techs, and lots of knowledgeable people become members and they are just as overwhelmed as everyone else. It's different when it's your cat.

Please let us know how we can help.

 

[Dbabz4]

*UPDATE 7/27*
Thank you all for getting me started!!! Great resources! Update 7/27: they are really happy with his progress overnight!!!!

-RR fine and he’s been off oxygen
-BG has gotten better. He’s on 2x/day glargine now. Still elevated but they are acclimating him slowly. 354 BG @ 6AM been hovering in 300s. Yesterday he was on 2U and they bumped him up to 3U overnight but I’ll probably taper down and chat with them for more specific guidance first
-EATING REALLY WELL!!!! His appetite has finally been coming back! It was meager up until last night
-Ketones resolved in urine
-Kidneys back to normal
-Rectal temp 101.8 now
-Current Meds: app stim and anti nausea and clavamox

He should be able to come home today!! I’m ordering the rest of his supplies to set up for home. The vet did very explicitly tell me that I needed the AlphaTrack monitor and not human— is that a liability thing?
they’ll also send me with the freestyle libre and a reader loaner, I confirmed they can give me anti nausea and more app stimulant supplies and insulin. I’ll also have a refill for the insulin but I’m not sure how much quantity it’ll be.

Does anyone have any tips for me for the next few hours? Other key things to ask the vet? Other supplies I need to acquire ASAP? Thank you all so much for your support here, I am crying with relief!

 

[Dbabz4]

Update: I have purchased
-Fancy Feast 3oz cans (beef & poultry classics mix)
-PureBites Freeze dried chicken treats (175ct)-low carb and FDM safe
-ReliOn glucometer, lance device, 100 lances, 100 glucose test strips
-KetoBM blood ketone monitor kit. A little pricier up front but it comes with lance device and 10 strips. Also bought 40 refill strips. Hoping I can use the ReliOn lance on this device once I run out of theirs—refills are more expensive
-100 insulin syringes for Lantus: CarePoint Vet U-100 Syringes 31G 3/10cc 5/16" w/Half Unit Marks

I will work on:
-I’m going home with a vial of Lantus and 1 refill plus the freestyle libre and monitor (on a loan)
-I am trying to purchase another freestyle libre sensor + reader for future boarding or cat sitter situations and for when I have my baby and my time might be limited

does anyone have any more tips for supplies I need?

 

[Sienne and Gabby (GA)]

I'm so glad your kitty is coming home!!

Well, the tip I would provide is that an AlphaTrack is a good meter but the strips cost a fortune. They run $1 each. I'm glad you got a Relion meter. If the vet thought about it, she would realize that telling you should use an AlphaTrack and then putting a Freestyle Libre on your cat just doesn't make sense. The Libre is a human continuous glucose monitor (CGM). It is not calibrated for cats any more than the Walmart Relion glucometer is. It is absolutely fine to use a human meter. Further, the research on the use of Lantus for treating feline diabetes was largely done with a human meter and those studies were all published in very well respected veterinary journals.

The Libre should have an app for your phone. Why is the vet "loaning" you a monitor?

 

[Dbabz4]

I'm so glad your kitty is coming home!!

If the vet thought about it, she would realize that telling you should use an AlphaTrack and then putting a Freestyle Libre on your cat just doesn't make sense.

The Libre should have an app for your phone. Why is the vet "loaning" you a monitor?

thank you!!! He’s resting now! Won’t eat but he got stressed in the car ride home. I thought the same thing about freestyle libre being ok but not a human glucometer! He’s using the original 14 day tracker and doesn’t trust FL 2 or 3. The 3 had some recalls and idk about the 2 but that’s what I’m trying to get a prescription for, especially because it will help me track a curve.
The vet tech also called fancy feast classics “McDonald’s for cats” even though this forum and many many websites list it as a decent diabetes safe one. I’m trying to reconcile the guilt of branching out from their advice with the recommendations I’ve seen here. They want him blindly on 3 units Lantus 2x/day and when I asked about titrating the dose back the tech made it sound like that was a horrible idea. I am going to figure out the spreadsheet stuff next

 

[Hendrick Cuddleclaw]

Welcome to the FDMB. This place saved my boy and saved me in the process. Give these people a chance, you will not regret it.

 

[Bron and Sheba (GA)]

The vet tech also called fancy feast classics “McDonald’s for cats” even though this forum and many many websites list it as a decent diabetes safe one.

I’m so glad Alfred is home.
That is rubbish that fancyfeast is McDonalds for cats. The dry prescription food the vet recommends is certainly McDonald’s or worse.
I wonder how much education on nutrition for cats the vet tech has been given. I was once told by a vet nurse that dry was much better for cats as wet food was 78% water! Go figure that out!

I’m trying to reconcile the guilt of branching out from their advice with the recommendations I’ve seen here

I know it can be hard. Many of us learnt the hard way. It’s just a simple fact that vets, because of the number of animals and diseases they have to treat, do not know a lot about feline diabetes. We live it 24/7. It is up to you… we are here if you need us.

They want him blindly on 3 units Lantus 2x/day and when I asked about titrating the dose back the tech made it sound like that was a horrible idea. I am going to figure out the spreadsheet stuff next

Giving insulin blindly is never a good idea. That is putting your head in the sand and hoping for the best. Home monitoring takes out all the guess work and will keep Alfred safe. And if you follow one of our dosing methods you will have a far better chance of getting Alfred regulated, than just making guesses as to what dose to give.
If you need help with setting up the spreadsheet please tell us and we can get someone to help you easily.
If you are starting off giving 3 units a day you need to be monitoring closely as you will soon know if it is too much. I would hesitate to reduce the dose…with DKA in the picture….until we can see some BG data and the results of ketone tests.
Do you know how much Lantus they were giving in the ER?
Keep offering food…remember it’s very important he eats lots at the moment.
Do you have a hypo box set up in case of low numbers?
Keep positing with updates so we can help you. This next couple of weeks is so important for his full recovery.

 

[Diane Tyler's Mom GA]

I think you can buy them from pharmacies. To be honest I am not sure but I will tag @Diane Tyler's Mom to see if she knows

Hi Dana ,I have never used the Libre ,I don't know where you can buy them @Dbabz4

 

[Sienne and Gabby (GA)]

3u is a high starting dose. There are a few considerations, though. The recipe for DKA: DKA = an underlying infection or inflammation + not enough calories + not enough insulin. Unless you have Alfred's insulin dosing schedule from the hospital, it's hard to know how much insulin he needs.

Lantus is a gentle, long-acting insulin. However, it's a depot insulin which means it takes about 5 - 7 days for the depot to form. This makes it quite different from the shorter acting insulin that your cat was getting initially when in the vet hospital. Usually, when they are switching a cat off of a short acting insulin to Lantus, they still supplement with the short acting insulin to keep the blood glucose numbers in a lower range. Vets do not like to suggest that someone unfamiliar with the use of short acting insulin let alone new to feline diabetes try to use 2 very different insulins simultaneously. This is my long winded way of saying that it's possible that 3u will be an OK dose but it may also need to be lowered as the depot forms. You'll need to be monitoring your cat's blood glucose in order to know whether the 3u is a good dose or not. If it's not, please make sure you have some high carb food at home along with corn syrup, maple syrup, or honey -- basically anything that's got a lot of carbs.

The other issue that may be clouding the dosing picture is what they were feeding your cat at the hospital. I doubt it was low carb food. Thus, there's another reason to keep a close eye on your cat's blood glucose numbers.

 

[Dbabz4]

Giving insulin blindly is never a good idea. That is putting your head in the sand and hoping for the best. Home monitoring takes out all the guess work and will keep Alfred safe. And if you follow one of our dosing methods you will have a far better chance of getting Alfred regulated, than just making guesses as to what dose to give.
If you need help with setting up the spreadsheet please tell us and we can get someone to help you easily.
If you are starting off giving 3 units a day you need to be monitoring closely as you will soon know if it is too much. I would hesitate to reduce the dose…with DKA in the picture….until we can see some BG data and the results of ketone tests.
Do you know how much Lantus they were giving in the ER?
Keep offering food…remember it’s very important he eats lots at the moment.
Do you have a hypo box set up in case of low numbers?
Keep positing with updates so we can help you. This next couple of weeks is so important for his full recovery.

Thank you! So I have checked him a few times since he came home and he’s been between 350-360. I don’t know the exact time he last ate because it wasn’t in the vet notes but I started a spreadsheet. If he’s supposed to eat at 7PM and doesn’t, do I skip his dose? The vet was doing multiple 1-2 IM and SQ injections. I can screenshot and post the timelines in here if that would help. I don’t know how to correlate it to the spreadsheet since they were doing it every few hours or so.

edit: he’s been home for 5 hours. 2 hours ago he got his 16mg tab cerenia and 1.5 hours ago the topical Mirataz. I think he got more sick because he howled a bit. He’s not eating the tuna I put out for him. RR is ~36 and still showing dyspnea. I am supposed to do his next dose in about an hour but am at a loss.

please see below @Bron and Sheba (GA) @Sienne and Gabby (GA) thank you

 

[Dbabz4]

 

[Dbabz4]

 

[Dbabz4]

 

[Bron and Sheba (GA)]

I will ask @Bandit's Mom if she can add the above data into your SS for you when she comes online. She will contact you.
Thank you for posting the above information. It looks as if the 3 units of Lantus twice a day is a guess at best because they were giving Lantus to Alfred multiple times a day s well as some regular insulin early on.
When is the next dose of Lantus due?
We don’t want you skipping any doses of insulin with DKA in the picture. We can help you with that when the time comes.
Do you have any antinausea medication and appetite stimulant you can give him? Do you know if he has had any of these two today yet?
If he won’t eat the low carb food, let him eat whatever he wants at the moment as eating anything is better than not eating.
What are your thoughts @Sienne and Gabby (GA) ?

 

[Dbabz4]

When is the next dose of Lantus due?
We don’t want you skipping any doses of insulin with DKA in the picture. We can help you with that when the time comes.
Do you have any antinausea medication and appetite stimulant you can give him? Do you know if he has had any of these two today yet?
If he won’t eat the low carb food, let him eat whatever he wants at the moment as eating anything is better than not eating.
What are your thoughts @Sienne and Gabby (GA) ?

Yes I just edited my last text post but let me resummarize: he has been home for about 5.75 hours. 2.75 hours ago he got his 16mg tab cerenia and 2.25 hours ago the topical Mirataz. I think he got more sick because he howled for a bit 30 min after the Mirataz and started panting but he’s quieted down now. He’s not eating the tuna I put out for him unfortunately. His RR is ~36 and still showing dyspnea. I am supposed to do his next insulin dose in about an hour but am at a loss for how to go about it if he still won’t eat and the meds aren’t helping

 

[Bron and Sheba (GA)]

Can you try some other foods. I’m talking to @Sienne and Gabby (GA) about Alfred

 

[Dbabz4]

I called the vet and they said even if he isn’t eating to do 1.5U so I just did that. PMPS 331 and I’m heading to the store to pick up a variety of food options right now. Just updated my SS too. Figuring out the early stages is probably the hardest part!! Thank you all. I’ll be posting updates. please let me know if I should start a new thread or switch to a different forum area

 

[Bron and Sheba (GA)]

I called the vet and they said even if he isn’t eating to do 1.5U so I just did that. PMPS 331 and I’m heading to the store to pick up a variety of food options right now. Just updated my SS too. Figuring out the early stages is probably the hardest part!! Thank you all. I’ll be posting updates. please let me know if I should start a new thread or switch to a different forum area

Can you test for ketones please when you can? It’s important we know daily where the ketones are up to.
Ae you able to test the BG during this cycle?
ETA: I would also ask the vets for a script for some ondansetron. It’s an antinausea medication and better for nausea than cerenia. You get the ondansetron from the human pharmacy

 

[JL and Chip]

2.25 hours ago the topical Mirataz. I think he got more sick because he howled for a bit 30 min after the Mirataz and started panting but he’s quieted down now.

That might be side effects from the Mirataz. I’ve seen it a lot with the mirtaz pills, less so with the transdermal. I actually refuse to use mirtazapine pills now because I’ve had such a high percentage of cats become distressed by it — big scared eyes, pacing, howling, panting, anxiety—almost like they’re in fight or flight mode. It can very dramatic to witness and almost scary. Every cat is different, but if it continues to happen, you might need to use a smaller dose or consider a different appetite stimulant. My “go to” is cyproheptadine. It doesn’t work in all cats but does work well in many and definitely tends to have fewer side effects.

 

[Dbabz4]

I’ve tried chicken puree baby food (safe kind), fancy feast, and tuna but he just won’t eat. He’s ignored his water too. I’m sure his last dose of buprenorphine has worn off by now and they didn’t give me pain meds so he’s certainly uncomfortable.

I called the vet again 2 hours ago and he said he may just not be hungry yet despite the meds and asked me to give it more time/follow up in the morning. DKA resurgence is unlikely but the pancreatitis needs to resolve and he needs to eat to make that happen. I am wondering if he’s extra stressed again coping to another environment (even if it’s home). A few min ago he hopped into the slightly wet bathtub to lay down maybe because it’s cool and peaceful. He is anything but recovered so far.

BG 3 hours post insulin is 299 and I really need some sleep so I will try to wake up in a few hours to check again. He has food and water available to him. Please keep him in your thoughts.
@Bron and Sheba (GA) @Sienne and Gabby (GA)

 

[Bron and Sheba (GA)]

Have you checked for ketones?
Try some Parmesan cheese.
You might have to syringe feed him. It’s really important he eats.
SYRINGE FEEDING

 

[Sienne and Gabby (GA)]

Pancreatitis is incredibly painful. Alfred may need more pain meds -- preferably buprenorphine. If he's still not eating this morning, it may mean a trip to the vet.

 

[Dbabz4]

He didn’t eat overnight. He’s about as stable as when he was discharged minus the appetite/thirst. SS has BG ratings and they’re still elevated but relatively stable. I think it might be from pain I am sure he feels horrible. I wish they gave me pain meds to take home because he has regressed a lot in the 24 hours since discharge and the last thing I wanna do is drive him the 35 min back for more hospitalization. He’s so stressed.

He got 3mL watered down chicken paste (Beech Nut baby food) 3.5 hrs ago and another 2mL 50 min ago along with 25mL subQ NS at 60 min ago.

The vet clinic that saw him the last few days rotates DVMs and 3 of the 4 have seen him but the one starting today’s shift has not so she may also be reluctant to give me advice and might tell me to bring him back. I don’t know if I can afford much more treatment. This is so difficult

 

[Bron and Sheba (GA)]

You should be able to just ring and ask for more pain medication. The vet can lookup the case files to see what has been given previously. You are your kitty’s advocate…he can’t speak for himself. And ask about ondansetron for nausea at the same time. It is terrible they did not send you home with all of these things. If he is not eating, he will go backwards and then you will find you might have to take him back to the ER.
Ringing and asking for the meds is a much better option.
Do you not have a local vet who could help you?
Please don’t just wait and see.

 

[Dbabz4]

I did just that. This morning I asked for the buprenorphine and got that from my local/home vet. $75 for 2 days but cheaper than another ER stay. I also picked up some Nutri-Cal. He still wasn’t eating—I think he was in intense pain so I had to syringe feed him and push back his Lantus dose time by a few hours. I gave it at 12:05 PM my time. Then did some more syringe feeds. The numbers are on my SS if you want to look.

He drank water after both syringe feeds so I’ll probably do that every few hours and hope he gets a little bit stronger. He also just ate a tiny amount of food off my fingers which is progress!

I’m going to call the ER vet one more time and ask for insulin dose advise because I was trying to get him on a 7&7 schedule for work. 2U doesn’t seem sufficient but it’s early in tx and I know the depot effect hasn’t happened yet so I don’t want to risk hypo.

 

[Bron and Sheba (GA)]

Stay with 2 units for now to let the depot fill and stabilise. Don’t chop and change the dose unless the BG is not high enough. If that happens stall, don’t feed, and then test again to see if the BG is rising and post and ask for help.
Are you testing for ketones? It’s very important you test for them every day as the result will help tell us if he is getting enough food and enough insulin.

 

[JL and Chip]

Food is your friend and almost a “medicine” when dealing with DKA. I would syringe feed frequently, starting with a few ML at a time, and if that stays down, then more ML at a time, even going for 20-30 ml if possible. Your goal is to get 150 percent normal calories per day into Alfred. It’s not easy to do via syringe but is possible. I had to do it for awhile with my DKA kitty. Sometimes syringe feeding helps to “prime the pump” where they’ll start nibbling on their own (but you might still need to supplement with a syringe).

If you stop back in the clinic, you can ask for a few cans of a/d or C/N (Critical Nutrition) — different manufacturers but both critical-care type foods that syringe feed very easily. My cats prefer the a/d (will run for it even if not sick, lol). You can also use a blender on other canned foods with a little water or broth added to make them go through a syringe better.

Pain meds are critical with pancreatitis. I’m glad you got some.

 

[Dbabz4]

Thank you so much for showing concern for Alfred. I am very thankful for your advice!!!!!

The buprenorphine helped a LOT. He has peed 2x today and although the ascites and pulmonary edema aren’t cleared up (abdomen tender and still straining to breathe but luckily 32-36RR on average) he has had some water and he even voluntarily ate a little bit. I talked to the vet and perhaps this is where this group and vets don’t see eye to eye but they said if his BG hasn’t spiked high like before (it’s close to or lower than the 350-400 avg when he was in their care) and I’ve been monitoring constantly (I have) and feeding him at intervals, that testing for ketones is probably unnecessary. They also said I should go to their recommended 3U is because his BG did not drop very much at all. See SS for numbers. I am going to syringe him just for good measure (I’ll do my best to hit 150%!). I did do the puree route, with a fun combination of FF classic, Nutrical, and a bit of water. He’s getting 12mL syringe feedings. He doesn’t love it but he cooperates enough.

With the unit increase. I’m going to attempt to check BG a few times tonight and see how he does. I’ll update tomorrow. Thank you!!

 

[Bron and Sheba (GA)]

talked to the vet and perhaps this is where this group and vets don’t see eye to eye but they said if his BG hasn’t spiked high like before (it’s close to or lower than the 350-400 avg when he was in their care) and I’ve been monitoring constantly (I have) and feeding him at intervals, that testing for ketones is probably unnecessary

I can’t stress enough how important it is to test daily for ketones. I sometimes wonder where vets get their training. Please test for ketones daily. It’s in Alfred’s best interests.

If you are going to increase to 3 units of insulin I would say you need to be monitoring very closely in case of low numbers. The ER gave the Lantus very erratically at odd times so it is very hard to see how they arrived at 3 units as the best dose. Remember Lantus dosing is based on how low the dose takes a kitty not how high.

 

[Dbabz4]

I will be monitoring!!! I just syringe fed him 12mL of puree. He was a little more resistant so I’m hopeful it’s because he’s getting a little stronger.

let me set up my KetoBM and I’ll add it to the notes

 

[JL and Chip]

I believe the number one ingredient in Nutrical is corn syrup so… I might skip that.

I agree strongly with Bron — test at least daily for ketones!

 

[Dbabz4]

Thank you all for the wisdom. He did have elevated ketones but the urgent care vet essentially scoffed when I called and wouldn’t offer advice because I used a human monitor. It was 1.8. I gave him 15mL subq NS before bed. When I woke up he had drank almost all his water too. I talked to another vet this morning who said since he is recovering from DKA this could be normal.
His BG was 299 AMPS and he ate a little bit from hand feeding. My husband syringe fed him an hour ago too. Hopefully my baby is feeling better.

 

[Bron and Sheba (GA)]

I’m very disappointed in those vets.
Continue to monitor the ketones daily and the BG as often as you can. With Post DKA it is important to make sure ketones don’t reappear. Alfred needs to be eating more. With ketones, food is like a medicine. Did you ask about ondansetron for nausea? That is your priority to get some antinausea medication so that he will eat. Can’t stress how important this is

 

[Dbabz4]

Yeah the tech was in the background saying how it’s not accurate and I could hear her the vet chime in saying “it’s terrible” and they said they could not give me advice as the number is an unreliable read.

the good news: 4hrs after his syringe feed my friend stopped by to check on him and he ate some wet food and drank water voluntarily. He even purred when she scratched his head!!!! I cried. I hope this means he is feeling better. Unfortunately I only have 2 days left of cerenia and maybe 3 days left of mirataz. I tried to do a chewy prescription and the urgent care vet declined to sign off on it. I’ll try his regular vet and see if they will. I know they make money off med markups so they probably want me to buy it from them.

 

[Bron and Sheba (GA)]

Yeah the tech was in the background saying how it’s not accurate and I could hear her the vet chime in saying “it’s terrible” and they said they could not give me advice as the number is an unreliable read.

That is just ignorance on their part. The silly thing is until pet meters were made several years ago, all vets used human meters. And if they recommend using a freestyle libre… the one that’s put on the skin… that is a human meter!!

the good news: 4hrs after his syringe feed my friend stopped by to check on him and he ate some wet food and drank water voluntarily. He even purred when she scratched his head!!!! I cried. I hope this means he is feeling better. Unfortunately I only have 2 days left of cerenia and maybe 3 days left of mirataz. I tried to do a chewy prescription and the urgent care vet declined to sign off on it. I’ll try his regular vet and see if they will. I know they make money off med markups so they probably want me to buy it from them.

That’s hopeful he ate on his own. Keep giving the antinausea meds and appetite stimulant. When you get more, ask for ondansetron for the nausea. It is better

 

[Dbabz4]

I am absolutely devastated to report that Alfred passed away this evening. I don’t know what happened. He was doing so well and looked good. I went to the store to get some supplies for him and I came home and he was gone. I am in pieces. Thank you all for trying. I’ll love him forever.

 

[JL and Chip]

I am absolutely devastated to report that Alfred passed away this evening. I don’t know what happened. He was doing so well and looked good.

Oh no! I’m so sorry. Finding them “gone” is a shock, but when it happens when they’re showing glimmers of improvement…how awful.

I do wonder if maybe there was a heart related incident. With pleural effusion and ascites and a RR over 30 with some breathing difficulty…well, who knows. I lost a dog unexpectedly to a heart issue and I can still feel the absolute shock of finding him.

I wish I could find the right words, but just know that in your short time here, we have come to care about you and Alfred. Please take care of yourself.

Fly free, Alfred. You were clearly loved.

 

[Bron and Sheba (GA)]

Oh no! I am so so sad to read this news. How devastating for you to find him gone. He was obviously a very loved kitty. I too am wondering if it could have been heart related as it happened so quickly.
We become very fond of our new kitties very quickly and understand your pain. Try and take care of yourself. Alfred knew how much you loved him
Fly free dear Alfred

 

[Sienne and Gabby (GA)]

I'm so sorry for your loss.

Fly free little one and land softly.

 

[Marje and Gracie]

I am deeply sorry for your loss, Dana. You really pulled out the stops to help him. Sometimes there are medical issues we don’t know about.

Gentle journey, Alfred.

 

[Dbabz4]

Thank you all for your kindness, sympathy, and advice. My heart is still in pieces with everything and I thank this community for existing because I learned so much in a short time off of your resources. I take comfort in knowing I was at least able to keep him comfortable and let him pass in a familiar and peaceful space.

Here he was in his prime. His little brother Bing Bong was able to see/smell him and say goodbye too. Yesterday I said my final goodbye and my husband took him for aquamation. Thank you all.

 

[Suzanne & Darcy]

I’m terribly sorry about how this turned out. I thought he had turned the corner and was healing. I am very sad for you. Alfred was a handsome boy and I can tell you loved him very much.

 

[Bron and Sheba (GA)]

How are you coping Dana?

 

[Dbabz4]

I am unfortunately not doing very well. But thank you for asking and checking. I think the pregnancy makes it harder to have a grasp on my feelings, too. I traumatically lost my beloved German shepherd during surgery 10 yrs ago 12/23/14. She was technically the “family dog” but she was definitely mine. I only got to see her during school breaks once I left for college. When she got sick I got these horrendous play-by-plays from the vet as it was happening and I was a complete wreck for months and had to go on medication for it. I was broken.

At the end of Jan 2015 I adopted Alfred and he helped pull me out of my grief. He was the first animal I ever chose to adopt as my full own. He is also the first pet I owned that I got to see every day. I am not used to getting ready in the morning and not having him around to greet me. His whole world was so small and I was at the center of it. I wish I had more time with him. I miss him more than words can express.

 

[Bron and Sheba (GA)]

I am so sorry you are going through this. Our kitties are such a big part of our lives and we miss them so much when they go. But know that he will always be there in your heart. Such beautiful photos of Alfred.
Take care