9/1 Charlie +8 315

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EllieKozak

EllieKozak

Member Since 2014
Mornin guys. We are back up and at it again! His amps was 411. How soon after giving the lantus can humulin be given? The last few days it's been an hour lapse between the 2 but is it safe to give at the sane time?
 
Re: 9/1 Charlie amps 411 gave 3.5 Lantus

Good morning!

Sorry, no experience with Humulin, except for what I have read on here....


Just wanted to say you are doing an EXCELLENT job with Charlie!!! Keep up the awesome job!
 
Re: 9/1 Charlie amps 411 gave 3.5 Lantus

Ellie,

My experience is that they can be given at the same time. Since I shoot insulin in the flank, I shoot each insulin on a different side. Very rarely shoot in the scruff.

Ketones are still negative I hope. You've done a great job

Hope this helps,

Claudia
 
Re: 9/1 Charlie amps 411 gave 3.5 Lantus

Thanks guys! He dosent have a lot of extra skin due to his weight loss but I try not to give the insulin near each other. Thanks for the advice and compliments it means a lot
 
Re: 9/1 Charlie amps 411 gave 3.5 Lantus

Hi there :cool:

R can be shot at tbe same time as Lantus.
I always shot in the scruff (no other option with BK) without problems.

How is Charlie? Ketones negative? Is he eating well? All Ps in place?
 
Re: 9/1 Charlie amps 411 gave 3.5 Lantus

You can shoot the R (i suggest you call it that instead of Humulin, because Humulin has both N and R) from the nadir of the previous cycle (so after +6 or so, whenever the numbers begin to rise) until about +1ish, maybe +2 of the following cycle. I would prefer giving the R at preshot rather than at +1 or +2, if at all possible.

So you will avoid shooting R from after +2 until +6 of each cycle. Other than that, you're probably ok. I shot in the scruff, in the same location.

You do want to avoid giving insulin and subq fluids in the same area and the same time. I gave subqs at +3 at least several inches separated from where I gave the insulin. The subq fluids can mess with the insulin absorption if you give them together.

Does that make sense?

It helps to have the info on the questions Sandy is asking - how is Charlie holding up? testing twice a day for ketones still?

and you are doing a good job - this is hard!
 
Re: 9/1 Charlie amps 411 gave 3.5 Lantus

I will also add that R subq should be shot in the scruff and you can move the Lantus shots around. Scruff shots generally have slower onset. You don't want to shoot R in the flank and have him dive quickly and get into that bad R dive/bounce cycle.

I shoot levemir subq in the chest just behind Gracies front paws, in the side sort of in the middle, and in the flank just in front of her back legs. I shoot left side in a.m. and right side in p.m. and alternate chest, side, flank. This helps to keep from developing scar tissue from always shooting in the same place. I only give R in her scruff. She can onset fast from R in the scruff. I wouldn't want to see what she does with it anywhere else ;-)
 
Re: 9/1 Charlie amps 411 gave 3.5 Lantus

Ellie,

You can give the R at amps, +6 and pmps until we get his numbers moving. Since you shot at +1 this morning, I'd give R at +7 today and pmps if he's still in pink numbers.

Did you see my comment about getting a pm+10 last night? There's nothing magic about the +10, but there are some wide open white spaces in those early morning hours, and it would be helpful to see a test here and there to help fill it in.

You don't have to test every hour at this point - i think you could go to every other or every 3rd hour if he still seems to be staying in pink numbers. Charlie's ears must be getting sore. Are you using neosporin ointment with pain relief? If not, that stuff works miracles on healing the ears. You can either rub a bit in each time (or every few tests) or slather it on at night and let it sit overnight. I've used it on my foot where the cats ran across and scratched me, and it completely takes the owie out.

Would you check here before you shoot the next R, though, in case there are any updated suggestions for you?
 
Re: 9/1 Charlie amps 411 gave 3.5 Lantus

hehe i was just studying Charlie's ss and saw your +6/326 pop up. It's always a bit bizarre when that happens. :lol:

Just for comparison purposes, that's roughly 240ish on a human meter, so below renal threshold for most cats. Not too bad. I'd give him another 2uR subq at +7 unless the +7 test is something surprising (ie, under 300). That will hopefully bring him down a bit farther so the pmps is better.

How's he doing?
 
Re: 9/1 Charlie amps 411 gave 3.5 Lantus

Hello sorry I didn't respond sooner. Had unexpected company but I was able to grab a few bg's through the day. He's still showing trace ketones but it was moderate on Friday so I think we did a pretty great job keeping my buddy home this weekend instead if the ER. I do think he's upset with me because he's giving me the cold shoulder today but between the constant bg's the pilling w metronidazole the sc fluids and chasing him around the litter box oh yes and 4 insulin injections a day I think he thinks I'm on a mission to torture him :(
But I can't thank you all enough for your constant support and guidance thru this journey. We are now just at the +8 with a 315. Should I give some R now? I can stay up til midnight tonight to test but have to work tomor so def need to get sleep tonight. He's coming to work with me for GI testing tomor so we will keep a close eye on things. Gonna run a pancreatitis test too. Anyone have any other suggestions on additional tests you might run if it was your cat? Money is no object when it comes to Charlie. Thanks again my friends! Oh and his attitude today is good, all his P's are in place!
 
Re: 9/1 Charlie amps 411 gave 3.5 Lantus

julie & punkin (ga) said:
Ellie,

You can give the R at amps, +6 and pmps until we get his numbers moving. Since you shot at +1 this morning, I'd give R at +7 today and pmps if he's still in pink numbers.
oot the next R, though, in case there are any updated suggestions for you?
Click to expand...

Thank you for this advice! I however didn't see this message at +7 and we are now at +8. Should I wait til pmps or it's ok?
 
you can still give it now. the main point is to give long enough in between the R shots that you let one wear off before the next, and to avoid the low point of the R cycle (seems to be about +3) and the low point of the Lantus cycle - I can't tell that yet, but typically they are about +4-7. If you give it now, then that's probably the last time today, since you need to sleep tonight.

Ellie, Sandy asked earlier about the root canal. Was there any follow-up done to make sure he doesn't have a remaining infection? We're still wondering about whether or not the infection component of the ketones has been resolved. Can you tell us anything else you know about that? Do you see any signs that his mouth might be bothering him - any pawing, eating on only one side, etc.?

Can you add the meds info to the spreadsheet too? just include it in the comments. All of that info is important - when he started on antibiotics, etc.
 
julie & punkin (ga) said:
Ellie, Sandy asked earlier about the root canal. Was there any follow-up done to make sure he doesn't have a remaining infection? We're still wondering about whether or not the infection component of the ketones has been resolved. Can you tell us anything else you know about that? Do you see any signs that his mouth might be bothering him - any pawing, eating on only one side, etc.?

Can you add the meds info to the spreadsheet too? just include it in the comments. All of that info is important - when he started on antibiotics, etc.
Click to expand...
He never had a follow up radiograph of the root canal tooth but I will speak to the dental vet tomor I'm sure she will be more than happy to do it. Remember though, the tooth was never infected it was just poking the roof of his mouth (he has parrot mouth) his teeth and gums look great no tartar or gingival disease but I don't want to leave any stone unturned so I will look into that as well.
He had a shot of convenia last Monday (7 days ago) because of the dka and he started metronidazole yesterday am. His stools are looser today than yesterday.
I will give 2 u r now. Question about ketones. If a cats bg is somewhat controlled but keeps getting an infection (I'm thinking IBD due to his stools) can/will that throw him back into dka? I'm
Hoping that this bloodwork tomor can shed some light on this!
 
some cats seem more prone to ketones than others. With Charlie having them 3 times, he's in that category. It's not uncommon for cats to have infections or other issues - we have several kitties on here with IBD, hyperT, pancreatitis, and they get bladder infections and dental issues, etc. ketones are less common.

It's possible that one reason Charlie's had them is that his basal insulin, the Lantus, hasn't been consistent and gotten to the right dose for him yet. It's a great insulin and with consistent dose adjustments per the protocol ought to be able to get him regulated. Even with their blood sugar regulated, a cat can still develop ketones, so it isn't necessarily only a cat in high numbers, although usually it is.

You're on the track now, however. :-D I'm still scratching my head about the vet not wanting him to get more than 2u. Cobb is our highest dose kitty at the moment, and he's getting 22.5u per shot. Cats need such varied amounts. Even without a high dose diagnosis, a cat might still need 5u per shot.

Do continue testing for ketones twice a day - they can rapidly go from trace to large, so you've got to stay on top of that. If you're having trouble catching a sample, you can use something non-absorbent in a spare litter box. I put a box lid (the kind from a case of copier paper) into a large garbage bag and put dried lentils in it. that won't absorb the urine and you can test it after he's out of the box. they can be rinsed off and reused. You still need fresh urine, but at least you don't have to catch him in the deed. Some people use aquarium gravel - anything non-absorbent will work. I stored the box in the garage in between using it. I tested punkin by putting him in the laundry room to eat dinner with the box in the room, then stayed there with him til he went. he had very furry thighs and i never even saw him pee, much less could get a strip stuck in it. :lol:
 
hmmm, i just now picked up on your comment about parrot mouth. I looked it up and it says an overbite of the top jaw. Is this something he has always had as a kitten, or has it developed after he was an adult cat? Are his teeth separated, ie, have they pushed out enough that there are gaps in between his teeth?
 
julie & punkin (ga) said:
hmmm, i just now picked up on your comment about parrot mouth. I looked it up and it says an overbite of the top jaw. Is this something he has always had as a kitten, or has it developed after he was an adult cat? Are his teeth separated, ie, have they pushed out enough that there are gaps in between his teeth?
Click to expand...
No it was diagnosed when he was a baby. We neutered at 6 mos then last November the root canal was done. Mainly for his comfort. The rest of his teeth look marvelous. She wanted to wait til he was full grown before doing the root canal in case his jaw structure changed (why we didn't do at neuter). Part of me wonders if the anesthesia set this horrible process in motion. :(
Thanks for the lentils /gravel tip! I took some lab litter home from work and he once again looked at me like I'm crazy!
 
Unless yo know for sure about IBD, I'd be more inclined to think that the loose stool is a response to the antibiotic -- more the Convenia than the metronidazole.

FWIW, most of us won't let the vet give Convenia. It's only indication is for skin infections. It can be problematic in that if your cat is sensitive or allergic, because it lasts for 2+ weeks, once it's in, you can't stop it.
 
Sienne and Gabby said:
Unless yo know for sure about IBD, I'd be more inclined to think that the loose stool is a response to the antibiotic -- more the Convenia than the metronidazole.

FWIW, most of us won't let the vet give Convenia. It's only indication is for skin infections. It can be problematic in that if your cat is sensitive or allergic, because it lasts for 2+ weeks, once it's in, you can't stop it.
Click to expand...
You know what? I didn't even think of the convenia! And the last time he was dka he got that too. And I think IV cefazolin. I will think twice next time before using the abs. How bout the metro now tho? Thinking the havoc he's been thru I'm wondering if it's good or bad to keep him on? He is still gonna get the sc fluids bid for at least a few more days or at least til neg ketones. I feel like an idiot not thinking of the convenia causing it. So focused on his sugar I can't think of anything else.
Quick side story-we just had the wood floors redone and now hubby wants to have walls painted and get a new dining room set. For 3 weeks it's been on hold (cept the floors done) bc I can't decide on a color or style! Can't focus on anything except Charlie! Does anyone else feel preoccupied with everything else in their lives? Weird!!
 
figuring out charlie is a bit like unraveling a tangled ball of yarn. you've got a lot of little bits here and there and we haven't put the whole picture together yet.

Sienne isn't saying that the convenia caused his DKA, i don't think. We know that Convenia was developed as an antibiotic for skin issues and it's named that because it's convenient to get a shot instead of pilling a cat. Punkin got convenia at least once or twice before i learned here about it. The issue is that if a cat is allergic to it, it's an enormous problem. It stays in the body at least 2 weeks, so you've got a 2 week allergic reaction to deal with. It's also not particularly good for other infections.

So - back to the infection question. Was the vet's thought that the ketone issue was related to his IBD? Is that why he gave the Convenia?

ok, so his teeth are normal spaced, not spread out and his mouth shape hasn't changed since he became an adult, right?

I know you read the links i gave you before about acromegaly and mentioned you can hear him breathe, although not to the extent it sounds like snoring. Does he have big paws? big stools? Before he became diabetic did he eat everything in sight? High blood sugar can make them starving, literally, so that's not unexpected then, but i'm wondering about before. You said he's 18ish pounds, am i remembering correctly? I can't find your post now about it.

To counteract the diarrhea from the metronidazole (which usually doesn't cause diarrhea, but is given to help it), you can give some probiotics - fortiflora from the vet is the first one people usually turn to. Do you have any of it? I don't think i'd stop giving it yet, but you want to firm up his stools.

are you tech savvy enough to do a google doc? it's helpful to have the essential stats on a cat somewhere readily visible - either in the signature line, or in a google doc profile attached to a signature line. then we won't keep asking you the same questions. I have a google doc with punkin's profile attached to my sig line - you can see that as an example. i included photos, but you can/don't have to do that.
 
Sometimes metronidazole can have the opposite effect you want. If he has loose stools, maybe try some slippery elm bark syrup. It's very effective. Metronidazole is also an a/b so he's getting a double whammy. Do you have him on probiotics? Many of us use the Renew Ultimate. It's FD friendly and my Gracie loves it in her food.

I would definitely avoid the Convenia.

The other thing is that they usually need to be fasted for the specfPL. My vet spoke with Texas A&M who developed the test with IDEXX. TAMU said a minimum six hour fast for FDs. IDEXX says 12 hour fast. This Primer on Pancreatitis has the most up-to-date info on pancreatitis and treating it.
 
julie & punkin (ga) said:
Sienne isn't saying that the convenia caused his DKA, i don't think. We know that Convenia was developed as an antibiotic for skin issues and it's named that because it's convenient to get a shot instead of pilling a cat. Punkin got convenia at least once or twice before i learned here about it. The issue is that if a cat is allergic to it, it's an enormous problem. It stays in the body at least 2 weeks, so you've got a 2 week allergic reaction to deal with. It's also not particularly good for other infections.

So - back to the infection question. Was the vet's thought that the ketone issue was related to his IBD? Is that why he gave the Convenia?

ok, so his teeth are normal spaced, not spread out and his mouth shape hasn't changed since he became an adult, right?

I know you read the links i gave you before about acromegaly and mentioned you can hear him breathe, although not to the extent it sounds like snoring. Does he have big paws? big stools? Before he became diabetic did he eat everything in sight? High blood sugar can make them starving, literally, so that's not unexpected then, but i'm wondering about before. You said he's 18ish pounds, am i remembering correctly? I can't find your post now about it.

To counteract the diarrhea from the metronidazole (which usually doesn't cause diarrhea, but is given to help it), you can give some probiotics - fortiflora from the vet is the first one people usually turn to. Do you have any of it? I don't think i'd stop giving it yet, but you want to firm up his stools.

are you tech savvy enough to do a google doc? it's helpful to have the essential stats on a cat somewhere readily visible - either in the signature line, or in a google doc profile attached to a signature line. then we won't keep asking you the same questions. I have a google doc with punkin's profile attached to my sig line - you can see that as an example. i included photos, but you can/don't have to do that.
Click to expand...
To clarify, I wondered if the convenia caused the loose stools. Vet gave him convenia bc of the dka. I will refrain from future convenia. We use it often at our hospital but we give the client the choice and suggest oral abs first but sometimes it's more "convenient lol" for the convenia. The vet gave him the conv hoping that would help get rid of infection (WBC normal clean urine)
His teeth/mouth feet etc are unchanged except his eyes are sunken in from weight loss. He is currently 7 lbs and last nivember when he had his dental he was 12lbs (his heaviest and he was not overweight). I did his spreadsheet on docs on google I will do up a profile for him ASAP. He is on forti flora too and before his dx he was my strongest and most eager eater but not ravenous like now. I wish I could get him to eat that max cal stuff!
 
Hi Ellie:

Just a thought, and you may have tried this. If Charlie likes the taste of Forti Flora, have you tried sprinkling it on the max cal to get him to eat it? How about crushed freezed dried meat? My Cinco will eat darned near anything if I sprinkle freeze dried salmon on it. I've been following your posts but haven't had anything to offer, so I've kept out, but wanted to throw this in. You're doing an amazing job!
 
hi ellie,

I don't see anything on his ss from last night's cycle - i hope all is well. If he's continued in the same pink AT numbers that he has been in, you can increase his Lantus dose by 0.5u to 4.0 with his next shot.

You don't have to reply on this condo - go ahead and start a new one for 9/2. I'm off to work but will check in on you when i get home. Hope you have a good day.

julie
 
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