911 hypo

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@tiffmaxee Chris has seen numerous vets over the past week or so, with varying helpfulness. You should see some of the earlier posts!
 
tiffmaxee said:
Sorry but mirtazapine doesn't work well enough alone for nausea.
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I completely agree with Elise on this. The one dose of mirtazapine that Saoirse had she was crazed with hunger (among other unpleasant side-effects - got the drop of my life when I discovered that night that mirtazapine can cause serotonin syndrome) but she was still licking her lips and pulling faces when eating. Appetite stimulants may get a cat to eat, but it doesn't automatically follow that the cat is no longer nauseated just because it's eating.
 
Critter Mom said:
I completely agree with Elise on this. The one dose of mirtazapine that Saoirse had she was crazed with hunger (among other unpleasant side-effects - got the drop of my life when I discovered that night that mirtazapine can cause serotonin syndrome) but she was still licking her lips and pulling faces when eating. Appetite stimulants may get a cat to eat, but it doesn't automatically follow that the cat is no longer nauseated just because it's eating.
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You are so right based upon my personal experiences and those of so many others.
 
Isn't cushings fairly rare in cats, acro much more common cause of diabetes?

The vet is probably thinking cushings due to the low K+ and high blood sugars which is a symptom of this disease. However, this is a symptom of diabetes with poor control in general, so I wouldn't worry as much that this test is going to be positive. He may just want to rule out, as cushings or acro can make treatment more complicated.

Many cats with either of these conditions are pretty high dose cats >7U twice a day of long acting. You cat seems to have a pretty quick response to much lower doses of insulin, that's a very promising sign.
 
julie & punkin (ga) said:
Ah, well, of course here on FDMB we all are big on testing, and the sicker a cat is the more essential testing is. We've seen how important the testing is.

I saw your earlier discussion about whether or not the relion is accurate - the thing is that the only essential blood sugar numbers are low ones. It's critical you know if a cat goes low - under 50 on a human glucometer or under 68 on an AT2.

If a cat is high, it doesn't matter if the meter reads 350 or 450 or HI. You know they are high and that's good enough.

So, for your purposes, you're going to save a lot of $$ by using the Relion and be able to get more tests in - and data is critical with every diabetic cat, moreso when the cat is ill like Poncho. I'd stick with the relion. If your vet wants an AT test here and there, give it to her. But overall, i think you can feel ok using the Relion and not worry about its exact accuracy. Does that make sense?
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BJM said:
I'm glad you've got him stabilized.
It is really important that the vet see how Poncho reacted to the aborted curve, ie, the dose has to be lower at lower numbers, or Poncho may crash.
The scale I provided seemed close to what he needed using the human glucometer and if you line up the estimates for the AlphaTrak next to them, she can see them side by side.
If she has e-mail, or can get on the internet from her office, getting her the link to your spreadsheet will show her how responsive he can be to the insulin.
I'm going to try to get the spread sheet to her. She gave me a scale to follow, testing only preshot. Here it is:
200-300 give 1/2 unit
300-400 " 1 unit
over 400 give 1 1/2
if under 200 no shot

What is making her think Cushings is possible? A key sign of that is very, very fragile skin that tears easily. Does Poncho have that? You hadn't mentioned it.
She said Poncho's skin is too thin.
Here's some links and info from our high dose forum ... and Poncho is definitely NOT high dose!
"
http://www.cat-health-guide.org/felinecushingsdisease.html
http://www.cat-lovers-only.com/cushings-disease-in-cats.html

Cushing’s disease is caused by a tumor of either the pituitary or adrenal glands, causing the production of excess cortisol. Cortisol is a naturally-occurring chemical in the body, which helps the body respond to stress such as infection or pain. With Cushing’s disease, however, the body continues producing cortisol even when the stressor has been removed. This causes a number of problems one of which is insulin resistant diabetes.

One particular symptom that helps differentiate this disease from acromegaly so quickly is that Cushing’s causes very thin fragile skin that may tear easily and/or not heal well. Females are most often the target."
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BJM, the vet has the records from the previuos vet who ran the 2 failed curves but I don't know if she focused on themaZ
 
How is Pedro doing tonight?

Cushings is fairly rare in cats. It can also be caused by steroid use. We have one member who posts here occasionally with a Cushing's cat, but several cats with acromegaly. BTW, the current poster's Cushing's cat does not have skin that tears, but does have fur loss on his belly. There is usually some skin condition present like thin skin or tearing. Pot bellies, weight loss, muscle wasting and unkempt coat are common conditions in Cushings. Insulin resistance (high dose) may or may not be present. Unless these symptoms sound familiar, I don't think I'd proceed with the testing for it. It's complicated to test for.
 
I'm going to ask a mobile vet I've used if he'll prescribe the anti nausea meds discussed and I think he can test for Cushings cheaper.
 
I'd ask why they think he has Cushing's. It's rare in cats and may not be necessary to test for.
 
I don't see high insulin doses, nor mention of fragile easily tearing skin in any of your posts, Chris. I wouldn't spend money on a test without some good clinical reason to do so.
 
Hi Christoph,

I was worried that Saoirse might have Cushing's prior to her diabetes/pancreatitis Dx because she was pot-bellied and had fur loss on her tum. She had also started pulling fur from her right hand side. The vet who Dx'd her diabetes said that Cushing's is extremely rare in cats. WRT Saoirse, her tummy fur regrew when she was switched to a species-appropriate, grain-free diet (getting her allergy-tested next week). Also, the fur pulling was due to pain in her pancreas. Again the fur regrew when the inflammation died down during the course of her treatment (finding food that doesn't irritate the digestive tract is the trickiest part). FWIW, Saoirse responded really well to small doses of insulin.
 
Let me know if you strike out with the mobile vet. I'd mention the IDEXX ROUND TABLE article if given a hard time. Tell them you fear fatty liver disease and food aversions if he is fed while nauseous. Good luck.
 
BJM said:
I don't see high insulin doses, nor mention of fragile easily tearing skin in any of your posts, Chris. I wouldn't spend money on a test without some good clinical reason to do so.
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Thin skin was the reason. I posted the Alphatrak 12 hr scale she wants me to follow and it seems reasonable, but I'm a novice at best. I'm being conservative with determining dose given BG reading after the hypo incident.
 
What's a cheap but good alternative to the Hills AD? I'm still force feeding even though he's starting to eat on his own and represents 75% of his daily intake. Do I stay with mid carb?
 
christoph said:
Thin skin was the reason. I posted the Alphatrak 12 hr scale she wants me to follow and it seems reasonable, but I'm a novice at best. I'm being conservative with determining dose given BG reading after the hypo incident.
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Where did you post the scale? Do you mean on the forum?
 
Finicky appetite is due to nausea. Max is acting the same way so it means he's not quite ready for me to reduce his ondansetron that he's been on since this p0ancreatitis bout due to dental. I learned this with my first sick cat. Poor thing was nauseous but I didn't realize it because she wasn't vomiting.
 
I think your vet's sliding scale is too aggressive and is likely to send him into another hypo, especially as you switch to a lower carb food.
Shooting a full unit with a pre-shot of 139 was too much for him.
 
BJM said:
I think your vet's sliding scale is too aggressive and is likely to send him into another hypo, especially as you switch to a lower carb food.
Shooting a full unit with a pre-shot of 139 was too much for him.
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I'm tweaking it....ex: this am BG 300...o.5 unit instead of 1 full unit. Scale is too general so I'm drifting to next lower range if BG is on low end of range. I
Her recommended dose was too high given 139 and I double checked with her and she said ok to give. Next day she admitted her mistake and that she had realized 1 hr after shot she might have been too high but didn't contact me. I'm not sure now I want to stick with her, but right now she's giving Poncho the fluids, meds to climb out of the hole....so far so good, except for insulin issue. I wont let that happen again if I can help it.
 
Many of us disregard the vet on dosing and follow what works, often based on recommendations here.

You'll want to be eagle-eyed as Poncho eats more on his own as the changing carbohydrate levels may further reduce his insulin need.
An alternative is to use the food list from Cat Info and pick up some retail foods with similar carbohydrate levels as the A/D, then worry about reducing those once he is really stable again.
 
christoph said:
I'm tweaking it....ex: this am BG 300...o.5 unit instead of 1 full unit. Scale is too general so I'm drifting to next lower range if BG is on low end of range. I
Her recommended dose was too high given 139 and I double checked with her and she said ok to give. Next day she admitted her mistake and that she had realized 1 hr after shot she might have been too high but didn't contact me. I'm not sure now I want to stick with her, but right now she's giving Poncho the fluids, meds to climb out of the hole....so far so good, except for insulin issue. I wont let that happen again if I can help it.
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In the vet's favour, she did acknowledge her error to you. You need prescriptions. It can be a bit unnerving, but one thing I've learned the hard way is that when it comes to veterinary treatment one really does have to be an advocate for one's cat. You're recording Poncho's response to insulin in his spreadsheet so you've got data to back up any reservations you may have in the future about agressive dosing and perhaps you could review the data with your vet when discussing dosage. As is often said here, you're the one holding the syringe, and - most important of ally - you're the one that loves Poncho.

:bighug:
 
BJM said:
Many of us disregard the vet on dosing and follow what works, often based on recommendations here.

You'll want to be eagle-eyed as Poncho eats more on his own as the changing carbohydrate levels may further reduce his insulin need.
An alternative is to use the food list from Cat Info and pick up some retail foods with similar carbohydrate levels as the A/D, then worry about reducing those once he is really stable again.
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Thanks. It looks like the Friskies pate he's been eating is ok alternative. I welcome any recommendations from members as I'm still unsure of myself, but increasingly less so as I proceed and learn.
 
Friskies pates, except Mixed Grill, are all low carb; watch those glucose levels!
 
Trying to be conservative with new scale not working I think. Pre shot am BG was 300 with Alphatrak and gave 0.5 unit, pm +12 BG 428 gave 1 unit. The new scale called for 0.5 unit more. Will follow scale more closely next dose. He did have a good meal @ +10-10.5hrs but I didn't expect 428
 
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I'm glad he's ok after the hypo, Chris. I agree with Eliz on the insulins for now. The prozinc allows you the flexibility to shoot the high numbers down. The longer duration insulins like Lantus and levemir need time to build the depot, usually, and aren't good at bringing down high numbers.

I think it's best to fine tune his scale with help from those experienced using prozinc or PZI.
 
My sub q fluid bag lost it's air somehow and flattened so it's impossible to read the fluid level. I browsed the internet and found no way to introduce air. The bag I'm using has only one stem line, but there is a small "plug"-like thing on the front near the bottom I'm assuming is an injection port? Do I inject air there or turn it upside down and pop this "plug" then close it. Or do I turn upside down and pull the line out then back in?
 
No idea. Not sure introducing air is such a good idea as I would have thought it has to remain sterile.

I think I would start a new thread with a description of the help you need as not everyone will read this thread.
 
phlika29 said:
No idea. Not sure introducing air is such a good idea as I would have thought it has to remain sterile.

I think I would start a new thread with a description of the help you need as not everyone will read this thread.
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Yes, I was concerned about contamination also. I started a new thread.....thanks!
 
Don't inject any air into the bag (bacteria). If you are able to hang it from something with a clothing hanger where it will free hang, even with the vacuum created, it should read the right reading on the markers. Try maybe a shower curtain rod or closet rod. As the bad gets emptier, the markers are harder to read, no way around it.

The lower numbers are meant to be read once this vacuum is created.
 
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Meya14 said:
Don't inject any air into the bag (bacteria). If you are able to hang it from something with a clothing hanger where it will free hang, even with the vacuum created, it should read the right reading on the markers. Try maybe a shower curtain rod or closet rod. As the bad gets emptier, the markers are harder to read, no way around it.

The lower numbers are meant to be read once this vacuum is created.
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It's hanging....just deflated and hard to read while giving fluid. Thanks.
 
We hang our bag of sub-q fluids from a clothes hanger on the back of the dark wood bathroom door. The dark wood behind the bag makes it just a little easier to see where the fluid level is at, though I agree it does get more difficult as the bag gets emptier and deflates.
 
phlika29 said:
Hey Chris. Cute photo:) Hope poncho is doing okay
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Thanks Sarah. Poncho is having a bad weekend....like he's shutting down, lethargic to the point of limp and very weak. I think he's been sliding since the hypo incident. I'm testing every 2 hrs or so since I was only able to get 20ml of food in him. +5 BG was 194 with Relion. I hope it's just a rough patch. Tomorrow morning we have a vet appt. I'm calling the mobile vet I use to see if he'll drop off some anti nausea meds. Prayers needed.
 
I'd get some more labs drawn. Sudden weakness can be electrolytes. He had been eating a little on his own? Also, are you still testing for ketones?
 
The scale from the vet. Friday night and yesterday I backed off the scale 0.5 due to BG was too close to lower range....so used that dose but the next pre shot numbers were high so this morning obeyed the scale. The BG@ +7 was 192 down from 194@ +5 Pre shot this morning was 371. He's still dealing with the URI for which he is taking doxicycline and that might be dragging him down. I started using the other 12 hr spread sheet.
 
Could you list that one again, plus the ones I generated so folks can give some feedback?
 
Her scale: Test 2x daily (12hrs) Alphatrak
BG <200 no shot
BG 200-300......0.5 u
BG 300-400......1 u
BG 400>..........1.5 u

Alphatrak Meter
538.5-615.....1.25 u
461.5-539......1
384.6-462.......75
307.7-385.........50
230.8-308 .........25

Human Meter
350-400......1.25u
300-350.......1.00
250-300........ .75
200-250........ .50
<200............. 0.25
 
Here are some of the foods that I give my cat, and they are all cheap and under 10 carbs:
Friskies - Special Diet Ocean Whitefish, Special Diet Turkey and Giblets, Turkey & Giblets Pate, Ocean Whitefish Pate, Chicken and Tuna Pate
Fancy Feast - Turkey & Giblet Pate, Ocean Whitefish Pate, Chicken Pate, Tender Liver and Chicken, Tender Beef and Liver, Chunky Turkey, Chunky Chicken, Trout Feast and the kitten pates
 
Thanks for the list. He seems most interested in seafood smells due to his sinus congestion but loses interest too fast due to that and probably nausea so I have to assist feed. He's taking doxicycline for it but I think his immune system is so weak the URI is hanging on. He goes back to the vet tomorrow for a checkup and I'm going to ask for an antibiotic injection. I fear he might have to go back on IV treatment.
 
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