A week in ICU

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Kindagot

Kindagot

Member Since 2021
My Burmese cat Benny is 15. He had Mild CKD. I noticed he was drinking more for a few days but put it down to his CKD (managed by diet) and the warm weather ( we are in New Zealand) his brother was also drinking quite a bit. FF to Sunday morning where all was not well, he was lying on his side completely dehydrated, breathing 50/60 breaths a minute. I took him to Emergency vets and they said DKD prognosis poor offered to PTS. We opted for treatment. He was given fluids. Later that night they phoned and said he would not make it through night and to come say goodbye I said to try antibiotics. The whole family made the 2am visit to have him brought to us in car ( we are in Covid lockdown) He seemed better to us and we thought he seemed a little better. This went on for 2 day sand then our own vet suggested we transfer him to a specialist veterinarian hospital. So I dropped my little man off to the Critical care Unit there, on examination they thought he would be with Critical for 2 days and then on to internal medicine ward for a while. Well poor Benny had a complication, he now has Congestive heart failure brought on by the fluid overload as his echocardiogram showed hypertrophic myocarditis. So he had the fluid drained and was put on a diuretic. He had to have an esophagal tube (no food for 3 days) and central line put in and had breathing difficulties after the general anaesthetic. They put him on Oxygen for 18 hours. He then had a hypo episode. Yesterday we had a short visit with him and he seemed brighter. I fed him a liquid treat and he lapped it up. 6 day since he had last eaten himself. Today the vet said he is much brighter and he started to eat himself after seeing us! I am hopeful. His BG is still bouncing around.
I am looking for reassurance here, that they will be able to get his diabetes stable? I understand they will be trying to get his right dose of insulin. He is on Glargine. He has a continuous blood sugar monitor attched to his skin
Has anyone else had a cat in ICU this long?
 
Hi and welcome to the forum. I am so sorry you and The family and Benny are going through this.
Yes we do have kitties that spend a week in ICU and come home.
It sounds as if Benny has had DKA….is that correct?
You will need to look after him closely for a few weeks as he is recovering from that. He has a lot going on, but thee is certainly hope. Don’t give up. Cats are amazingly resilient.
Yes the diabetes can be stabilised. It takes time to get the correct dose of insulin, it doesn’t happen overnight. He just needs to be stable with the DKA and the hypertrophic myocarditis and you will be able to adjust the dose at home over time. We can help you with that. We do that all the time with kitties. we have some very experienced people here who can help you. I am so glad you have found us.

I live in Sydney, Australia….so waving to you across the ditch!:)
I’ll watch for your ereply
Bron
 
Yes DKA was the initial diagnosis. He had not been flagged for DM previously as he has blood checked regularly for CKD
>Thank you so much for your reply! I am looking forward to him coming home. The vet said she is confident that his DM can be managed in the hospital setting, it is just a question of getting him home. My poor baby. I am so relieved he started eating. It is so difficult as we are in lockdown and visits are not allowed, other than they bring him to the car for us to see him briefly. His regular vet who has known him since he was a kitten loves him and she assures me he can live well with his illnesses.
 
That is good your regular vet is reassuring.
I can’t answer you fully now as I have to go out but I will come back and talk you you about looking after him once he gets home.
There are some things you can do now to get ready for him.
What a lucky boy he is to have you all.
Back soon:)
 
Welcome. Waving from Canada.

Kindagot said:
I am looking for reassurance here, that they will be able to get his diabetes stable?
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If they can't, this forum certainly can. There is a wealth of researched information and experience here.

Your family has been through a lot and you are dealing with a steep learning curve. Believe me, treating feline diabetes (and balancing everything else) will become second nature quite quickly. And we can help you every step of the way. There are a number of caregivers who are or have balanced multiple issues.

Until Bron gets back (she should not be long), may I suggest some reading?

This information applies to NZ as well. Scroll down the food list for NZ-specific foods.
And just in case:

Trips to the vet have become much harder since Covid started. :bighug:
 
Have they given you any idea about when Benny might come home? Has the congestive heart failure settles down? And do they think that will be an ongoing problem or just a one off from the overload of fluid.?

Don’t worry about the blood sugar bouncing around. That is normal. I imagine he will come home with the freestyle libre meter still attached to his skin, so you will be able to monitor his Blood sugars. They only last a couple of weeks so unless you are going to put on a second one, you will need to look at getting a glucose meter that you use your self. We all use them and they are not hard to use……just take a few days to get the hang of it. It doesn’t hurt the cat and they won’t hate you!
A human glucose meter is the best one to get as it is far cheaper to run than the pet meters. And our dosing methods are based on the human meters. It is the test strips that cost the money ongoing. You can buy a human glucose meter from most chemists. I find buying the test strips online is cheaper but you will need to get the first lot with the meter so you know which ones to buy later.

With DKA there are several things you can do now to get ready for Bennys return.
  • buy a bottle Ketostix for testing ketones. Can be bought a pharmacy.
  • Ask the vet for antinausea medication such as cerenia or ondansetron. Most post DKA kitties are nauseated for a time.
  • May also need an appetite stimulant. Always give the antinausea medication first before the appetite stimulant.
  • Ask the vet about giving sub Q fluids at home. This may not be possible if there are issues with the congestive heart failure.
  • get a range of canned food for when they get home including some higher carb foods. Look for canned food with carbs 10% or less.
  • set up a spreadsheet and the signature before Benny comes home. I will provide a link
  • buy a human glucose meter
  • get a copy of the path of all results from the ER

Once you get Benny home
  • you need to give one and a half times as many calories as he/she 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 Benny 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..
  • Ask the vet about subQ fluids……*****may not be possible if there is still some congestive heart failure..
  • Set up a spreadsheet and test the BG frequently
  • Post daily with updates and ask for help as often as needed.
I did have a list of foods available in NZ but I can’t find it. Hopefully you can get some of the foods listed in the link below
As he also has early CRD I would look for foods that have phosphorus levels of 250 to 200mg Phosphorus/ 100kcals. There is a column for that in the list.
If your other kitty is also drinking more I would invest that as well.
They are beautiful kitties. Are they litter mates?. They look like lilac Burmese.. one of my kitties is an Australian Mist and is 1/2 Burmese.

FOOD LIST

I see @Red & Rover (GA) has posted the Australian information for you…thanks Kel…….a lot of it will be the same as in NZ except for some of the food.
What foods were you feeding before this?
 
This is fantastic information! Thank you so much.
He was fed a raw/wet mixed diet before CKD diagnosis in April. I have been experimenting with lots of different low phosphorus foods for both him and his brother Billy (litter mate) also CKD. Benny really liked the Proplan Renal diet kibble and has been digging into that ( probably sending him into DM). They both quite like the Ziwi wet food. He has started eating himself (❤️) last night so would imagine that is the same as the feeding tube mix of Hills A/D. Although, I did poach some chicken breast for him and gave to the vet. He also likes Vitakraft Chicken and Taurine liquid treats which I was using once a day to give him some Phosphorus binder powder.
Ketostix are urine dipsticks? How do I do that? I have recently changed their litter trays to Tidy Breeze system I get shipped in from USA. It is a stone like gravel over a grate that has a urine pad underneath. Both of them use the same trays. I am not sure whether they actually identify as separate cats, they have always been together., born together. Billy has been in a terrible state all week and we have to carry?cuddle him 24/7. He was refusing to eat and is constipated ( I am giving him lactulose) he had a full blood panel done on Thursday and is seeing the Cardiologist on Tuesday to see if he has any heart problems.
I have looked at Brons spreadsheet for Sheba. (Wow) It is giving me a good idea of what there is to come (hopefully) I did not dare to ask about DKA on here before now as I did not want to tempt fate but seeing his update photo today I know he is fighting away!

Yes Lilac Burmese essentially catdogs!
 
Ketostix are urine stick which you dip into the Jerome to test for ketones. You compare the result against the colours on the side of the bottle exactly 15 seconds later. The colour will keep changing so it’s important to get that 15 seconds mark. You need to tell us if there are any ketones at all. Put the result into the remarks column of the spreadsheet. It is food and insulin which will stop the ketones reforming as well as any infection being treated.
The raw diet you fed should be good…are you adding supplements? Adding a cooked egg white to the food will help increase the protein and lower the phosphorus.
The proplan renal diet dry would be high carb….I would throw that out!
Was the phosphorus high in Benny’s lab results?……just wondering why you are adding a binder if he is mild CKD.

You have a couple of good canned foods made in NZ …….. Ziwi Peak and K9 naturals

I can imagine Billy is missing Benny a lot.

Kindagot said:
Yes Lilac Burmese essentially catdogs!
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Yes!! My Harry is very like a dog in many ways. Eats like a labrador and follows me like a dog. Sheba was also an Australian Mist who had the same traits.
 
You are right about the Proplan Renal dry food! I am sure that is what has given Benny diabetes. Billy will not eat it.
I started using the phosphorus binder after reading up on Tanya. I wanted to be proactive with their CKD.
I presume that Benny will come home with the BG meter on. ( I think they last 2 weeks?) I have no idea when he will be able to come home, only that he needs to get the DM under control. SO they can find his dose. He has not been having a regular dose. They have said anything between 1 and 3 units when I have asked. He weighs 6kg.
 
Kindagot said:
You are right about the Proplan Renal dry food! I am sure that is what has given Benny diabetes. Billy will not eat it.
I started using the phosphorus binder after reading up on Tanya. I wanted to be proactive with their CKD.
I presume that Benny will come home with the BG meter on. ( I think they last 2 weeks?) I have no idea when he will be able to come home, only that he needs to get the DM under control. SO they can find his dose. He has not been having a regular dose. They have said anything between 1 and 3 units when I have asked. He weighs 6kg.
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Did they say what insulin they are using? . They could be using one of the faster acting ‘in and out’ insulins at the moment because of the DKA but eventually he would do best on Lantus which is a longer acting and more gentle insulin which is great for cats.

I don’t think you need to be using a binder unless the phosphorus is raised. Do you have the results showing the phosphorus levels?

Yes, the libre meter lasts 2 weeks……although sometimes it stops working or falls off sooner. So I would recommend looking into buying a human meter so you are prepared. You will need it eventually.

You might like to read through this thread which I started about a home made diet for CKD cats
HOME MADE DIET FOR CKD CATS
 
Yes, when we saw him yesterday he had been shaved on both flanks. One side had a monitor and the other side had a sticker that looked like it used to be the monitor. He or Billy might break it. Benny was half dead after having and O tube and central line put in on Wednesday but still managed to pull out the line! The vet was exasperated, I took it as a good sign!
Is there a particular monitor you recommend?
 
Kindagot said:
SO they can find his dose. He has not been having a regular dose. They have said anything between 1 and 3 units when I have asked.
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Gargline is a depot insulin. Some is used by the body right away. Some is stored to gradually build up a working depot. This can take up to 5 days.

https://www.felinediabetes.com/FDMB/threads/what-is-the-insulin-depot.150/

What gargline craves most is consistency. The typical way to determine the dose is to start with 1 unit (this may be too little because of the DKA). Increase by 0.25 units so you don't go straight past the optimum dose.

They could be trying to dose by the preshot glucose reading (which leads to hypos). Ask how they are determining the dose.

Some basic reading about glargine (Lantus)

Regarding DKA: there's also this Primer
Ketones, Ketoacidosis, and Diabetic Cats: A Primer on Ketones

Sorry to bombard you with information. Like Tanya's site, take it slow. There's a lot to take in. Let us know if you have any questions.
 
Kindagot said:
Yes, when we saw him yesterday he had been shaved on both flanks. One side had a monitor and the other side had a sticker that looked like it used to be the monitor. He or Billy might break it. Benny was half dead after having and O tube and central line put in on Wednesday but still managed to pull out the line! The vet was exasperated, I took it as a good sign!
Is there a particular monitor you recommend?
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Poor boy,he will be happy to get home with his family.
If you can find the Abbott freestyle optium human meter, that is a good one. It can also test for ketones in the blood which may be easier than trying to get a urine sample. You need separate test strips for the ketone testing and they aren’t cheap though. You can just use it to test the blood glucose if you like. I used to buy all my strips on eBay as they were much cheaper.
https://www.davidjonespharmacy.com.au/abbott-freestyle-optium-neo-blood-glucose-ketone-m

Because he has had DKA he may well stay on an ‘in and out’ insulin for a couple of weeks before starting glargine, as glargine is a depot insulin and it takes up to 5 days for the depot to fill. If a kitty has DKA or is recovering from it, starting glargine too soon can leave them open to ketones appearing because of the depot not being full from the first dose……does that make sense? So don’t be surprised if he does not come home on glargine, but on another insulin…. The swap over can be done when the ketones are well gone.
 
He is on Glargine already. The normal vet emergency centre put him on Caninsulin and then arc.co.nz put him on Glargine put I think this might be supplemented with a shorter acting one as well? The care has been above and beyond at the specialist centre. They even did continuous ECG to get his Potassium dose right! They said we can have another carpark visit tomorrow and I think I might take Billy to see him. If Billy is this upset, then Benny must be missing him too.
 
A question about the ...
Abbott Freestyle Optium Neo Blood Glucose Ketone Meter
How many lancets, test strips should I buy. It is not easy to get hold of things in NZ in these challenging times it is even worse!
 
Kindagot said:
A question about the ...
Abbott Freestyle Optium Neo Blood Glucose Ketone Meter
How many lancets, test strips should I buy. It is not easy to get hold of things in NZ in these challenging times it is even worse!
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You should be able to buy the meter and the test strips and the lancets at chemists. Once you have bought the first lot of test strips you can buy them online at eBay. Same with the lancets.
I would get a box of 100 lancets and a box of 100 test strips that go with the meter you get.
Then once you know what strips to buy you can get them online.
Only use the lancets once…same as the syringes.
The syringes I used to buy from the chemist ….cheaper than the vet.
It will depend on what insulin you are using as to what syringe you will need. There are different syringes to go with different insulins. The vet will probably give you the first lot from his place.
Then if you later swap over to another insulin like lantus, if the vet will give you a script for it, you can get it from the chemist….it is much cheaper that way.
Here is an example of the test strips for sale in Australia…. Not sure if they ship to NZ or not. You would need to ask. They probably do as I have bought test strips from overseas many times.
https://www.ebay.com.au/itm/Abbott-Freestyle-Optium-Neo-Blood-Glucose-Strips-100-Tests-/123880447340
 
You had asked about kitties who start their journey with DKA and an ICU stay. Gabby was one of those kitties. She was initially diagnosed with DKA, hepatic lipidosis, and pancreatitis. I had two vets tell me that she might not survive. Gabby was a tortie and had a great deal of attitude. She was home after 3 nights at the ICU. I managed her diabetes for 6.5 years. It sounds like your cat is a fighter, as well!

It is typically for a cat that has DKA to be on a basal insulin like glargine along with a bolus insulin -- a short acting insulin that can "boost" the action of the basal insulin. (Usually something like Humulin R is used.) It truly sounds like you've got a great veterinary team on your side.

Please let us know how we can help.
 
:)That’s good news.
Make sure you ask the vets for the antinausea medications cerenia and ondansetron. Benny may be eating well now but DKA kitties frequently get nausea and need the help of antinausea medication along the ways they recover.
I don’t know what the vets will tell you to do at home, but many don’t give much at home advice.
Remember to feed frequently… it’s so important and test daily for those ketones.
 
The vet says he is eating small amounts and frequently. Is it ok to give him food as often as he wants? I need to write a list! I have very bad menopause brain!! I am on my way out to buy the monitor you suggested at the chemist and some high carb food for Hypo emergency. Then pick up time! Thank you once again for all your advice. I think I will be glued to this wonderful forum for sometime.
 
Kindagot said:
The vet says he is eating small amounts and frequently. Is it ok to give him food as often as he wants? I need to write a list! I have very bad menopause brain!! I am on my way out to buy the monitor you suggested at the chemist and some high carb food for Hypo emergency. Then pick up time! Thank you once again for all your advice. I think I will be glued to this wonderful forum for sometime.
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Look at post 6 in this thread. That tells you all you need to do.
Yes you can feed when he asks. He needs to eat 1 and a 1/2 times his normal amount of food every day at the moment. This will help keep the ketones away.
Just don’t feed the 2 hours before the preshot BG as we don’t want that test influenced by food.

***if when you test the preshot number, it is under 200………stall, dont feed and post and ask for help. Then test again 20 minutes later to see if the BG is rising. We don’t want you skipping any doses of insulin but we need to make sure it is safe to give the dose.
Make sure you get several cans of the higher carb food as sometimes, if the BG isn’t high enough to give the dose, we suggest giving some higher carb food to bring the BG up so the dose can be given……..this is only done with kitties that have had DKA and we need to make sure that the insulin can be given… so anyone else looking at this post…this is not for you, so please do not copy.
You may also want to get a variety of low carb cans as well in case he is not interested in his usual foods.

Please let us know what type of insulin you are giving and the dose

I am going to tag @Bandit's Mom to help you set up the spreadsheet and signature as we need them up and running to help you with dosing etc.she will be in contact.
 
Bron and Sheba (GA) said:
Look at post 6 in this thread. That tells you all you need to do.
Yes you can feed when he asks. He needs to eat 1 and a 1/2 times his normal amount of food every day at the moment. This will help keep the ketones away.
Just don’t feed the 2 hours before the preshot BG as we don’t want that test influenced by food.

***if when you test the preshot number, it is under 200………stall, dont feed and post and ask for help. Then test again 20 minutes later to see if the BG is rising. We don’t want you skipping any doses of insulin but we need to make sure it is safe to give the dose.
Make sure you get several cans of the higher carb food as sometimes, if the BG isn’t high enough to give the dose, we suggest giving some higher carb food to bring the BG up so the dose can be given……..this is only done with kitties that have had DKA and we need to make sure that the insulin can be given… so anyone else looking at this post…this is not for you, so please do not copy.
You may also want to get a variety of low carb cans as well in case he is not interested in his usual foods.

Please let us know what type of insulin you are giving and the dose

I am going to tag @Bandit's Mom to help you set up the spreadsheet and signature as we need them up and running to help you with dosing etc.she will be in contact.
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Thank you! I was just looking for that. Glargine is being used, not sure of dose until he is discharged.

He will still have O tube for feeding if needed.
 
Kindagot said:
Thank you! I was just looking for that. Glargine is being used, not sure of dose until he is discharged.

He will still have O tube for feeding if needed.
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Great he is on a glargine…same as Lantus. Looks like they have had him on that so there shouldn’t be any issues with the depot having been filled already.
That’s is also good they have left in the feeding tube….sounds like they have done a great job with Benny.
Looking forward to seeing a photo of him at home. billy will be pleased! Although he could hiss and be a bit funny in the beginning because of the different smells on Benny.
Don’t forget to ask about the congestive heart failure….if it’s still an issue.
 
Benny home.jpeg
He is home! Insulin due in 4 hours, tube feed in 3 hours. Water through tube in an hour. And test test test using the scanner!!! I think I feel confident. Thank you all for the help.
 

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Kindagot said:
View attachment 63014He is home! Insulin due in 4 hours, tube feed in 3 hours. Water through tube in an hour. And test test test using the scanner!!! I think I feel confident. Thank you all for the help.
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He is gorgeous. Must be happy to be home.
How did Billy react?
What is the dose of insulin?
what food are you feeding through the tube?
Is he eating on his own at all?
It’s best not to feed within 2 hours of the preshot BG as we don’t want the BG to be food influenced. Can you move the feeding forward a bit?
 
Just had a massive purry cuddle.
Billy, lots of sniffing and has stopped meowing (he was doing this pretty much all the time unless being cuddled)
1.5 units
Hills A/D
Yes, Vet said to let him have his Proplan renal as he has been eating this plus liquid treats. She said we will adjust diet as he recovers.
He was fed at 3pm so I could feed him at 6.30pm and do the shot at 9pm?
 
Kindagot said:
He was fed at 3pm so I could feed him at 6.30pm and do the shot at 9pm?
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Yes that would work.
How often is he being fed via the tube?
Is he also other food on his own inbetween?


Kindagot said:
Vet said to let him have his Proplan renal as he has been eating this plus liquid treats. She said we will adjust diet as he recovers.
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Yes I agree with that. It is more important he eats what he will eat, at the moment, than eating low carb food. That can be adjusted a bit further down the track when there haven’t been any ketones showing for a couple of weeks.
Don’t forget to get those ketones tests done.

When you get the preshot, can you post it before you give the dose so we can see the BG is high enough to shoot please?
I’m hoping @Bandit's Mom sill be online soon so she can help get the SS and signature set up for you.
 
Thank you @Bandit's Mom and @Bron and Sheba (GA) I have just done BG tube feed BG and my first Insulin shot ( where is the valium? lol) that was terrifying. I hope I got it right. 1.5 is such a tiny dose it is hard to see. The libre device does not measure above 375. It just say high. I have looked at the graph on Benny's scanner and it looks like this is the pattern since Wednesday is High most of the time but dipping mid afternoon to 150/160.
 
Well done! It’s a bit scary the first time. Now you will be fine!
I’m surprised it’s only eating to 375. They usually read higher than that before saying high.
I would check the reading every 2 hours to see when it comes down and put it into the SS.
Put the PMPS reading into the PMPS column of the SS.
Do you think you could add the information from the graph at the vets to the SS? It would be valuable data.
I would also offer some food or snacks every couple of hours. Remember it’s important he is eating 1 and a half time as much as he usually eats.
 
@Kindagot how are things going today.
How is Benny eating? Is he eating anything on his own?
I noticed you increased the dose of insulin this morning to 2 units. Did the vet suggest that?
Have you tested yet for ketones?
Bron
 
@Bron and Sheba (GA) thank you for asking after him! He is doing ok. He is eating minimal kibble but eats 20ml of the 60ml feed for his tube himself. He is drinking well. He is urinating quite large amounts (fluid intake 250ml a day) . His blood sugar did not comedown overnight at all. I have worked out there is an app and i my using my phone to scan him hourly. I phoned the vets at 6am this morning and they said to up his dose to 2 units (from 1.5). I am watching very carefully for any precipitous drop in BG and completing his spreadsheet. He had a hypo episode in ICU on Wednesday after having 2 units Glargine and an additional SM inj 1 uint, so I want to be ultra careful! It is very comforting to know that you are looking out for him. I am waiting for ketones sticks to be delivered but having looked at all the info on here about DKA I will pop out to get some today. (The queue at the chemist warehouse yesterday was long as we are still in lockdown) The good news is, that he did not have ketones in his urine or serum at the Vets yesterday, in fact he only ever showed traces in his serum of 0.1-0.8 and that was on Tuesday, there does not seem yo have been any in his urine at all since the vets started testing. I will start testing.
Billy hissed at him twice last night and is very wary of him. I am smearing Benny with Billy's saliva though!
 
Kindagot said:
@Bron and Sheba (GA) thank you for asking after him! He is doing ok. He is eating minimal kibble but eats 20ml of the 60ml feed for his tube himself. He is drinking well. He is urinating quite large amounts (fluid intake 250ml a day) . His blood sugar did not comedown overnight at all. I have worked out there is an app and i my using my phone to scan him hourly. I phoned the vets at 6am this morning and they said to up his dose to 2 units (from 1.5). I am watching very carefully for any precipitous drop in BG and completing his spreadsheet. He had a hypo episode in ICU on Wednesday after having 2 units Glargine and an additional SM inj 1 uint, so I want to be ultra careful! It is very comforting to know that you are looking out for him. I am waiting for ketones sticks to be delivered but having looked at all the info on here about DKA I will pop out to get some today. (The queue at the chemist warehouse yesterday was long as we are still in lockdown) The good news is, that he did not have ketones in his urine or serum at the Vets yesterday, in fact he only ever showed traces in his serum of 0.1-0.8 and that was on Tuesday, there does not seem yo have been any in his urine at all since the vets started testing. I will start testing.
Billy hissed at him twice last night and is very wary of him. I am smearing Benny with Billy's saliva though!
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Good you hear Benny is doing OK amd eating some himself.
Did they give you any antinausea medications?
Is Benny up walking around and seeming pretty normal? ie not lethargic?
That is good he hasn’t been showing ketones any more at the vet.

With the SS you need to put the preshot BG into the column that says AMPS (am preshot) or PMPS (pm preshot). At the moment I think you have it in the +1 column of the US version of the SS. It looks as if you have it right in the world SS version. Does that make sense?
Was the +1 BG the same as the preshot number and was the +3 14.4?
I might ask @Bandit's Mom to just check on the SS to see it is all OK.
 
@Bron and Sheba (GA) He is far from normal unfortunately. He is very tired. He is ok to get to his litter box, get down the stairs just the basics really. They said he will be very tired because he has been kept awake a lot in hospital. There is general improvement every day though and so as long as we are going forwards (!). I have been reading his clinical notes from ICU. They are grim, at one point after his GA he had to be intubated again and did not move his head for 5 hours. He has anti nausea tablet x 2 daily. Also still on ABX so bound to feel queasy from that. I have to feed him 4 times daily and do water in between. I am thinking as he has his shots at 9am and 9pm that 5am, 8.30am, 3pm , 8.30am are going to be the best I can space it out. Does this sound like a good schedule?
I edited the SS
 
Remember we don’t want him eating in the 2 hours before his insulin doses. Can you work around that?
Also if you can get him to eat any extra that would be good.
Poor baby has been through a lot.

I’m glad he is getting antinausea meds and is having an antibiotic. .. very important.

Are you able and happy to post the notes from the vet?

thanks fir fixing up the SS. He’s responding well to the insulin, although they are big hourly drops. He could keep going down for a couple more hours. I’d check him 1/2 hours until nadir ( lowest point)
 
@Kindagot Fiona, are you giving one of the tube feeds immediately before you give the insulin? If not this is what you need to be doing. I think he needs to be getting some more food in the first half of the cycle to try and stop those big drops.
Can you ring and ask the vets if you can give an extra feeding at +3 each cycle to try and stop the big drops?
Did you see my note above about testing again in 30 minutes to see he’s not dropping too low.?
 
@Bron and Sheba (GA) that's funny! Exactly what I thought and immediately brought forward feeding. I have just finished giving him a tube feed. He wasn't interested when I offered food. I was told to feed immediately before insulin. This does make it difficult spreading feeds out as they are 9am and 9pm doses. I will check with vet about smaller more often feedings.
I have reviewed the scanner and it seems that he is dipping down to 8/9m/mmol at 3pm and at 3am, however, he has only just been increased to full calories. He is going in for a review and also another echo on heart on Thursday.
So, 0 feed, +3 feed, + 8 feed ,0 feed +3 feed +8 feed ? Does that sound a bit better for a schedule?
 
Kindagot said:
I have just tested 6.4 m/mol . What do you think? Test every 15 minutes?
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Yes at the moment as we don’t want him to drop too much. He’s quite safe at the moment.
Well done bringing forward the feed!
Did you read my PM I sent you?


Kindagot said:
So, 0 feed, +3 feed, + 8 feed ,0 feed +3 feed +8 feed ? Does that sound a bit better for a schedule?
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He really needs another feed in there around +6. Talk to the vet about adding more calories. He needs 1 and a half times as many calories as he normally gets at the moment.
 
tiffmaxee said:
Bron asked me to check in on you while she is out. What an intro to FD for you.
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@tiffmaxee Thank you! Hectic. It is so hard. I haven't slept for 32hours apart from catnaps! Benny is snoring away. Luckiy he has this Libre patch so I can just wave the scanner at him and he is blissfully unaware. You are all such a kind bunch of people.
 
Screenshot_20211122-150116.jpg
This is the graph from the App. I am hoping that the feed I brought forward will keep him at this level until another feed in 2 hours?
 

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Kindagot said:
View attachment 63017This is the graph from the App. I am hoping that the feed I brought forward will keep him at this level until another feed in 2 hours?
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You can see how by giving some food it makes a difference to how the BG drops. That’s why I would like you to ask the vet if you can add another feeding in each cycle. Not to divide the feeds up more but to add more calories so he can get the insulin he needs. If he was eating more on his own we could do it that way, but he’s not yet.
You are doing for a great job!
I’m heading out now but Elise will keep an eye out for you.
 
Every so often we see a low number with the Libre that doesn’t make sense. Do you have a meter to double check with an ear prick should that happen?
 
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