A week in ICU

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Human. I am not sure you can get Pet one in New Zealand. Supplies are a real problem at the moment.
 
Pretty flat. That’s good. I agree with Bron that you should ask your vet about a meal at +6. He needs the calories and small meals more often help regulate the bg.
 
Ok. He is being tube fed so I gave him some Dine chicken pate, 20ml so only about 25kcal and a smear of honey on his gums as he hit 3.9. Back up to 5.1 now.
Vet said she will call me back regarding what to do. I'm not sure upping him from 1.5 to 2 units this morning was a good idea. He had a symptomatic Hypo last week in hospital on his 4th day of insulin.
 
After a symptomatic hypo they can be more sensitive to insulin. Has he lost a lot of weight? He needs enough calories to handle the insulin he needs.
 
His numbers are all over the place , he went back up ti 5.1 after the dIne. vet said to give him half feed. Just finished that and he he is now 2.3. What do I do?
 
I have given honey and spoken to Vet . Will feed 1/2 portion of tube feed again in 30 mins. We have set a plan for insulin dose tonight within BG parameters.
 
Feed him, she said clinically he sounds ok. He has just had poop. Lying down, trying to sleep. I had to give the honey diluted in water (30ml) through his tube so I am just letting his tummy settle a little and then will feed some more. Do you think I should maybe blend some Fancy Feast beef in gravy (15 carbs) instead of the prescription A/D diet can?
 
AD is not a diet food. I don’t recall the carbs in it. Do you know? It’s more calories than fancy feast though. I’d add a few drops of honey to the AD.

AD is 13,2 carbs. So add honey.
 
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Thank you that sounds good idea. I am terrified. The vet seemed quite laid back about it. He symptomatic hypo last week was spotted because he was lethargic. He's a cat. He's 15. He's just spent a week in hospital and wants to sleep. I am finding the decision making overwhelming. Thank you do much for being there for us!
 
It’s scary I know. I always feed every 20-30 minutes, just a small amount when under 50. Benny was at 40 (2.3) the last test. I understood the timed feedings but not when he’s under 40 or hovering in the 50’s.
 
Have you scanned again? I just saw the 54. Give a little more food and scan in 30. Are you doing ok?
 
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The Vet said in 2.5 hours after his next full feed to check BG. Over 20 give 1.5u between 10-20 give 1.0u and under 10 to wait an hour test again then call them if still under 10.
 
The problem with that is the vet is dosing based upon the pmps. Lantus is dosed based upon the nadir, how low it takes the cat. To get enoug insulin into Benny he is going to need lots of calories and carbs until out of the woods. See what Bron thinks as to dosing. She really is knowledgeable about treating DKA.
 
Hi, I’m back. Looks like Benny has had you both on your toes.
That must have been scary for you Fiona. Looks like he is back over 50 now so that’s good.

Kindagot said:
The Vet said in 2.5 hours after his next full feed to check BG. Over 20 give 1.5u between 10-20 give 1.0u and under 10 to wait an hour test again then call them if still under 10.
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What are you up to now? Is it +9?
I am concerned that the vet said “in 2.5 hours after his next full feed to check the BG……..Benny needs to have not eaten for 2 hours before the preshot BG so the BG is not food influenced. To feed, then test is not the correct and safe way to do it. It order is always test, feed then shoot in that order.
Benny really needs to be having regular and closer together feeds via the tube so that he doesn’t have the drops he had today. The feeds don’t have to all be the AD. He can have them as prescribed and then have other food via the tube in between.
 
Yes I agree with you both. Perhaps i got muddled about the feeding then testing? I am extremely sleep deprived. We are +9.5 So shall I test him when he is due for shot , give him his last feed of the day and then if his BG is over 375 l give him a unit? I was just reading https://www.aaha.org/globalassets/02-guidelines/diabetes/diabetes-guidelines_final.pdf an dit suggests for the PM shot that if a cat has gone below 175 at all during the day the dose should be reduced by 50%.
 
tiffmaxee said:
The problem with that is the vet is dosing based upon the pmps. Lantus is dosed based upon the nadir, how low it takes the cat. To get enoug insulin into Benny he is going to need lots of calories and carbs until out of the woods. See what Bron thinks as to dosing. She really is knowledgeable about treating DKA.
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I agree with Elise. Benny is going to need a lot more food /calories each day than he is getting so that he can get the amount of insulin he needs to combat ketones.

Ketones form when there is not enough insulin, not enough food and an infection or inflammation. And ketones if not treated early progress to DKA.
So to treat ketones and DKA you have to make sure there is enough food, enough insulin and the infection or inflammation is being treated.
Benny earned a reduction in dose when he went under 2.8 (48).
If he is high enough I think he would be best to go back to the 1.5 dose.
What I would do is not feed for the 2 hours before the dose is due….get the feed in before that. Then see if he is high enough to shoot. If he is not we can stall, dont feed and see if he is coming up on his own.
what do you think of that plan?
 
Kindagot said:
Yes I agree with you both. Perhaps i got muddled about the feeding then testing? I am extremely sleep deprived. We are +9.5 So shall I test him when he is due for shot , give him his last feed of the day and then if his BG is over 375 l give him a unit? I was just reading https://www.aaha.org/globalassets/02-guidelines/diabetes/diabetes-guidelines_final.pdf an dit suggests for the PM shot that if a cat has gone below 175 at all during the day the dose should be reduced by 50%.
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That is not a very recent document and I have never heard of reducing the dose by 50%if the cat goes under 175.

You must be very tired…that concerns me ….as Benny will probably need monitoring during this coming cycle.
Is there anyone who can help you or keep an eye on him while you get a couple of hours sleep at some point?
It is very hard making decisions when you are exhausted.
 
He us at 11.1 now. I can keep going until his shot. His shot is due in 2hr15. So I will test, feed and test again and see what you guys think ? I can sleep for 90 minutes now. I can then just go back to baby days of 2 hour feeds! My husband will help.
 
Kindagot said:
He us at 11.1 now. I can keep going until his shot. His shot is due in 2hr15. So I will test, feed and test again and see what you guys think ? I can sleep for 90 minutes now. I can then just go back to baby days of 2 hour feeds! My husband will help.
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11.1 Looks like he might bounce from the low numbers…..this is common so don’t worry if he does. Very normal.
You need to test and then post and let us know what the BG is….don’t feed until we tell you though.
Good idea to have a sleep now.
It will see you in2 hours 15.
I’m going to tag @Bandit's Mom and ask her if she will fill in the lower BGs on the SS. We need to see those as well. They can be added by doubling up in the squares but I don’t want you to worry about that at the moment…go and get that sleep.
 
Can p
Bron and Sheba (GA) said:
Are you willing and able to monitor him the whole cycle if necessary?
And to give extra feeding during the cycle so he doesn’t drop so fast and so much.?
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I could but I think Benny could do with a good 8 hours sleep overnight. He is fed up. Feeding by tube, constant fiddling with him. I want to feed him and then rest for 5/6 hours.
 
Kindagot said:
Can p

I could but I think Benny could do with a good 8 hours sleep overnight. He is fed up. Feeding by tube, constant fiddling with him. I want to feed him and then rest for 5/6 hours.
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I think no matter what dose you give, you are going to have to get up and monitor him because the depot plays a part in the following dose even if you reduced the dose.
And you are going to have to give him some extra feeds apart from what the vet says. They are simple not enough. You can’t just leave him for 5 to 6 hours at this point.
I would rather see you give the 1.5 units but if you think you won’t be able to monitor closely you could give 1.25 units….that is 1/2 way between the 1 unit and the 1.5 unit mark….you need to eye ball it. Do you have a magnifying glass?
What do you think.?

I don’t suppose you got the Ketostix today and got a test for ketones.
 
No Ketone stix. I couldn't leave him to get them. They should arrive tomorrow. Ok I will go for 1.25 and monitor every 2 hours for the night. I will feed as necessary. What level should I be feeding him at? The first 25% drop?
 
Kindagot said:
No Ketone stix. I couldn't leave him to get them. They should arrive tomorrow. Ok I will go for 1.25 and monitor every 2 hours for the night. I will feed as necessary. What level should I be feeding him at? The first 25% drop?
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I would feed him a small snack every 2 hours. We can talk about amount after.
Are you sure you will wake up each time?
Can someone else help you?
If it starts dropping you will have to monitor more frequently. I want you to be comfortable with what you decide to do
 
I have given him 1.25u he was at 22.4 , 15 minutes after his feed. I will wake up. I will set alarm for every 2 hours. I didn't sleep at all last night but as long as I am dozing I will be ok. Thank you. I will update in morning. I will aim to feed again in 4 hours and give snack however, this would not be sustainable, in the hospital his BG was measured every 3 hours more if necessary. I want to be able to give the insulin he needs and 4/5 feeds a day hoping that as he regains his strength he will start eating himself. I think the on duty vet probably discharged him a day or 2 too early. I hope you sleep well in Australia! Thank you again!
 
I think I will need to stay in contact with you for a bit longer tonight just to see how he’s going.
It won’t always be like this. Looking after a DKA kitty when they first come home is very time consuming and exhausting both physically and emotionally.

I would aim to give a snack at +2, +4, +6 and +8 ( including the ADfeeds he has.) I wouldn’t wait 4 hours to give the first snack.
It is better to give the snacks routinely and not as a reaction to a falling BG.
If you give the feeds at those times it will help stop the BG dropping so fast.
The onset of the insulin is usually around +2 so if you give a snack at +2 the insulin has something to work with.
+4 and +6 the BG is dropping towards nadir (lowest point in the cycle) and a snack then helps.

With each of the snacks I would give a couple of teaspoons of ordinary low carb canned food if you can blitz it to go down the tube.
If you find the BGdropping like it did this morning, I would give a little more food.
If you are at all concerned post and ask for help. Change the subject line to gain attention to something like DKA kitty…I need help.
You could also tag bandits mom for probably the next 8 hours and me for the next 3. After that Elise may be back online.

Would you be able to keep the SS up to date as you get the tests scanned. That would be really good if you could.
ThanksBron
 
@Bron are you -2hours on NZ? I will blitz up some food for the tube now so it's all good to go. The only thing is I do not want to overload him on fluid and every time I feed through the hole it is 20ml flushes.
 
Kindagot said:
@Bron are you -2hours on NZ? I will blitz up some food for the tube now so it's all good to go. The only thing is I do not want to overload him on fluid and every time I feed through the hole it is 20ml flushes.
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Yes I am 2 hours behind you. It’s just coming to 8.30 pm here.
Maybe if you are giving extra feeds reduce the water to 15 mls each time. Would that work ?
 
Kindagot said:
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I would say he is bouncing from. the low numbers this morning. Bouncing happens when the BG drops too fast, too low or lower than the cat is used to. The body then panics and dumps regulatory hormones and stored glucose into the system to “save itself”. Bounces can last from 1 to 6 cycles and there is nothing you can do but wait them out. Bouncing is very common is newly diagnosed cats so don’t worry.
Were you able to give him a snack via the tube?
 
No , as it was showing High I thought I would wait until I had word from you. My inclination is to leave him be for am hour as stress does not help the high BG. I will definitely keep monitoring him overnight and will feed at +5/6 regardless. I have been going through his notes and it seems he was getting 6 hourly feeds in hospital. So 1/4 RER every 6 hours reduced if he ate kibble. (which he was but he has not since +8 on his shot last night.) I think stress is playing a part. Billy is very wary and Benny is too vulnerable at the moment.
 
I would still give him some extra snacks even if his BG is higher because it’s important that he gets enough food into him. Just normal low carb snacks. If you’ve missed the +2 one I would give one at +3, then his usual AD at +5/6.
 
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