amps415+4,515 I don't know what to do for Toonces now.

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Janet

Member Since 2014
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I don't know what to do for Toonces anymore. She's been under the bed since getting home from the vets yesterday. She is still eating well and drinking lots of water (I put it under the bed with her). It's been three days since an increase so I am going to increase her to 4.5 tonight at her 9:15 pm shot. Should I be increasing her faster?

Janet
 
Hi Janet,
I hope that Toonces will be feeling better soon. I'm sorry not to be able to help you with the ketones, dosecrease, etc., but wanted to bump your post up to the top of the list to get more experienced eyes on it.
I believe that hiding is a sign that a cat is not feeling well, but at least Toonces is eating and drinking. Keep a close watch on her.

Sending lots of healing vines Toonces' way,

Ella & Rusty
 
Just sending hugs and scritches and another bounce up. Healing takes time , I hope Toonces will feel better soon.

on your double post, first you need to delete the reply you added, posts that have been replied to cannot be deleted until the replies are gone. there is an "x" button next to the edit button. Then you can delete the first post. or you can just leave it and let it slide down the list.
 
First of all I want to point out you have addressed 2 of the 3 factors that contribute to the development of ketones - calories and infection -
Toonces is eating (& drinking) well and has been given an antibiotic to address the UTI that was detected.

Now the focus is getting enough insulin to ward off the development of ketones.

Testing for ketones is essential. Have you purchased Ketostix? If not get some today and sooner rather than later.

I see you are testing BGs frequently during the AM cycle, however the PM cycle lacks data.
PM cycle monitoring is essential. You will need to come up with a strategy to accomplish this.

Many set alarms to test during the night. I worked from home and my office is in a building separate from our house, which is where BK lives. Many were the nights I slept on a small futon in my office with BK so that I could monitor.

Toonces needs more insulin, possibly the occasional bolus with R, a powerful fast acting insulin that should not be used without the guidance of an experienced user. It's available without a prescription in most states, from the pharmacist. We purchased it at out local Rite-Aid and at the time it was $35.00.
There are experienced users here and we can guide you in the use of R, if you are able to monitor closely.

I don't see a profile for Toonces. Is there a post here or on the Health board with the back story. The more history we can see the better we can help.

I'll be looking for your response, I'm home until this evening.
Please note - my responses take some time - I am a lousy typist (and a person with Parkinsons).
 
sandy, i put her profile in my signature...I don't know how to name it but will figure that out later. Other than take her back to the vet for another iv and another huge bill, what would i do if there are ketones in her urine again? They were there yesterday at the vets but after her iv just as a trace.
 
Janet said:
Other than take her back to the vet for another iv and another huge bill, what would i do if there are ketones in her urine again? They were there yesterday at the vets but after her iv just as a trace.
Click to expand...
Thanks for linking the profile - it helps those who are willing to help get a fuller picture. Don't worry about naming it right now - someone will be able to help with that later.

We recommend a trip to the vet/ER for any reading higher than trace.

:?: Do you have Ketostix to test Toonces urine?
Ketones can develop to a critical stage very quickly

In one instance, June 22-23 2008, Black Kitty went from, negative ketones to large in exactly 24 hours (testing his urine with Ketostix).

The importance of vigilance can't be overstated.


If it reads trace amounts of ketones, we can guide you in the use of R to supplement the Lantus so that Toonces can safely get enough insulin to stop the production of ketones.
 

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I have a couple of additional thoughts.\

First, ask your vet for a prescription for fluids and all of the paraphernalia that go along with giving fluids. Marje can help you with where to order the materials from and she has a video on how to give fluids. There's no need to take Toonces to the vet for fluids if they are charging you an arm and a leg to do something you can do at home.

You may want to invest in a ketone meter. This is just like a BG meter -- in fact it tests for glucose and ketones. There are different (and more expensive) strips for testing ketones. You can get a free meter from Novamax although it can take a while for the meter to be delivered. The meters are also available through American Diabetes Wholesale and you'll get it a whole lot quicker. Just make sure you order the right meter. It also looks like the meters are available through a number of retail outlets. (The strips will be a lot cheaper if you buy they online, though.)

Chances are that you need to give the antibiotic that the vet gave Toonces some time to work. Once the AB kicks in, there's a very good chance that the numbers will come down. This usually takes more than one day. Is there any remote chance that the vet took a urine sample using a needle into Toonces bladder? (It's called a "cystocentesis.") The urine is then cultured for a few days to see what kind of bacteria grows. As a result of the culture, the vet would know which antibiotic the bacteria is sensitive too. (This is called a C & S - "culture and sensitivity.") It's really the best way to know if the proper antibiotic was selected to deal with the infection.
 
Get the vet to write a scrip for 12 bags of fluids, which is one case with refills. Then you can take it to any pharmacy and using a pet medical discount card:
http://www.petmedicationcard.com/


To get an estimate on how much a medicine costs at your local pharmacies, you can use this web site: http://www.easydrugcard.com/drugpricing.html

With the pet discount card, one case of fluids, is the same cost as 1 bag - so better to get a case and have it on hand.... I got a case of Lactated Ringers brand fluids for $20 from my local food store pharmacy.

To get the needles and lines, this is the least expensive place to order it online and no scrip needed -

Lines:

http://www.thrivingpets.com/index.php/i ... ee-72.html

Needles:

http://www.thrivingpets.com/index.php/t ... f-100.html

This place doesn’t require a prescription for the supplies (unlike some other places) and BONUS – is one of the cheapest places I found.


What you may want to do, is get some needles and one line from the vet (so you have it immediately) and then order online. I used one line for every two bags of fluids.
 
hi janet!

Here are 2 options for dose increases:

from the modified guidelines on the "Tight Regulation Protocol" yellow starred sticky:

Increasing the dose:
Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing.
when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing.
After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.

After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.
Click to expand...

from the Tilly's Diabetes Homepage that our modifications are based upon:

Phase 2: Increasing the dose

Most cats need to have their dose increased. Do it in 0.25 IU or 0.5 IU steps (0.25 IU if the cat is getting a low dose and/or relatively low BGs, 0.5 IU if the cat is getting a higher dose and/or relatively high BGs). Hold each dose for 5-7 days.

However, if the cat is producing continuously high BGs (nadir always >=300 mg/dl), only hold the dose for 2-3 days before increasing it by 0.5 IU.

Alternatively, if the cat is continuously producing moderately elevated BGs (nadir always >=200 mg/dl), increase the dose every 2-3 days by 0.25 IU ( if the cat is getting a low dose) or 0.5 IU (if the cat is getting a higher dose).

From this point onward test for ketones once per week, or more often if the nadirs are still >=200 mg/dl.
Click to expand...

In your situation, with Toonces having a history of ketones and now showing trace ketones, it's important to get enough insulin into her. I would increase the dose every 4 cycles (2 days) by 0.5u until you are seeing nadirs under 300 and the overall range is better.

If you want to learn how to use R, please say so. Several of us have experience with it and can guide you. i used it with punkin. it is just one more tool in our toolbox of how to help our cats.

one of us would check in with you every hour after you give it. it requires the injection being given at a time so that the nadirs of the Lantus and the R don't coincide, and it requires about 4-5 hours of monitoring once per hour following the shot. You need to be able to give a very tiny dose - 0.1u, one tenth of one unit, with your syringes. there are pictures of tiny doses in the New to the Group sticky at the top of this forum. Holler if you can't find them. You can practice with a syringe and some colored water, tea, etc, so you can see it. You want to be able to draw up 1unit of fluid and squeeze 10 drops out of it. It's a stronger insulin that pulls the blood sugar down more quickly than the Lantus would, and it's out of the body in around 4 hrs, depending on the cat.

Let us know if you want to do that and we can give you more directions.

Be hopeful - if she's eating we just need to address the insulin issue. :YMHUG:
 
i meant to add that i would be checking frquently for ketones. the blood meters are a great idea because they show up more quickly in blood than in the urine. you want to catch it early and take care of them. the fluids are one thing you can do at home that helps address ketones, too.
 
Hi Janet and Toonces!

I can't give you any advice, but I can offer you good vibes.

Good Vibes! Good Vibes! Good Vibes! Good Vibes! Good Vibes!

Hang in there, you are not alone in your challenges! We are all pulling for Toonces.

Rebekah and Ole
 
I'm completely overwhelmed right now. I watched the vet tech put the iv in Toonces and she had a hard time getting the needle in. I also would not feel comfortable at all trying the additional r insulin. Toonces is still drinking and eating and I am adding warm water to her food. The iv she had at the vets was a 24 hr drip...maybe she could get an 8 hr drip so it would be a day visit instead of an overnight stay. I will call him tomorrow. I will set the alarm and check her at 3 am I can check her again when I get up at 6am. I,m praying that the antibiotic and the 1/2 unit increase will work...I will continue to increase every 2 days if her Nadirs are not below 300.

Thank you for all your help.
 
Janet --

There's a difference between an IV (i.e,. intravenous) drip and fluids that we're talking about. The way people administer fluids at home are by subcutaneous fluids. You would poke Toonces with a needle -- in a similar way to how you give insulin -- and the fluids go under the skin, not into a vein. It doesn't require the precision of sticking a needle into a vessel. It also goes a WHOLE lot faster. For some reason, I don't have Marje's video on how to give fluids bookmarked. I'll see if someone can stop by and provide it for you so you can look to see what it is I'm talking about.

Frankly, none of the folks here would give fluids if it had to be IV fluids.
 
Oh,thank you for clarifying that Sienne, I was feeling like such a wimp for not being able to do an iv.
 
that's not being a wimp, janet! i wouldn't do it either. can't even imagine trying! *shudder*

that's fine if you don't want to try the R. just know that it is an option if you want to try it. it's just a different insulin, nothing to be afraid of.

sometimes stress comes from feeling you haven't got any control. checking for ketones frequently will help reassure you that she's doing ok in the ketone department.

getting fluids into her will help you have confidence that you're keeping her hydrated, which helps prevent ketones. btw, your vet will do this for probably $15 if you want them to do it instead. my cousin took her cat twice a week to get subq fluids for 6 years when she began to have kidney failure. i kept telling her she could do it at home, but she was more comfortable with that. nothing wrong with it.

increasing the dose per schedule will get her to the right range as soon as possible.

beyond that, have a glass of wine and try to not worry too much.
 
On New Year's Eve 2011, Zener told me "more petting, less worry". :-D Giving subcutaneous fluids is not all that difficult (especially with Marje's video) but it's not all that pleasant either. :roll: :lol: The cat ends up with a hump of fluids around the shoulders that gets absorbed in the body over the next day or so. And it can be very helpful for the cat to feel better and for fighting ketones. We've done it at home a few times but are always glad to have the vet tech do it. :lol: :lol:
Liz
 
Janet

While it is a little nerve wracking at first (and I recommend you have someone help you the first few times), with time it gets easier. Just be confidant.

You can buy the Lactated ringers solution at Walgreens .....a case of 12 is about $23 with a $20/year pharmacy card. As Hiliary said, the best place to get lines and 21g needles is thrivingpets.com.

Please let me know if you have questions or need help.
 
Hi Janet,

I'm completely new to this FDMB board but I have a whole lotta experience with giving at home sub-q fluids. It's very simple to do so and it sounds like it can really help Tounces get rid of those ketones faster.

I also wanted to say that should you decide to give Tounces fluids yourself that you can buy the lactated ringers at Costco without being a member, but you do need your vet to call in the prescription. Also, the pharmacy at Costco does not always have them in stock so if you are even THINKING about giving fluids, I'd call your vet and have them send the prescription to Costco now. I think it costs like $25.00 for a case of 12 bags of lactated ringers. Your vet will charge you something like $15.00 for one bag of fluids, plus they'll charge you more money for needles and the "set-up" than what you could buy them for online, with your vet's prescription.

As for 'drip lines' and needles, I've always used www.thrivingpets.com. I don't know, maybe other folks here know of an online pharmacy where you can get them for less money but their prices are pretty good. You don't want to buy fluids from them though because you'd need to pay the shipping fee and it would be expensive. A case of fluids weighs a lot.

http://www.thrivingpets.com/index.php/s ... -sets.html

Whatever you decide, it sounds like you do need to get more fluids into Tounces ASAP if you don't want her to do a long hospital stay for ketones due to dehydration. Having dealt with dehydration issues before with a kitty who had CKD and another one with pancreatitis, if they are constantly thirsty and truly dehydrated you cannot make up for it by trying to get them to drink more water.

From her most recent vet visit, it sounds like Tounces is already dehydrate and won't be able to make up for it by only drinking water.

I would buy a bag of fluids from the vet, the drip-line, and the needles for now and then have him call in a prescription to the pharmacies of your choice. I'm not a vet but it sounds like you nee to start giving her fluids ASAP to get rid of those ketones.

Tounces needs the fluids. You'll either have to give them yourself or get her completely rehydrate at the vet.
 
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