Animal hospital closed and need advice

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ReesesMommy

ReesesMommy

Member Since 2017
Reese has been doing pretty well since he's been diagnosed almost 2 weeks ago (up until this point).

Last night he decided he didn't want to eat even though I tried everything I could think of to coax him. The window for his insulin had passed so this is the first time he's skipped a dose. Throughout the night he was asking for food so I gave him a little snack but he really didn't eat all that much.

This morning I tried again to get him to eat and he had his treats (with his hyperthyroidism pill felimazole) and some of his old canned food (I'm trying to transition him off royal canin urinary s/o kibble which he's been on most of his life, to the vet suggested purina dm, he's 75% new food and 25% old food now then get him on the canned version) but again it wasn't enough to be able to give him his injection.

Now I'm getting quite panicky what to do since the animal hospital isn't open until tomorrow. Is it really bad that he's now missed 2 injections? I usually give them while he eats, 7am and 7pm :nailbiting: He also has thrown up today and I'm wondering if he's not feeling well because of the antibiotic he's on. Both my other cat and dog have been on it and have also had trouble with keeping it down. Or it could be the transitioning to the new food.

Kinda going out of my mind because I'm constantly monitoring his behaviour and I only just remembered to eat my own food now. I'm paranoid I'm going to do something wrong or make the wrong decision.

Thanks for reading,

Rachel and Reese
 
Do you test his BG levels? Skipping two doses in a row seems a lot. If he's still eating quite a bit of RC s/o he's getting high carb food in him. How much is a shot? Could you maybe give him half a shot? Even if he's not eating well he still needs insulin. If he was asking for food it would be good to feed him (don't worry so much about the when, but about the how much -- most important is to get food in the cat).

Here's a thread on the "no food, no insulin" advice that is generally not good: http://www.felinediabetes.com/FDMB/threads/some-bad-advice-for-newbies.9070/
 
You could try other foods. The foods that vet's recommend are too high in carbs. Vets get most of their education from the representatives of pet foods and drug manufacturers. Supermarket foods like Fancy Feast classic, Friskies pate, Sheba pate or even 9 lives are just fine. Read the ingredients. You do not wheat. corn, or other grains. We have a database by Dr. Lisa, a vet. that is wonderful. You can email a link to your vet. You can just tell the vet that the food you choose is lower in carbs the n what he recommended.

It's not the end of the world if you miss an injection or two. Many of us will give a reduced dose. Perhaps half of usual dose.
 
No I haven't been taught how to test yet. I have such a phobia of all things medical (I get severe panic attacks)that my vet thought it was best to get comfortable with injections first.

Yes I'm so worried now that he shouldn't have skipped 2. He gets 2 units twice a day of Lantus. So I should try to feed him some more urinary so canned? Do I go against what my vet put on the insulin about not changing doses without them?
 
It's better to reduce the dose when your kitty doesn't eat. 2 units in a big dose to start with. I would feel better with 1, or even 1/2 unit, especially since you are not testing. You can find videos on YouTube showing how to do it. Just have treats on hand as a reward. We also have videos on the board. I just can't make a link with my phone.
 
He had a spoonful of his old canned food just now, how much of it should I aim to get him to eat? Then still give him his insulin at 7pm? Everything is so confusing :banghead:
 
FWIW DM is decent for a diabetic cat. Quintus was on Purina NF (for kidney failure) and I'm stuck in the middle of transitioning him to DM paté. I mix up his kibble with the paté.

Do you know why he is not eating? if it's because he doesn't want to eat the new food, I'd backtrack on the transition. It's better to have a cat eating non-optimal food than not eating optimal (or better) food.

As I see your situation, there are several issues that are worth separating so that it is less confusing:

- what food you are feeding him and going to feed him: the priority is that he must eat. Once he is eating, worry about what he is eating, how to transition off the HC food he is used to, and what LC food you want to switch to or mix in (DM or other veterinary diet, or commercial diets popular here)
- how much insulin to give: this is tricky without data. Understand that insulin is used to bring glucose into the cells so they can function. Even when we don't do anything, we still need some insulin, or our cells starve. In your case it's hard to advise you because we don't know how high his BG is, or how well his pancreas is functioning. Have any tests been done since you started Lantus? Has a curve been done at your vets, and when, and what were the values? What was his initial (diagnostic) glucose level? Has he been on 2ui since the beginning? Answers to these might help. As you're flying blind I would personally halve the dose if he's not eating, which is the guideline my vet had given me initially before I was home testing (it was with vetsulin however)
- home testing: this will give you "eyes" to be able to deal with unforeseen situations like this one, and it will give us data to be able to help you better. It would be really worth trying to do it. Take it easy at the beginning, particularly if it's difficult for you: just collect some numbers and get used to the procedure. Put them in a spreadsheet as you go along. Then when you're comfy with the procedure you can use the numbers as feedback to understand how well he is doing on the dose of insulin he is getting.

Back to today:
- is there no "on call" clinic you can reach to get phone advice from?
- a cat that has not eaten in a day is Not Good, even for a healthy kitty. Get food into this cat, any food, I'd say.
- I'm making a guess from his 2ui of Lantus that his initial levels must be pretty high. I'd give him his dose tonight if I manage to get food in him, or half a dose if I didn't. (Specially as you just skipped two so the depot is partially drained. Even if this dose had become "too high" for him he won't be getting the full effect of it.)

Good to know:
- no food + no insulin (and sometimes just one of those missing) => risk of ketoacidosis, which is a serious condition (and why we're here saying "at least some insulin and food")
- if his BG is (by chance, as we're blind) back to much better levels, his appetite might decrease
- if you've been transitioning him from HC food to LC (like I'm doing) you're going to see BG drop. You say you're on 75% DM, when did you do the last "mix change"?

Does any of this help?
 
2 units is a high starting dose for a cat. Usually, the cat is started off on 1 unit.

Do you have any lab results/tests that the vet did? Specifically, glucose numbers.

Here is the link to Janet's testing video. It's very helpful:

(And welcome from the Kawarthas. This forum is the best place you never wanted to be.)
 
We can also help you save some money. While Lantus is cheap in Canada (but not from the vet), testing strips can get expensive. The cat-specific AlphaTrak glucometre is expensive and the strips even more so. We can give you options about human glucometres that work just as well. There is no correlation between an AlphaTrak and a human glucometre but we have reference guides for both. Do not buy anything without asking about it first here.

Why was your cat on the urinary s/o food?
 
ok update on Reese, he had some more of his canned food at 3:50 and 4:20 and I keep trying to get him to eat some more but hes definitely grazing. Its like he wants to eat but isnt sure if he should, he circles his dish and looks at me and then gets into position to eat but then only has a little bit. I did manage to get a hold of the emergency vet clinic but they said they can't really help me until they get more information, the blood glucose. If I take him there he will get too stressed and the numbers could get messed up so I don't know if thats a good idea. If he eats half a can of food is that enough to give him his injection? I dont really think I should wait until 7pm. The emergency vet said not to give him any insulin if he still doesnt eat.

To catch up on everyones questions, hes on antibiotics for possible pancreatitis (Clavaseptin). My gut says its the antibiotics causing his inappetance and nausea but I don't know if I should just stop them or not. My vet opens at 8am tomorrow.
 
Reese was on urinary s/o because of struvite crystals years ago and we have tried to transfer him to a new food for years but he just kept throwing them up, including the senior food. Hes eaten a bit more of the canned version of urinary s/o with some kibbles of purina dm mixed in.
 
First of all welcome!!

There are very experienced people here and we will try and help you but we need more information what were his blood glucose levels last time he was checked?
What insulin is he on?
Has he had an urianlysis done?
Was he tested for ketones?
Is he underweight or normal and how much does he weight?


Nausea is one of the symptoms of pancreatitis, and looking at the food and not eating it or just a few licks is a common behavior when they have nausea did the vet gave him some anti-nausea medication?

One easy thing you can do is raise his food plate so that he won't have to lower his head that could help, also at this point give him anything he wants to eat you could even try baby food ( just make sure it does not have onions in it)
 
Rachel, can we back up a bit. My wife and I tore our hair out micro managing our first diabetic cat. This might just be a one day thing and in the morning it will seem like it never happened. I am in no way encouraging you not to keep an eye on Reese but this is life with a diabetic cat, they'll make you go nuts. Please keep trying to feed him, keep notes on how much and when, check the litterbox for anything strange etc. Sooner rather than later you're going to have to bite the bullet and start testing him and if you could right now it would help us, you and Reese. We know this is not easy.
PS I know all about panic attacks.:banghead: They definitely do not help but we can help you. Someone will be here all night. :)
 
Thank you everyone for your responses. I'm so glad I joined this board. He's eating some more canned food now thank goodness on his own but I never know how much food is enough before i'm able to give him his injection. I am trying to calm myself down, its very difficult being an anxious person already. I know I have to start testing and I will talk to the vet about that tomorrow. The last time he was checked (the day he was diagnosed) his blood glucose level was 27.8 (my vet said the number could be that high because stress contributes to that and could alter the blood test results but hes still diabetic) and the urinalysis confirmed he had diabetes. Hes never been tested for ketones and is on Lantus 2 units 2 times a day. He weighed 18.2 lbs on October 10 and weighed 16.7 lbs on December 10. He has no anti-nausea medication.
 
I agree the best thing you can do right now is start testing at home, I know is scarry, I would even sweat the first times I did it, we can help you with that and it will take off a lot of the stress and panic because you will know how he's doing, and you will know if it is safe to give him his insulin or not and also it will help to know if his behavior has anything to do with his glucose levels or you have to start looking for something else, specially if he has pancreatitis.

Yes stress at the vet can raise his numbers, Babu could get 100 more at the vet that what he got at home, that's one of the reasons we strongly recomend testing at home

You can use a human meter which is less expensive than the pet meter and you could buy it today
 
ReesesMommy said:
Thank you everyone for your responses. I'm so glad I joined this board. He's eating some more canned food now thank goodness on his own but I never know how much food is enough before i'm able to give him his injection. I am trying to calm myself down, its very difficult being an anxious person already. I know I have to start testing and I will talk to the vet about that tomorrow. The last time he was checked (the day he was diagnosed) his blood glucose level was 27.8 (my vet said the number could be that high because stress contributes to that and could alter the blood test results but hes still diabetic) and the urinalysis confirmed he had diabetes. Hes never been tested for ketones and is on Lantus 2 units 2 times a day. He weighed 18.2 lbs on October 10 and weighed 16.7 lbs on December 10. He has no anti-nausea medication.
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27.8 was high but terribly high considering he was at the vet and his numbers could be raised because of stress , but still I think 2 units twice a day is a very high dose to start with, even if he were eating normally, taking into consideration the Lantus protocols ( you can start getting familiar with everything I'm including the links ) and the fact that you are not testing yet and this number was taken almost 2 weeks ago, blood glucose levels can change a lot specially if he had an infection and he's getting better, if it were me would give him no more than 0.5 units and make sure he eats

Also you can buy ketones strips and test for ketones your self, I'm not in the US so I'm not sure where but I do understand they sell them on human pharmacies

Here you will find some information about Lantus and how it works http://www.felinediabetes.com/FDMB/...the-basics-new-to-the-group-start-here.18139/
 
Other questions that have been asked that I haven't got a chance to answer yet:

No he has never had a curve done yet

He's been on 2 units since hes been diagnosed

He went from 50% urinary s/o dry and 50% purina dm dry to 75 dm and 25 s/o on December 24th

Hes now almost eaten all the canned food I gave him so should I give him his insulin at 6pm est? The 2 units? Also do I continue the antibiotic? he usually has it at the same time as the insulin and his meal.
 
ReesesMommy said:
Other questions that have been asked that I haven't got a chance to answer yet:

No he has never had a curve done yet

He's been on 2 units since hes been diagnosed

He went from 50% urinary s/o dry and 50% purina dm dry to 75 dm and 25 s/o on December 24th

Hes now almost eaten all the canned food I gave him so should I give him his insulin at 6pm est? The 2 units? Also do I continue the antibiotic? he usually has it at the same time as the insulin and his meal.
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Changing his diet can have an impact on his numbers so they may be lower than when he was diagnosed, as I said if it were me I would give him his insulin but a lower dose (as I said the starting dose according with the protocols is 0.5 units) at least until you can test him ( or the vet ) and get an idea of what his actual numbers are, it is much more dangerous, that he goes too low , hypos can kill (this is a link with information about Hypos that is when his glucose levels go too low that is very important that you read http://www.felinediabetes.com/FDMB/threads/how-to-treat-hypos-they-can-kill-print-this-out.15887/ ), than that he is too high for a while

As for the antibiotic I think you should check with your vet before stopping it.
 
ReesesMommy said:
To catch up on everyones questions, hes on antibiotics for possible pancreatitis (Clavaseptin). My gut says its the antibiotics causing his inappetance and nausea but I don't know if I should just stop them or not. My vet opens at 8am tomorrow.
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Antibiotics can cause GI upset (and not just in cats; I was sick as a parrot last time I had to take a course).

Here's an article about Clavaseptin side effects (inc. nausea and inappetence):

https://www.livestrong.com/article/225036-side-effects-of-clavaseptin/

Any time my little ones have needed antibiotics I was always instructed by the treating vet to make sure the course was completed.

I suggest ringing your vet first thing in the morning for advice. Perhaps they might be able to prescribe an anti-nausea treatment (e.g. generic ondansetron, a human drug which you can get at a regular pharmacy with a written Rx from your vet if s/he doesn't carry it) and possibly an appetite stimulant (e.g. cyproheptadine). Here's helpful info for you:

Nausea/inappetence - symptoms and treatments


Mogs
.
 
Thanks everyone. I decided to half the insulin dose, he ate half a can of food so I gave him only 1 unit tonight. To be honest I dont think my syringe has 0.5 on it. I'll call my vet as soon as they open in the morning. If hes hungry between now and 6am (next dose) do I give him food or hold back till 6? Ill keep him on the antibiotics too.
 
ReesesMommy said:
Thanks everyone. I decided to half the insulin dose, he ate half a can of food so I gave him only 1 unit tonight. To be honest I dont think my syringe has 0.5 on it. I'll call my vet as soon as they open in the morning. If hes hungry between now and 6am (next dose) do I give him food or hold back till 6? Ill keep him on the antibiotics too.
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I would give him as much food as he wants, better safe than sorry.

Also I suggest you look for syringes with half unit marks on them you will need them to adjust your doses properly since the increments or decrements are usually done in 0.25 units
 
ReesesMommy said:
Its like he wants to eat but isnt sure if he should, he circles his dish and looks at me and then gets into position to eat but then only has a little bit.
Click to expand...

For me this is clearly a sign of nausea.

ReesesMommy said:
My gut says its the antibiotics causing his inappetance and nausea but I don't know if I should just stop them or not.
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I wouldn't stop the antibiotics, but it is quite possible they are giving him nausea. So maybe adding an anti-nausea medication would help. Also, how are his stools? We give Fortiflora here while on antibiotics to help with the gut microbiome, but there are other cheaper probiotics.

ReesesMommy said:
He went from 50% urinary s/o dry and 50% purina dm dry to 75 dm and 25 s/o on December 24th
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So, if you recall I'm doing a similar transition with Quintus. One day I messed up my "half-half" numbers and he got lots more DM than he should have, compared to his old food, and lo and behold, his numbers dropped like a stone. Then he "bounced" (meaning that because he hit low BG numbers relative to what he was used to, his glucose went back up. and he felt tired and crummy).

If no curve has been done and you're shooting blind I would absolutely urge you to take things into your own hands and start testing at home, particularly if you're changing food. Some cats become regulated on food change alone. So imagine if that were the (lucky!) case for your cat, it would be like giving 2ui of insulin to a cat who doesn't need insulin... could be bad. You'd want to be able to see that coming and be able to adjust the dose.

Calling your vet tomorrow first thing sounds wise.
Where do you live? Getting a meter also sounds like a plan.
 
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