? Dosing Advice Prozinc 1

MrWorfMen's Mom said:
it doesn't sound like he's eating enough and that may be contributing to the issue.
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Just to clarify.......At Bear's weight he needs roughly somewhere between 250 to 300 calories per day. I don't know the calorie count of the Friskies off hand. My girl is about the same weight (16lb.) and she got 1/2 can FF with each shot and 2 snacks each cycle of between 1/3 and 1/2 can plus a few chicken treats for a bedtime snack and she is maintaining her weight and in remission. If Bear needs to gain some back, he can eat more. Also, diabetics don't get all the nutrition out of their food when they are unregulated you don't need to limit him, If he gets hungry, give him some grub.
 
MrWorfMen's Mom said:
Oh that adrenal rush will drift off and you will suddenly be drained no doubt.

If that's Fancy Feast cans they are 3.3 oz. If it's Friskies, aren't the cans more like 5oz? I was just looking to see how much he had been eating and for his weight, it doesn't sound like he's eating enough and that may be contributing to the issue.

I'd be inclined to give him 1 unit with testing at +3 along with a snack and another test sometime in the middle of the night (say +6 or +7) and again leave food out for him....something you know he will eat. That would keep your dosing consistent from this morning.
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I'm OCD with details but I had to make myself summarize some of our visit otherwise Bear wouldn't get his insulin until after 10. I don't type fast.
 
DO you mean he ate the whole can? If so YEAH! Yes to the 1unit with test at +3. I'll try to check back in around then but no guarantee so if he is dropping really fast/too low by any small chance, (I don't think he will) you can give him some higher carb food or if he's real low add a half tsp of honey or karo to his food to bring him up and test again 20- 30 minutes later to be sure he's coming up and make sure he continues to stay up without feeding again (see hypo instructions in the stickies).
Funny you mentioned not typing fast....I don't either and my fingers aren't working tonight.
What time is it there? I think you are on Central time...correct?
 
MrWorfMen's Mom said:
Just to clarify.......At Bear's weight he needs roughly somewhere between 250 to 300 calories per day. I don't know the calorie count of the Friskies off hand. My girl is about the same weight (16lb.) and she got 1/2 can FF with each shot and 2 snacks each cycle of between 1/3 and 1/2 can plus a few chicken treats for a bedtime snack and she is maintaining her weight and in remission. If Bear needs to gain some back, he can eat more. Also, diabetics don't get all the nutrition out of their food when they are unregulated you don't need to limit him, If he gets hungry, give him some grub.
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Bear has put on 1 lb and 5 ounces since August 28th, about a month ago. He is overweight about 3 lbs. Not that I think Bear should lose weight with his BG all over the place but I will watch him like a hawk, I promise.
 
Did you give him his shot yet? Do you think you'll be able to wake up and test him during the night?
 
The recipe for ketones is infection + insufficient insulin + not enough calories, so it's important to make sure he gets enough calories right now, even if it means letting him back on the kibble for a few days. We also need to get the insulin back up - not all the way to 3u, but higher than it's been.
 
MrWorfMen's Mom said:
DO you mean he ate the whole can? If so YEAH! Yes to the 1unit with test at +3. I'll try to check back in around then but no guarantee so if he is dropping really fast/too low by any small chance, (I don't think he will) you can give him some higher carb food or if he's real low add a half tsp of honey or karo to his food to bring him up and test again 20- 30 minutes later to be sure he's coming up and make sure he continues to stay up without feeding again (see hypo instructions in the stickies).
Funny you mentioned not typing fast....I don't either and my fingers aren't working tonight.
What time is it there? I think you are on Central time...correct?
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I just checked he has eaten about 2 ounces now, which is a half a can and 6 or 7 chicken treats since we came home.
 
Ok well I tend to be a night owl but with this cold, I probably won't make it till 2:30 AM. If you have any major concern and need help and none of us (Kris, Rachel, Djamila or me) are not around, post in health with the 911 pre-fix. There are some great folks from Australia, New Zealand that are usually on at night.

I doubt you will need any of this, and you are doing a super job with Bear but I know only too well how nice it is to have company when dealing with a low number. We affectionately call them PJ parties!
 
Djamila said:
The recipe for ketones is infection + insufficient insulin + not enough calories, so it's important to make sure he gets enough calories right now, even if it means letting him back on the kibble for a few days. We also need to get the insulin back up - not all the way to 3u, but higher than it's been.
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Remember he had pretty good numbers today and at night he seems to have lower numbers. Last nights wasn't that great.
 
@Djamila - I am very glad to see you here. Do you think we should bump Bear up to maybe 1.5 units? I suggested 1u for consistency and in case sleep overtakes Lora given the day she's had. Your thoughts?
 
Grrrr...this isn't how I wanted to do his dosing. I was really hoping we could be methodical instead of continuing to just guess and see what happens. But with the ketones, I'm too afraid to leave his dose low. Ketones are more dangerous than a hypo since if he goes low you can give him some honey or karo. So I'm going to say 1.5u tonight, but please make sure you get up and check him at +3, and if he's below 200 then get up again. I'll give more directions about that in a minute, but I want you to be able to shoot.
 
I'd rather give him 1u, but it's too dangerous with ketones. I think we have to increase and send wake-up prayers for Lora in a few hours.

Lora, if Bear sleeps with you, you might just take your testing kit to bed with you so you can just roll over and check him.

This is going to get confusing because I'm going to try to give you every scenario in case no one is around later.

+3 test
>200 you can sleep the rest of the night
Between 150-200, wake up again at +4.5 and test again
Between 80-150 give a snack and test at +4.5
Between 50-80, give a high carb snack (kibble, or add honey/karo to regular food, or give a high carb wet food if you have one) and test again in an hour to make sure he's rising
Below 50 Give honey/karo with food and keep testing every 20 minutes until he starts to rise.

+4.5 test
Between 100-150, give a snack and sleep the rest of the night
Between 70-100 give a snack and wake up at +6 to test again
Below 70 give some kibble and wake up at +6 to test again

+6 test
Above 50 - you're done and can sleep the rest of the night
Between 40-50 give some kibble and keep testing every 30 minutes until he starts to rise. Then you can sleep
Below 40 give honey/karo and keep testing every 20 minutes until he starts to rise. Then you can sleep.

Okay, that is a quick rough guide that I hope covered everything. As Linda said, there are usually folks out on Main at all hours day or night, so post if you need help or if I left out a scenario or it doesn't work or something. There is more finesse to all of this than you'll see in these directions because they are intended just to keep you all safe through the night.

My hope is that he'll stay steady and you won't need to wake up again after the first one, but I want you to have directions for all of it since he's been a little less than predictable the past few days.
 
Done . I know you both are trying to cover everything but before I forget or you are gone,- his morning shot should be 10:30AM since tonight's is 10:45PM? I will be tied up with nurse and mom from 9:30-10:30AM.
 
Yes, 10:30 would be about right. You have about an hour of play with Prozinc, but if you're busy with the nurse until 10:30, then we can help you get the shot time back to your preferred schedule another day.
 
Djamila said:
Yes, 10:30 would be about right. You have about an hour of play with Prozinc, but if you're busy with the nurse until 10:30, then we can help you get the shot time back to your preferred schedule another day.
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All right I will leave these instructions out and follow them. Thank you both.
 
One thing to keep in mind with the ranges. Fairly often our kitties will do something like giving us a 204 or a 197 when the range directions are for 200. And then we are left trying to decide what to do. It's so close, so do you follow the directions for the top range or the bottom range? In cases like that you need to go with your gut. We call it Mama Sense. Trust yourself, and ask for help if you need it.

I'm about to sign off for the night too, so take care and hopefully you'll be able to get some good sleep and not have to test all night!
 
Woke up just in time for +4.5 and saw that 85 at +3. Glad to see he's come back up now to 241. Was holding my breath as I am sure you were. If you fed him food to get BG up at +3, then give him a little more food and head back to bed. If you used honey or karo by any chance, I'd feed and check again +6 or +7 just to be sure. Bear is a bit unpredictable right now. :)
 
Djamila said:
One thing to keep in mind with the ranges. Fairly often our kitties will do something like giving us a 204 or a 197 when the range directions are for 200. And then we are left trying to decide what to do. It's so close, so do you follow the directions for the top range or the bottom range? In cases like that you need to go with your gut. We call it Mama Sense. Trust yourself, and ask for help if you need it.

I'm about to sign off for the night too, so take care and hopefully you'll be able to get some good sleep and not have to test all night!
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@MrWorfMen's Mom
Bear turned up his nose to all wet food, plus the chicken treats so I resorted to kibble but he would only eat 9 of them I only touched a finger with honey to his lip and when I tried again he turned away. I have never given him anything sweet before and I guess he doesn't have a sweet toothe. Good night and thank you for checking on us. :) I replied to the wrong post again, lol. I need sleep.
 
Oh Lora I'm glad Bear is home. I hope you were able to get some sleep and that he's doing well in the morning!

I'd get ketone tests whenever you can for now. Treating at home is difficult, and you want to stay on top of this.
 
I'm really glad you had great help from these folks. My kitty has had TWO bouts of diabetic ketoacidosis and it's very serious and expensive to treat in hospital. It takes weeks afterward to get back to normal. Here are some general guidelines (learned the hard way):
  • Feed higher carb (medium carb or even kibble) food to allow larger insulin doses to be given safely. Lack of calories means his body will break down fat, etc. and that results in ketone production. You can slowly switch to lower carb over time and reduce insulin as needed.
  • Hydration is key. Add a lot of extra water to wet food meals (3+ Tbsp) and consider sub Q fluids too. That helps to wash out ketones.
  • Test for ketones at least once a day for a while.
  • Ask your vet for antinausea meds (ketones make them nauseous) and appetite stimulant meds (they MUST eat). Some people give Cerenia for nausea/vomiting but I've used ondansetron (human chemo nausea med) to good effect. Mirtazapine is often used for appetite but makes some kitties "weird". I used cyprohepatadine, a human antihistamine.
  • Have Bear checked for any source of infection or inflammation (UTI, dental, pancreatitis, etc.).
Sometimes the vet won't prescribe these meds but they're essential to get kitty eating and keep him eating. You might have to be "assertive".
 
Well, he gave you a bit of an adventure last night. I hope you slept well (and are still sleeping) the rest of the night.

A couple of things going forward: normally you want him to hit those green numbers. However because it was the middle of the night we were trying to steer him away from those just for that cycle. So the next time you get an 85, throw a party instead of giving carbs. That whole list of what to do can pretty much be thrown out now as it was specific to the circumstances last night, and not the rules that you would generally want to follow.

Kris is our expert on ketones as she has unfortunately had to deal with it a few times now. Good luck at the vet this morning, and let us know how it goes. It sounds like you might have found a good vet which is a very rare thing when it comes to feline diabetes!

Since you're around today to monitor him, I would recommend staying at the 1.5u dose and using the food to steer him, however I'd really like @Kris & Teasel and @Rachel to take a look and see if they agree with that since I don't have as much ketone experience.
 
I think staying at 1.5 u and steering with food is a good move right now. All the usual rules go out the window with ketones in the picture. It's essential to be able to give enough insulin and do it safely by balancing it with enough carbs.
 
I agree too. You want him to get insulin and food in...ketones come from not enough insulin and food (plus an infection usually). That means you just have to be more aggressive and use food as a tool for steering when needed.
 
I can well imagine that's how you feel! :woot: Bear is really putting you through your paces right now. Is he eating any better this AM?
 
Is he drinking on his own? Wonder if he might lap up a watered down slurry of wet food? Or maybe get some meat baby food (without garlic or onions) in it. Warming food sometimes entices them too. Of course kibble is just fine too if he will eat any of that. You may need to consider assist feeding if he doesn't start eating on his own. I'm a bit surprised the vet didn't prescribe something for nausea and an appetite stimulant (see Kris' post #126) ......something you could call your vet about. Got to get the little guy eating.
 
Ha! It was going so fast I didn’t catch the name. :p

Yep gotta get him eating. Do you have any forti flora? Some cats like Parmesan cheese sprinkled on food too. Or maybe tuna water?

Will he eat kibble? Anything is fine at this point if he will eat it.
 
@MrWorfMen's Mom @Rachel

Sorry, this time the nurse had to come late so I was with her. Bear might have eaten two Ckn breast Treats at testing, then I gave him 1 ounce of Friskies Tuna & Egg with about 3 Tbls of water. He licked most of the water up and ate maybe 1/4 of the meat portion. I then put down 10 Science Diet Kibble and he ate one. Later he was drinking at his water bowl. I won't be able to go on the symptom of staggering for hypo, cause he is very unsteady on those back feet.
 
Bear & Lora said:
@MrWorfMen's Mom @Rachel

Sorry, this time the nurse had to come late so I was with her. Bear might have eaten two Ckn breast Treats at testing, then I gave him 1 ounce of Friskies Tuna & Egg with about 3 Tbls of water. He licked most of the water up and ate maybe 1/4 of the meat portion. I then put down 10 Science Diet Kibble and he ate one. Later he was drinking at his water bowl. I won't be able to go on the symptom of staggering for hypo, cause he is very unsteady on those back feet.
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I worked with him and gave him extra time to eat as he is eating so slow, so his shot was at 11:05 C.S.T.
 
While at the vet ask them for the meds Kris mentioned. Tell them he isn’t eating well and you want to be proactive. The worst they can say is no.

Yeah give the tuna a try. It’s not ideal as I don’t think it’s a balanced meal but any food is good.
 
Right now, anything he will eat is just fine as long as no garlic or onions. Some cats like Kentucky Fried Chicken! Just take the skin off. Seriously, there are times when we all resort to whatever will work. I kept sugar donuts in my freezer for a quick sugar hit when Menace was tossing me low numbers because she won't eat any cat food but her low carb and trying to get honey or karo into her was a nightmare. Found out she loves sugar donuts when I caught her pilfering one day! :woot:

Talk to the vet about something for nausea and an appetite stimulant too.
 
Just watch Bear for any increase in lethargy, confusion or strange eye movements but also be aware that not all cats show signs of hypo. Testing is the only sure fire way to know where BG is at.
 
Yes to feeding anything remotely protein-like that he'll eat (minus seasonings like garlic/onions). Those meds are very important to get him feeling better and eating to halt ketone production. I wouldn't wait to chase them down from the vet.
 
Kris & Teasel said:
Yes to feeding anything remotely protein-like that he'll eat (minus seasonings like garlic/onions). Those meds are very important to get him feeling better and eating to halt ketone production. I wouldn't wait to chase them down from the vet.
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The Vet's office doesn't open till 2PM, Vet said she was going to be at that ER Hosp till 3AM. I am supposed to just pick up the fluids but am going to call and see if they require an office visit charge so I can ask for extra meds that you mentioned. The Real Tuna worked, he ate 1.5 oz warmed with 0.3 oz water added. He looks better than earlier. Thank you for your experience and information.

God blessed me with some common sense, thank you Lord, or I wouldn't dare attempt to be Bear's nurse, more or less. It still is somewhat intimidating.
 
Yeah to Bear eating. Sending more appetite vibes!

It's tough and so frustrating when they won't eat. You are doing a great job with Bear! Hang in there! Bear will improve and things will get easier and we are all here to help you along!
 
Kris & Teasel said:
Yes to feeding anything remotely protein-like that he'll eat (minus seasonings like garlic/onions). Those meds are very important to get him feeling better and eating to halt ketone production. I wouldn't wait to chase them down from the vet.
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By the way that real canned tuna's water was drained yesterday, because when I did that ketone test I used the water from the can and diluted it with half bottled water, and Bear drank all of it. I kind of freaked out when I saw the results of the test. Anyway my OCD is kicking in, the point is Bear had 1.2 oz of real tuna drained of water and 0.3 bottled water added. When I get more sleep my OCD will be better, lol.
 
Bear 10-01-18.jpg

@MrWorfMen's Mom @Kris & Teasel@Djamila@Rachel
So here is my precious Bear getting his fluids. He is such a Trooper. I got the Cerenia from the Vet. When I asked her about an appetite stimulant she told me the Cerenia would help him with his nausea and he would get his appetite. NOPE! I syringe fed him a 2.5oz jar of Ham&Gravy Baby food-80 Calories so I could shoot. If he didn't feel so crappy I know I wouldn't have gotten away with that, lol.

The Vet said Cats usually feel better after the second day of fluids. I hope she is right.

I just reread Djamila's post about throwing a party for a green number. I would feel more secure with a yellow crazy as that sounds. Bear really is feeling bad and I would hate him to suffer Hypo while he is so delicate. This could be ignorant of me but I just am too new to this to know.
 
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Bear & Lora said:
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@MrWorfMen's Mom @Kris & Teasel
So here is my precious Bear getting his fluids. He is such a Trooper. I got the Cerenia from the Vet. When I asked her about an appetite stimulant she told me the Cerenia would help him with his nausea and he would get his appetite. NOPE! I syringe fed him a 2.5oz jar of Ham&Gravy Baby food-80 Calories so I could shoot. If he didn't feel so crappy I know I wouldn't have gotten away with that, lol.

The Vet said Cats usually feel better after the second day of fluids. I hope she is right.

So should I do a repeat of last night with the same perimeters, +3 Test if it's low, feed and retest at 4.5 etc?
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I probably should of asked much earlier what you would do tonight if you were in my shoes? If I don't get a reply I definitely understand.
I know everybody has been making a lot of time for Bear and I, especially you Linda. Thank You so much!

If I'm on my own tonight and Bear's BG are green I will try to give a little food (maybe syringe food) and retest just to make sure he isn't close to hypo.
 
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Well it's 2:30 in the morning here in Oklahoma. Bear tested at a 229 BG. I should go to bed but I want to be honest with you. I am scared. Bear seems so weak. I am putting him in the litter box every so often because every step is hard for him to make.
He looks up from my lap at me when I test him like I am so miserable and sick and it touches my very soul.

He made all yellow today and I tell myself that has got to be good because his blood sugar isn't bouncing and no pink, red, or black but is it really? I read that article in the main forum, the one that her cat had ketadosis and was at the ICU. I read that before any of us knew Bear had that too. That sad story was burned into my memory when I read it.

The vet made it pretty clear I could do at home what they would do at the hospital without Bear's BG raised up due to anxiety and stress. I think he has a chance but he isn't doing well right now and even his complaints when I stick his ear are weak and sad. Not the irritated, complaints he gave before.

I'm not giving up on hope but I can feel it diminishing a little bit. I want tomorrow to be better, better for my Bear.














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Oh Lora! I know how tough it is to see our babies sick and miserable. You're doing everything exactly right for Bear and taking such great care of him. I wish I had something I could say or do to make this easier for you but know that we're here for you :bighug:

As for the yellows, it's not really bad that he's been in flat yellows all day. Sure, getting some greens would be great, but we've actually seen it happen a lot before where a run of flat yellows precedes a suddenly low number. Not sure WHY, but it seems to happen. Could be that is going to happen here.

Have you gotten another ketone test in? I wonder if they have gone down or are staying the same.

I'd call the vet today and let them know Cerenia didn't work and ask for an appetite stimulant.

Lora, I think DKA can be done at home, but I'm not 100% convinced that you should do it at home. I'm not saying you CAN'T, only that maybe the best place for Bear is a hospital for a few days to get him stabilized. Most kitties I've seen in DKA spend at least a couple of days with the vet so they can be monitored and get IVs or whatever else they need. Often, I believe it includes a fast acting insulin to help bring their levels down to get those ketones out. NOT something I would recommend doing at home. I don't really know enough about DKA to give you advice, but maybe it's something to think about. If you choose to keep treating at home, that's fine, but I just wanted you to know that if you decided you wanted to give a hospital stay a try, that's okay too.
 
Oh Lora. So sorry you got left to your own devices last night but I would have made the same decision regarding insulin. Those are lowish yellow readings which is encouraging. I can only imagine how you are feeling. Nursing a cat with DKA is pretty intense and I agree with Rachel. It can be done but I'm not sure it should. You have other responsibilities and you don't want to make yourself sick with all this. I'm wondering if it would be better to have Bear hospitalized for a couple of days to get him stabilized. I am also wondering if the vet checked his teeth or for a Urinary tract infection as inflammation/infection are often part of the reasons for the DKA developing.
If you decide to continue to nurse him at home, I would definitely have the vet check for a UTI and give you an appetite stimulant. The key here is to keep Bear well hydrated, and getting enough calories and insulin into him. It would be much easier if he would start eating some on his own.
Sending healing thoughts and prayers for Bear and you. :bighug::bighug::bighug::bighug:
 
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