Gave insulin even though Ming won’t eat

I’ve briefly read everything you all have wrote. Thank you so much, truly.

Right now I’m bringing Ming back to the vet. He ate nothing for me after the treats. And I did a ketone test and I honestly can’t say if it was trace or moderate ketones. I might have waited too long but there’s ketones I’m assuming. I was talking to the night assistant all night whose had 4 or 5 sugar cats and she talked about all the things you guys did. Was even stumped why he was recommended for 2 units and talked about insisting on Cypro.

He stuck it out in the 20s the whole night or the 390-400s
 
And I’m thinking of giving him 4.4 or 4.6 units. Assistant said it would probably be okay to give 4.6 units. I’m only hesitant to go to 4.6 because I’m chicken and I don’t want him to go too low and bounce right back up
 
Try to think of it as a steep curve instead of a bounce. The insulin is supposed to bring him down, and then it wears off and the BG rises. Every hour in the lower numbers is another hour when he can heal a little. The fact that he rises again after that cannot be avoided at this point. And staying high and flat all the time denies him time in the healing numbers. High and flat is no good. A smile shaped curve is what you're aiming for at this point.
 
So I ended up not giving a dose but they're giving him insulin via IM. I'm not sure what that means but they know he needs to go down. I walked in and immediately Ming was swept away and they all went to work lol I probably looked like a zombie because a few coworkers asked if I got any sleep and if I was exhausted. I am teetering between spacing out and tearing up. I'm just thinking the WORST right now: what if I pour all this time and money into him and it turns out, all his illnesses are just too much and QOL is bad? But I keep reminding myself that when he's good, Ming is super bright and funny and fat and loves food lol So even if we can't get all of his illnesses in control, at least when he's good, he's good.

He has ketones around 3.5 mmols. And they're calling the ultrasound specialist today. They'll check BG hourly and ketones whenever he goes. He also had bacteria in his urine from Friday but for some reason, no one did the culture for it so they're doing it now. I don't blame them for forgetting - sh*t happens and the head tech was NOT pleased that that was missed. The head vet said it would be beneficial to see the internal medicine specialist vet.

I'm on board with whatever. I've got no money but I'm thinking I'll pay off this debt slowly somehow. Money can be made but there's only one Ming.

I've gone home to sleep. I have to work the night shift tonight so I'll see Ming tonight.
 
Djamila said:
So the paste is "junk food" I assume? Is it just at the grocery store? I haven't seen those before, but it's always good to know what options are out there when a kitty is anorexic.
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Yes it's junk food. I think it's basically like baby food. Something the night assistant does all the time is get baby food that's meat only and feed it to anorexic animals. Almost always does the trick.

I found it at PetSmart. They just recently started carrying it but before PetSmart had it, Walmart had it too.
 
I'm also wondering if my vet's glucometer reads lower and mine reads higher. I did BG at 630am and he was at 22.2. At the vet, they used their meter and got 20.1.

I've read there's differences and the night assistant said the difference is usually by a fraction and now whole numbers. But she made a point that it's impossible to test and there will always be variables between even a single drop of blood.
 
Been told his BG is down to 8 or 144. And that he’s eating treats. Still not on appetite stimulants. I stressed again that he’s not really eating even if it’s just treats.

I just don’t see the point in waiting? I understand mirtazapine might make him loopy but I quickly read up on cypro and it seems like it’s relatively safe if not overdosed. Vet B said she would consult with Vet A about that.

He’s on dextrose so his ketones should be gone soon.

And the ultrasound specialist isn’t available until Thursday and see if we can hold off until then. But I f he still doesn’t do well overnight, then he’ll go to that big expensive trauma centre/referral centre in our city (Canada West for all us Canadians) for an ultrasound.

Coworker who is an assistant said he’s feistier than this morning. But he’s still in pain in the abdomen, vet said.

Night nurse who is the experienced sugar cat owner told me to DEMAND Cypro hahaha. I tried. Vet said she would’ve given it to him if he wasn’t eating on his own by noon. I almost wish he hadn’t eaten just so he’d get it. That’s kinda backwards, right?
 
What's hammered into us here is treat nausea first because that will often get them eating again. Give appy meds only if nausea has been addressed adequately. Pain is a deterrent to eating to so if he has a sore abdomen he needs pain meds. Is he getting any?
 
Oh Crista. I'm so sad to read that he has ketones. As Kris said, nausea (and pain) first. Then appetite meds. And no more lowering the insulin dose. Even if it means throwing a full on temper tantrum in the waiting room.

Okay, you've been given more than enough advice with all of these vets and techs and us and you are probably beyond overwhelmed and exhausted. Please know that we are all sending prayers and good thoughts and healing vines and positive energy and whatever else everyone believes in. Thank you so much for keeping us updated. I really hope you can get some rest tonight despite all of the worry.
 
Kris & Teasel said:
What's hammered into us here is treat nausea first because that will often get them eating again. Give appy meds only if nausea has been addressed adequately. Pain is a deterrent to eating to so if he has a sore abdomen he needs pain meds. Is he getting any?
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Ah I see I see. Yes, the night nurse mentioned he’s already getting cerenia and bupe so why don’t they just give him the appy meds. Haha she’s got a very strong opinion and I’m thankful for that. When she heard they recommended 2 u, she called me to tell me that she thinks that’s stupid but that it’s ultimately my choice.

And yes I believe he’s getting pain meds.
 
Djamila said:
And no more lowering the insulin dose. Even if it means throwing a full on temper tantrum in the waiting room.
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Definitely. I will ahah I think Vet C just didn’t really understand that he’s not a wait and see kinda kitty.

He’s on that IM insulin tonight with specific instructions to make sure he stays in a good range. Short acting insulin for better control.

The internal medicine specialist said she is happy to see him on Monday. I’d be happy too. I only hope the $$$$ is reasonable lol

They say he’s being more feisty compared to this morning. Which is good and bad imo. Good because it means he’s got energy but bad because it still means he’s not 100% better. I know him. I think we all know our kitties. And although to the vets and others, certain behaviours sound promising... knowing how our kitties usually are, it’s not as promising to me as it is to them. I’ll see what he’s like when I get there in a couple of hours. Last night, when I went to pick him up, I knew he wasn’t good. He didn’t perk up when he saw me and went right back to sleep. That’s not him.
 
No more ketones this morning!

He had some trace last night but it was probably the last of it leaving his body. He was much perkier last night and ate dry foods and treats mostly. Licked at wet food. I really wonder why dry food is more appetizing when he’s sick?

We were giving him diluted humilin almost every hour or two because his BG was in the 20s the whole night. But at least he wasn’t super lethargic. I believe during the day today, the doc is ensuring that Ming’s BG will get lower and they’ll transition him back onto ProZinc. She said something about making up the humilin each time rather than diluting a whole bunch. She wondered if pre-making diluted insulin/humilin lessened the effects of it. I’ll be watching him tonight again for my night shift.

Then an ultrasound tomorrooooow. I feel better about him now. He was more himself. I’d say he’s about 60% himself.
 
Pancreatitis can last a couple of weeks sometimes, so he probably isn't going to seem fully like himself for awhile still. Same with DKA. The recovery can be slow, even after the ketones are clear. Just keep lovin' on him and give him time.

I'm so so so happy to read that he is clear of the ketones! Any word on the possible UTI?

What are you hoping for from the ultrasound? Is it just to get a baseline and confirm the pancreatitis? Or is there suspicion of something else? The cause of the ketones is already known: he has inflammation (the pancreatitis and the possible UTI) + he wasn't eating (and wasn't given appy meds) + they lowered the dose.

As for the food, sometimes when a cat gets sick on a food, they develop an aversion to it, so that could be a factor in why he doesn't really want to eat it right now. Also, most kibble is filled with flavor enhancers that aren't found in wet foods. That's part of why we often recommend Fortiflora. It's technically a probiotic, although from everything I've read it's not all that effective in that regard. But what it's really really good at is getting kibble lovers to eat. Sam will practically bite my fingers off when I start sprinkling some on his food. He only gets it now when he's sick, but it works every time. I've often joked that he would eat a shoe if I sprinkled it with fortiflora first. My other cat doesn't really care for it, but my other cat also doesn't like kibble, so there may be a connection there.

It's so good to hear that Ming is feeling better, and to hear your "voice" sounding more hopeful again. Hugs to you and chin scratches for Ming!
 
And then tomorrow, Vet A who is the boss lady vet will take over his case tomorrow. So that’ll be interesting.

When I came in yesterday morning, Vet A was there too and Vet C was ... I want to say frazzled but mostly upset to know Ming didn’t do well overnight at home and was briefing Vet A on what was going on. At one point, Vet C was sighing and Vet A just went, “Do you want me to tell you what to do?” And Vet C said “YES, please!”

It was both funny and really nice to see them working together. They went to the back OR to discuss and work out a plan.

When I came in later that night for my shift, the day time assistant told me Vet C was beside herself, and watching Ming like a hawk and worried and not wanting to let me down. I could tell she was very worried about Ming and I guess me coming in that morning was quite shocking. She wasn’t the doctor on call that night but told us to call her instead if anything happens to Ming.

Anyway, I’m really grateful and so extremely, incredibly lucky to be in this position where I can fall back on so many people for so many different opinions and backgrounds. Everyone’s input was so invaluable. I think if I didn’t have this forum, I would’ve kept Ming on 2 units at night and for the day, brewing in ketones. If I didn’t have these doctors, I would’ve continued going to my last vet and not really moving forward and looking for advice from specialists.

So I really really really hope this is the beginning of a new path into getting Ming’s health issues in control.
 
Thanks Djamila! Yeah, I was so down yesterday. It didn’t help that I was also watching the show, This Is Us. If you haven’t watched it... it’s a really good show but also a tear jerker every darn episode!

I think the ultrasound is just to make sure his pancreas isn’t completely messed up. And I’m also curious to know what it looks like in there now. The last time he had one, i heard it looked like there was a lot of scar tissue.

The internal specialist said steroids should be saved for those who aren’t responding to treatment but he did so we’re definifely holding off of steroids for now.

I actually don’t know anything about a possible UTI. I’ll ask about that later when I go in.

And ya, I was eyeing the flortflora last night that was in the lab. I’ll be asking if I can have some tonight.
 
Crista & Ming said:
It didn’t help that I was also watching the show, This Is Us.
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Lol...I had to stop watching it because it makes me ugly cry every. single. episode. So good though!

Maybe I'm imagining the UTI thing? I thought you said something about bacteria and a culture, but I have a terrible memory! If there's some fortiflora in the lab, definitely give it a little sprinkle on Ming's food and see if he likes it. That way you know before you buy a whole box. It does last a really long time, but still a little pricey up front.
 
Oh right yesss. He had some bacteria in his urine. I’ll need to ask about that as well. I vaguely remember reading his his notes that there’s no growth. Not sure if it was related to the urine. Anyway that’s me guessing.

Vet B and C both raised concern/speculated that perhaps the raw food has too high of a bacteria load for him to handle. What do you think about that?
 
Yay for no ketones!!! One of the best things we could hear!

As for the bacteria...I don't know enough about it to be sure, but it seems unlikely that raw food bacteria is causing urinary tract bacteria. While there is some bacteria possible in the food, cats have such a high tolerance in the gut to handle bacteria, I don't think that would cause problems. And it seems like if it did, it would cause GI upset, not urinary.

Yes give the forti-flora a try. My cats love it! I sprinkle a tiny bit on food when I need them to take meds mixed in or something and I have to fight to make sure the right kitty gets it!
 
What was causing Vet B and C to have those concerns? The vomiting? Are they thinking it wasn't pancreatitis, but rather some sort of food poisoning type thing?

Pancreatitis isn't caused by food, so I would say no in that regard. The ketones have a known cause already. I don't remember you saying Ming was having diarrhea, was he? I'm not sure what from the food could be in play here. And Rachel is right, cats have a very high tolerance and aren't any more inclined to get sick from raw food than they are from kibble (which has it's own bacterial issues if you dig into some research on it - warning: it can get pretty nasty if you start reading about the bacteria in commercial kibble).

So I guess I'm not clear what they are concerned about with the raw food?
 
Ming was a lot more of himself tonight. He needed to be fasted for his ultrasound after midnight. He ate some FF just before that and then after, was asking for food. He chose the wrong time to be hungry :rolleyes:

Vet B and I guess by extension, Vet A decided on 2 units of prozinc last night. I was like okay....... why...... and the chart said to discontinue humilin. Then I asked Vet A what numbers should Ming be within and she decided we should give humilin if his BG isn’t below 18 mmols.

For most of the night he was in the 20s and then at one point, was at 17. High, high, high.

No ketones of course.

But funnily his mood was very good. He was purring and meowing and climbing on the bars. He stuck his hands out a lot.

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I only hope they see that 2 units did nothing and decide to up it during the day.

Also Vet A talked to me about steroids again. It would be a very low dose once every 3 days. She said she wouldn’t recommend it if she didn’t think it was time/a good option.

I am willing to try but also scared. I asked the night assistant with the sugar cats what she thought and she said: “ Steroids are great for reducing inflammation so I guess thats why she wants to use them. tho to ME he has pancreatitis due to poor control so when THATS better resolved his pancreatitis will too but I only understand the basics“

I might have to let Vet A know again my fears and ask if we are starting steroids, to perhaps at least start them later so Ming has time to recooperate? Not sure. And also maybe see what the internal medicine specialist says.
 
And as for the bacteria, I asked Vet A. She said they haven’t gotten the report back from the lab. I think Vet B and C were just speculating as to why he had bacteria in the first place. I’ve heard the same reasoning before from one of the vets at the clinic Ming used to go to.
 
Also one more photo of him after I changed his bed:

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Good bye beautiful belly fur! I’ll miss you until you grow back :arghh:
 
Ooooookay. I’m sleepy and really will need to talk to Vet A again tonight. She said she will talk to me more then.

He finished his ultrasound and they found he has micro abscesses on his pancreas. She mentioned something about them possibly or being necrotizing. So we’re treating him on a stronger antibiotic for a month plus the steroids. And then monitor and change his insulin doses accordingly.

She did say she will most likely increase his insulin and I hope she does lol 2 units doesn’t do anything. And that I should continue to test his BG and let her know and work out the dose as he continues his treatment.

I asked if she’s seen his last two ultrasounds which were done earlier this year. She said she did not but will be calling my old vet to get copies of them.

She said with treatment, he will still have pancreatitis flare ups but ideally, it should be down to once a year instead of every month.

My night assistant with the sugar cats was extremely (and oddly) optimistic. She texted: “Ok I wonder if thats the reason hes diabetic? The abcesses are impeding the cells from producing insulin how interesting! Perhaps once the infection is resolved so will his diabetes!”

I have a list of questions already. If any of you also have questions, I will definitely ask them for you to the vet.

For now, I must sleep lol another night shift is up ahead.
 
Okay dokey.

Ming started his pred today. He is getting 6 units this morning. He was on 4 units last night and nothing happened lol BG high high high. And he got ketones. Ketones were high for one of his pees and then trace amounts for the next two pees.

His fluids were at a high rate so that probably is flushing everything out. My vet told me not to get too worried about the ketones and that she suspected it would happen because of how high he was. I think since she’s taking over now, she’s definitely more aggressive with her treatments and kind of only did the 2 units as a sort of ... courtesy. She even told me that she’s doing 2 units because that’s what her books or whatever said. Of course, it would’ve been nice NOT to do that but what’s done is done. And he’s finally getting a higher dose.

He’s acting GREAT though. Purring and eating relatively well. He’s even eating wet food now.

He’s getting bupe 3 times a day now instead of 2.

My vet is going to talk to a specialist today that advocates for steroid use in cats with diabetes. She’ll forward whatever response she gets to me as well. I think that will be very interesting.

Vet also suspects he’ll probably be getting 8 units at one point just because of everything that’s happening.

And Vet A said the fatty blood is not from diet and is a good indication that pancreatitis is impending.
 
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