? Lucy's AMPS 201 Shoot .25?

[Joanj]

Hi,

Lucy's AMPS was up to 201 for the first time in days. No insulin for 96 hours. She was at the vet til 630 last night, getting blood work and sub-saline so not sure if that's affecting it.

Should I wait and do another BG later and see if it's come down or go ahead and give .5u or .25. Last time she got .5 her BG went down to the 60's.

Is it a bad thing to just give Lantus sometimes, depending on BG or, since she hasn't had it in 96 hours, to ride it out and wait to see if BG goes back down? I think Lantus would be more effective if given on a schedule or is it ok to give once in a while, depending on BG?

I got labs I will add to the ss today. Her labs had improved from her hospital stay and she got a B12 shot and some sub-q fluids. She's a little anemic, which the vet said we'll watch for now.

Thanks!!

 

[Tracey&Jones (GA)]

Lantus works better with consistency. So does preventing DKA.

I hope someone with better experience comes along.

 

[Joanj]

Just too her BG again 2 hours later snd its down to 141. No insulin given.

 

[Tanya and Ducia]

I think Lantus would be more effective if given on a schedule or is it ok to give once in a while, depending on BG?

Hi Joan,
Lantus works best if given the same dose 12 hours apart consistently. When you restart shots - if you'll have to do it at all - I would try quarter of a unit, not half each cycle. Unlike with older types of insulin you base your Lantus dose on the nadir - the lowest in each cycle and not on the pre-shot numbers.

What did your vet say about Lucy's number w/o insulin? Any comment on SS?
Does the vet thinks you should resume insulin therapy?
Any word from vet on ketones level?

I hope you'll get negative read on that one soon!

Ducia too was anemic after her DKA - resolved with food and hydration in less than 6 weeks, no medication was ever needed (touching the wood). I could not confirm her suspected pancreatitis at the time of her release so we focused on feeding well and were giving her Cerenia. It has an anti- inflammatory properties in addition to anti -nausea, perhaps that worked but we never needed any additional meds for it.


ETA: sorry for the barrage of questions. I am just trying to understand slightly unusual case of good numbers and ketones possibility...

ETA: I forgot to mention that regular sunbathing is good for anemics too.

 

[Joanj]

I updated my ss with lab results from the hospital and from yesterday. Looking back, I'm not sure the vet clued in on the no insulin part. I did tell the tech her last insulin was 6/8 but he focused on the lab tests and there was so much info flying around I forgot to clarify about the low BG and no insulin.

He did say he didn't think the pancreatitis was still an issue so didn't suggest pain meds.

I'm understanding that it's better to go ahead and stay OFF the insulin in a case like mine with pretty consistent low numbers. Starting and stopping isn't a good idea.

I have been taking her out into the sun for a little each day so we'll continue that. The vet told me to just focus on more food and enough water. He suggested something like Gatoraide to mix in with the food for electrolytes but I have pedialyte so I put some of that in with the water I'm doing by dropper and also into her food to make it thin enough to do by syringe.

The vet tech fed her 40cc yesterday and I watched how she did it. Larger syringe, which she gave me one, and her technique works better than mine too so hoping to get the required food down more easily.

I didn't see on the lab test that they did ketones. I ordered new test strips at the pharmacy and will do one today.

 

[Tanya and Ducia]

I'm understanding that it's better to go ahead and stay OFF the insulin in a case like mine with pretty consistent low numbers.

I would agree with that IF the ketones test turns out negative, preferably consistently so in a couple of days.
Now that we know that being in good numbers does not prevent ketones development testing urine is going to be very crucial factor in decision making whether to shot or not.
Link to a post about it: http://www.felinediabetes.com/FDMB/threads/12-08-oldtimer-alex-update-ketone-awareness.84669/

It is very odd they didn't run ketone check... I would ask to talk to the vet about it - just a phone conversation..
Lucy had some on May 31 test - 50 mg.
I might be mistaken but it is possibly a Moderate level.
@Chris & China Chris do you know how what ketone level 50 mg is?


ETA: Joan, thanks for uploading the blood works. I am no expert , sadly, but I would talk with the vet about her low Potassium level. You mentioned earlier that Lucy received some saline via IV at the vet. It is often that vets prescribe Lactate Ringers Solution subcutaneously instead - it contains Potassium and that's what helped us to restore Ducia's low P levels. I could never manage giving her Potassium Gel via syringe, but you certainly much better than me at the assisted feeding. Another thought I'd like to throw in is that her MCV is slightly elevated. With human patients it could mean lack of absorption in intestines. Ask you vet about it too. She is anemic ok but you already are doing all that's needed - food and hydration. Perhaps Lucy can benefit from a short course of LRS sqf which you can do at home?

 

[Joanj]

The vet just suggested adding pedialyte to food and water. I can ask to do some lRS at home. I put a call in to the vet. The tech said its unlikely a newly diagnosed cat would go into remission. She said if she was in remission shed be eating and drinking on her own.

 

[Joanj]

I guess what im afraid of is the vets going to have a stroke cuz i havent been giving the insulin and because im using the ReliOn.

 

[Tanya and Ducia]

The tech said its unlikely a newly diagnosed cat would go into remission. She said if she was in remission shed be eating and drinking on her own.

Hm...not to contradict to the professional but I have heard too many odd things from vets...
Certainly, eating on her own is paramount.
.." The tech said its unlikely a newly diagnosed cat would go into remission."... how does she explain good numbers - and good numbers w/o shot after eating High Carbs Gluco?

 

[Tanya and Ducia]

I guess what im afraid of is the vets going to have a stroke cuz i havent been giving the insulin and because im using the ReliOn.

lol.., some vets do that.
My vet thinks that any number below 150 is Karo involving emergency. So he does not get to see our SS - for his own sake; I too fear he gets stroke or poop himself, .

 

[Joanj]

Does your vet know you use a ReliOn and if so what do they say about that.

 

[Tanya and Ducia]

Does your vet know you use a ReliOn and if so what do they say about that.

He recommended human meter when Ducia was Dxed but only because I openly admitted to being penniless. He understood.
I never speak FD with him - not only because he disapproves strongly of my dosing but because I can see it in his face - he has no clue what my Relion numbers mean.

 

[Joanj]

My vet wants her to come in tomorrow for a glucose curve and compare our two meters during the time to get a better idea for her own use. She said if the numbers are this low and shes not eating there may be something else goin g on. She said to continue to force feed will lead to decline anyway. Do you think so?

I may get to the point where i have to decide on quality of life for both us us if things dont improve.

 

[Tanya and Ducia]

She said to continue to force feed will lead to decline anyway. Do you think so?

I think this is complete baloney.
Or at least being so certain so early on that road to recovery makes it sound baloney.
I do not mean to disrespect your vet.

Yes not eating is the worst but I think there are some things that could be tried. Lucy is home so very recently, we do not know what wrong was with her. I think it is a little too early to be sure she won't start eating. IMHO anyway.

One thing I would try is to talk to the vet about trying another appy stimulant and anti nausea med if the current one isn't working. I never used anything but Cerenia + Mirt but others successfully used human meds like Ondansetron or Cypro - or the combination of both with Cerenia.
@Chris & China Chris do you have any info on which human meds helps?

Another thing is that she might be slightly dehydrated it is not helping with the appy. Her Potassium level is low and it can explain her low energy level. Until something is done to improve the P level it is inaccurate to take her weakness as a sign of sure deterioration. Both can be helped with LRS SQF at home - dosing and frequency to be set by the vet, of course. Again, IMHO only.

I mentioned the Esophageal Tube before. It did save Ducia. HERE is the link to Dr. Lisa Pierson blog - there is great informative section on the subject. And I can attest that caring for cat with the tube is not difficult at all, honestly.

These a few things I'd try or at least discuss with the vet.

PS. 2 vets told me - on separate occasions and days - that Ducia would not make it because - and the long list of possible ailments followed none which thanks Gawd came true. It was 15 month ago. She is doing fine.

What did yo vet told you to do with the dose for tonight?
Did she recommended to shot?

 

[Joanj]

No she didnt say to change anything. Lucys BG was down to 104 anyway a few hours ago.

My biggest concern right now is how much more money is it going to cost to figure all this out? More meds, more blood tests, the glucose curve tomorrow. At some point i will have to call it quits if she doesnt improve. Im willing to keep syringe feeding but might have to muddle thro without more blood tests. Well see tomorrow what the outcome of the curve is.

Another issue is, I'm not sure I'll ever get her to eat 2 cans of fancy feast a day. Ive tried to get her off dry food before but shes never been interested except a little fancy feast fish pate type some mornings.

I guess I'm just depressed and stressed over this and cant imagine what it would be like to have my life back. 4 dogs, another cat, a busband and all housework is pretty much being neglected right now.

 

[Tanya and Ducia]

My biggest concern right now is how much more money is it going to cost to figure all this out?

I understand this so well. And unfortunately way too many people on this Board alone are worrying about the same thing..
I am sorry you have so much on your plate right now. I wish things get better very soon!

At some point i will have to call it quits if she doesnt improve.

You are the only one who knows Lucy best and if the time come you will find what's best for everyone. Managing FD and family/social life is one tough balancing act. If Lucy no longer appears happy or no longer does cat things like purring, grooming, going to the litter box on her own then it is different picture. But I was under the impression that Lucy was not perky but still doing the cat business..

When I was considering some expensive tests for Ducia someone on here pointed me to the Care Credit. It is sort of a cred card for medical and vet expenses. Many clinics accept it. What is good about them is that they won't charge interest if you pay off in full in 6 months. Many on the Board used it for dental, for instance.
https://www.carecredit.com/apply/


I thought it could be good idea to re-post with the Title line edited to ask advise on not eating and what kind of meds were proven helpful . I never used anything other Mirt and Cerenia and not familiar with the treatment but many on here have. If ppl comment with the info on meds you can discuss it with your vet tomorrow- if she see the point in it then she might write you Rx and you''ll save on another visit. My vet charged me about $60 per bag of LRS +lines and later I learnt that I could have gotten it from any human pharmacy for less than $20.

I guess I'm just depressed and stressed over this and cant imagine what it would be like to have my life back.

Things do get better with time, I promise. It is a lot to take in a few very stressful weeks. Try to get some rest.
Sending good appy wishes to Lucy!

 

[Joanj]

Thanks so much for your support. It means a lot.

My stepdaughter had to do the LRS and got it from costco for fairly cheap.

Thanks for the info on care credit. Maybe I'll give that a try.

 

[Tanya and Ducia]

You are welcome!
Please talk LRS therapy with your vet first - do not start it yet.
Dosage and frequency has to be very carefully calculated BC over watering might over load the heart and could be very dangerous.

I could not pay for Ducia's tests at the time of her being in DKA and she was released from ER "suspected " to have triaditis, pancreatitis, jaundice, etc., etc. But whatever findings the vet was expecting from additional $$$ tests would not alter the course of treatment - mostly food, hydration and insulin so we focused on it. The follow up blood test was done month or so after the DKA; the next one (and the last so far) 6 months later. I am still a little tight on the budget . But what's important is how well Ducia recovered on mostly food and water - you can see the progression of blood values improving over time in her SS/LAB tab. (BTW, you can see that Lucy 's BT results are better than were Ducia's in March or April 2017. )

Hang in there!

 

[Joanj]

Thanks, I will! She actually seemed a little more alert this evening. Its good to know you had such success with the basics.

Since shes going in for a curve tomorrow, if they want to give her some RL, Ill ok it and ask about doing it at home for a while at least.

Her BG was 105 tonight. I told the vet I'd seen higher numbers in their office than here at home so hopefully she wont freak out if hers are high and tell me to restart the insulin now despite my low numbers.

 

[Tanya and Ducia]

Her BG was 105 tonight. I told the vet I'd seen higher numbers in their office than here at home so hopefully she wont freak out if hers are high and tell me to restart the insulin now despite my low numbers.

Hers are going to be higher if she like all/most vets uses pet calibrated meter, like Alpha Track.

Actually, I was wondering today if restarting her insulin at a very small dose would be good...
Lucy overall numbers are lower than recommended to shoot for someone in the beginning but you already have some data and stocked w Hypo Tools (right?). And you feed and could test late... I was hoping to hear from someone on the Board about the dose.

Talk with your vet about it after the curve is done. Lucy went very low - 49 on 1U dose. Then she got a pre-shot numbers of 68 on 0.5 - it was certainly too low for you to shot on that night.

But now numbers are higher a little and maybe some insulin would help get things back on track. Besides it is still unknown if she has ketones. If one to err on the side of caution and assume that she does then shooting a little at a lower than usual numbers might be a necessary risk to ward off ketones .

Keep us updated - sending good vetty wishes to Lucy!

 

[Joanj]

Thanks, i will! Yes, I have insulin and syringes so i could do low dose. Hopefully .25 or .5 wouldnt send her too low. Ill see how her alpha trak matches up to my Relion also.