Marilyn in Trouble? Rebound? Help Please.

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Barn Cats R Us

Barn Cats R Us

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Hi All,

Not sure if Marilyn's in trouble, or not. She's feeling horrible within the last hour+. I'm nearing the end of her 2nd 12-hr curve, and her numbers, all but one, are higher than last weekend's curve. She was on 1 Unit Humulin N BID for last week's curve. The vet raised it to 2 Units Humulin N BID, last Monday. I would've rather increased a half unit only, then I wouldn't be wondering, or confused, about rebound right now. When I lifted her up for her BG test a half-hour ago, she was making little noises...like maybe a painful abdomen...I don't know.

I have Relion Ketone Test Strips here, but they are of no use to me, since I can't do a free catch in my situation. I've been searching for the Precision Xtra meter, but I'm having problems locating it in stores...and right now, since I don't have it, it's neither here nor there. She's due for insulin in a little over an hour. Should I give it now? Do Sub-Q fluids help with ketones? If she is rebounding, an early insulin injection wouldn't be helpful, correct? I'm confused; I only started wrapping my head around rebound a couple nights ago...and I don't fully understand it yet.

Thanks,

Deb
 
Deb,
Don't shoot early. I'm looking at her SS and I am hoping others will see it before shot time too. back shortly.

Carl
 
I have no experience with Humlin, so I am hesitant to answer regarding your dose. But, I do unfortunately have experience with ketones.....Yes, sub qs are helpful in ketone treatment. The painful abdomen makes me think more of Pancreatitis than ketones. I give my Kitty, sub qs twice a week and have given an greater intervals---she has chronic pancreatitis.

If you suspect ketones, I would be hesitant to reduce the insulin dose. Ketones are the combination of a lot of things, but insufficient insulin is a primary culprit.

I have not looked at the SS, but if you suspect rebound...do not increase your dose.

Carl, stated he is reviewing the SS, so hopefully he will have advice based on the spreadsheet.
 
Deb,
Have you seen any ketones with her so far? I know you're juggling two sugarkitties, and trying to keep them straight.

Fluids won't hurt, so fine that you are giving them.
Couple of other questions....
Is her abdomen tender when you touch it? Does she seem like it hurts when you do?
Is she showing any signs of dehydration?
Are her pupils dilated?
Does her breath smell like nail polish remover?
Is she eating ok?

Re: her SS. You see the two nights in a row when she went down to "blues"? I think what you have seen since then is "bouncing", where her liver has dumped glucose into the system because she went "too low" at least as far as her liver is "thinking".
the danger with reducing her dose would be that the numbers may continue to go up. And with higher numbers, the risk of ketones goes up. Same token, if it is "rebound" we're looking at, increasing the dose isn't a good idea either. It'll just keep the cycle going....

I think I would suggest dropping her dose tonight to 1.5 units. With that, you really need to try to get her to pee on a stick in the next 12 hours, to rule out ketones.
The tummy soreness/pain concerns me. If it's pancreatitus, that means the vet most likely.

Before you shoot, feed her and make sure she eats okay. Food in tummy is important. No food, you can't shoot, or would have to reduce even more.

I'll be on for a while, so post as you can.
Carl
 
Can you smell her breath? Does it smell like nail polish remover (acetone)? If yes, go to the vet, do not pass go, do not collect $200 (unless you're planning to hand to the vet, of course)

Pancreatitis can be very painful. Will she let you gently massage her belly? If no, its painful enough you probably should go to the vet.

Otherwise, some options.
If she has an upset stomach, 1/4 of a 10 mg Pepcid (not the complete, the basic one), may be helpful.

If it is milder pancreatitis (she will let you touch her belly), fluids may be helpful. And a morning office visit to the vet would be a good idea.

It could be something else entirely, so if she worsens, again, go to the vet.

The Humulin is so short acting that going to a TID (every 8 hours) dosing cycle may get you better control. You can see that your lowest point is roughly 4 hours from the insulin, suggesting that the insulin is only effective for 8 hours.

I am not seeing the classic checkmark sign of a large glucose drop followed by a huge increase, which would suggest rebound to me. Nor do I see that pattern of high, high, high, suddenly LOW which also suggests the dose is too high.

I'm thinking you might increase 1/2 unit for the next shot, IF you can be up to check at around +3, just before what appears to be the nadir. Have ready some higher carb food, just in case.
 
Hi Everyone,

Don't know if anyone is still awake. I really have to get my hours switched around. I apologize for causing a commotion at these hours. I will update spreadsheets shortly. Since I last wrote, I found a deer tick on the Rotty (had to remove it), and the Pom's trachea started its' collapsing "thing", since he sensed my stress.

Okay, Marilyn's #'s are back on the meter; still high, but not off the meter. Gave 150 mL LR SQ at 12:15 AM EST. I "massaged", or pressed lightly around the abdomen; she didn't make any verbal objections, or squirm. Offered her a 1/2 can of DM, and she dived right in; almost had half eaten by the time I had her insulin injection ready. I did give her usual (usual for the past week) 2 Units Humulin N. Unfortunately, I forgot to smell her breath before I gave food. I can only smell "fish" now. I can check again later, as it looks like I will be up until sunrise...at least. I can keep BG monitoring, and maybe give her a half until in a few hours, if need be. I'm getting ready to take another BG now, since she ate.

Sorry, I'm a little panicked, and not sure if I'm missing anything. The ketone strips are a no-go here, I must obtain a meter. If it wasn't so hard to find, I would have it, and it would have taken away, or confirmed, one of my panic pieces to the puzzle. Again, sorry to have bothered you all this late. I don't know what I would've done without you.

Thanks ever so much,

Deb
 
Correction, I will only give another half unit, in a few hours, if you guys confer; and you would have to be awake to do that! I gave the usual 2 units, since it was mid-point between the 1.5 and 2.5 units suggested above. Since both explanations seemed reasonable, I split the difference. Thanks again.
 
Hi Deb,
Don't worry about the commotion, we're used to it here! Good on the fluids, and good that she doesn't seem to mind you touching her belly. The 2 units is okay. I am hoping to see her numbers come down in the middle like they did for a couple of nights.
I bought my blood glucose and ketone checking meter at walgreens, not sure if there are any close to you. It is called a nova max plus. Strips are hard to find unless I buy them online though.
Don't give insulin "in between" the normal shot times quite yet. Hopefully we'll be able to get you switched to a "better" insulin, one that lasts closer to 12 hours, but if you start shooting more often before we can figure out exactly what might be going on with her, it'll make it harder to figure out. Humulin could be shot every 8 hours like BJ said, but it'd be better, I think, to see some sort of consistent patterns in her numbers first.

don't apologize. you aren't bothering us. this is pretty much why we're here after all. :smile:

Carl
 
Hi Carl,

Okay, smelled her breath again...still "fishy", so I guess it's a good sign that food is the strongest odor I can detect. Hopefully it's not strong enough to mask an acetone odor (?). She's acting okay; this might sound odd, but I can tell when she's feeling really bad by the "shape" of her eyes when she looks at me. She's looking better now...but then again, her numbers have come down. I agree about not going TID on insulin yet; would rather get a better understanding of what's going on first. Might not be able to gain an understanding with the Humulin...who knows what chaos Clarky went through all of those months...I only know, with him, the outcome (so far) is the best you can hope for; any permanent damage from aforementioned chaos, will more than likely rear its ugly head later, I'm sure.

I'm just not getting the consistently higher numbers on the second curve. Her dose has doubled; she's been on the low carb DM twice as long, and had dry DM discontinued...I'm just not getting it. That's why I panicked, thinking I jumped past her required dose, by doubling the original dose (start low, go slow...lol). Maybe she was making her "squeaky" noises as I was handling her, simply because she felt so crappy from the extreme BG...I don't know. I only know she's not "squeaking" now. She's such a little, sweet, funny kitty...unless you ask her giant-sized brother, Wolfy Munster.

I had already done some research on the Nova Max. I saw some reviews that claim the test strips don't seat well; don't make contact...have you had this problem? I've seen the Precision Xtra Ketone Strips online from $50, upwards to $90...FOR 10 TEST STRIPS! There's nothing I can do about this. I have to acquire a meter ASAP, since the urine test strips simply won't work for me. I'll see if a friend will check-out Walgreens tomorrow in person, since I don't have the luxury of time to continue searching the web. Wow, I'm half past delirious...must sleep.

Thanks again...I was quite frightened...and thanks to all who came to my rescue.

Deb
 
By the way, a vet is coming to the house, this coming Tuesday, for rabies vaccines. I attempted to have Marilyn declared exempt, with everything her body is going through right now, but the answer was no. Any thoughts on this? Seriously, I must sleep now...right after this last BG....
 
The Nova Max has had some negative reviews. The one time I used it it didn't match the urine ketone strip results and at the vet later, Spitzer did not have ketones. (He doesn't have much fat left to burn, so that may be why - unregulated still, d*mn it).

Since your cats are outdoors and have a higher risk of exposure to animals which could be rabid - raccons, for example, are being giving vaccine via baits in PA and OH - it is safer for them to be vaccinated, than not.

Read more about standards for rabies vaccination here:
Compendium of Animal Rabies Prevention and Control, 2011
 
Another option might be to occasionally corral the cat in a large crate, like a 4' long dog crate, with a clean plastic tray of aquarium gravel. To test, tilt the tray one direction, shove the non-absorbent gravel the other direction and dip strip.
 
re: fluids - keep the fluid injection on a different side from the insulin injection as it may adversely affect how the insulin works.
 
Be careful with the fluids.....a healthy cat can take being given 100 mls if it may feel dehydrated, etc. but......giving 150mls is a little heftier amount with no proof it is even needed. With no knowledge of possible kidney or heart problems I wouldn't push the envelope with 150. If you feel fluids are needed, I would suggest b.i.d. of 75 mls.
 
The curves you got yesterday and today are typical N curves. You can try increasing the dose if the BGs remain like they are now. When I started treading Tone earlier this year I first got a good response to the insulin (I started on Lantus) but then I got little response on Lantus but did see more response with N. I switched to Levemir with similar results as with Lantus. I even go some Hi's. I kept increasing the does and non Tonis is doing good on about 8 units of Levemir and 5 units of N twice daily. I still get unexpected BG. Like yesterday's PMPS was 88 so he only got 6 units of Levemir. This morning he was 264 which is about 50 higher than normal.

Remember that each cat is different.
 
BJ: They are all strictly indoors, for years now; I think the "no" answer regarding rabies vac exemption, was because she bit a vet tech last week. It's better safe than sorry; you never know when a rabid bat will fly through the door in these parts. I only wanted to put if off until she's feeling better...but I'm not the one getting bitten (heck, she only has like 7 teeth left, since her dental surgery a few years back!). Also, Marilyn has a large "cat condo" type cage, about 4 feet high. Right now it's split in two, and she's on the top half for easy access. She requires a cage at feeding time, or she would never get her share, and would have perished a long time ago. I was just about to discuss the litter box...when the phone just rang. A friend just found both the Precision Xtra, and the Nova Max at CVS. I told him to get both. The Nova Max is $20 and comes with 2 ketone strips; they didn't have "just strips" in stock. The Precision Xtra is twenty-something, with 10 strips costing sixty-something. If the Nova Max matches up, I'll probably have to go with it, in the future, since I'm guessing its' strips will be more reasonable cost wise.

That's good thinking about SQ fluids vs. SQ insulin. The thought crossed my mind, but I couldn't remember her last insulin injection site. I'll have to make note of these details on her chart...it's quite the balancing act.

Larry: It sounds like you both have had a rough time. I hope that's not where we're heading; I don't know if I can deal with it.

Hope: Thanks for your concern. Marilyn had a complete physical, and blood labs, done last week. Luckily, it looks like I'm only dealing with FD and dehydration.

Thanks all,

Deb
 
Do I wait until Marilyn's BG levels are back over 300, before testing for ketones? These strips are like gold; don't want to waste any. Thanks. Deb
 
Humans get a warning to test for ketones when over 250.

And ... each cat is different. SPitzer has been running up over 300 ... as in 400s, 500s, or "HI" - consistently because I can't get him well regulated, yet he doesn't seem to have them. Other cats - at 250 they're going into ketoacidosis. Watch for tell tale signs - lack of appetite, ketone breath (smells like old fashioned nail polish remover due to the acetone in it), listless, just ADR - "ain't doing right" Thats when you test. When in doubt ... test. Routinely, maybe once a week if you can and the glucose has been running high.

If you're routinely crating her to make sure she eats, the urine testing may be done as mentioned above. Other tactics used include putting plastic wrap over the litter so urine will puddle, and using a long handled serving spoon to go for the catch.
 
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