Oct 7 Felix HOME FROM ER; +8.5=200, PMPS=179

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Susan&Felix(GA)

Susan&Felix(GA)

Member Since 2017
previous thread Oct 6

I woke up this morning to Felix vomiting small amounts of liquid multiple times, the kind that suggests an empty tummy. There was a little dry EVO still in his bowl, so I figured if he hadn't eaten it to settle his stomach, he was possibly too nauseated to eat. But he was very hungry! Although we were within the two-hour-before-AMPS window, it seemed like he needed to eat if he would. Once he ate, he seemed to feel better.

He tested 83 at +9.75, 83 again at +10, and 102 at +10.5.

It's +11.5 now, and I may be shooting lower than I have before. I wonder how low he went last night. I guess he's earned another reduction (SLGS).

Would you shoot 5.5 units (he's been on 6u for three days), assuming the AMPS test is still moving up? I can monitor today, although I'll be out the first hour or so after his shot (to pick up a couple foster kittens from their spay/neuter at the vet).
 
See where he is at AMPS. Usually when you shoot lower then you have we recommend starting with a +1 & +2 test. Would you be back by +2? With DKA in the mix it's better to shoot. Also remember the 6u depot will be at play for the first 4-6 cycles. My guess is he may bounce today but he is a cat and I could be wrong.
 
Yes, I would be back by +2. He was heaving again just now but didn't bring anything up. I'm concerned about not being able to get him to eat. When he went down to 40 the other day, he loved the Karo, but it may be trickier with a tummy ache in the mix.
 
It does make it trickier with tummy upset. I had to use honey over karo with Doodles. The karo would make him vomit, he had food allergies and not a food motivated cat. Have you gotten the AMPS yet? Another option would be to shoot when you get back if you can be that far off schedule.
 
AMPS=102. He was under the bed (probably from foster kitten running around), but he purred and ate a little when I pulled him out, so I shot 5.5 units. He then came to the kitchen and asked for more food. The kitten is shut in her room and he's out on the couch in good spirits.

I'll ask about the cerenia or ondansetron.

Better hurry out now so I can get back.

Thank you! :cat::cat:
 
Thank you for all the vines, everyone. I am so touched and appreciative. :bighug::bighug::bighug:

We were at the ER vet about five hours, but most of that time they weren't actually actively working on Felix. It's a busy place, so they took him in back fairly quickly to get his vitals and did a couple glucose tests, but mostly they were squeezing us in between other things.

We don't have a diagnosis, so treatment is for symptoms. Eventually, he got subQ fluids, an injection of maropitant (Cerenia), an injection of famotidine (Pepcid), and his first dose of Sucralfate liquid. I'm going to have to ponder on that last one in relation to his insulin schedule, because it's three times a day, no food two hours before or two hours after. :confused: He had a CBC and comprehensive panel, which the doctor said was "boring"--that's good! If the bloody vomit doesn't resolve, they suggest x-rays, ultrasound, and possibly endoscopy.

Overall, the vet seemed more concerned with Felix's diabetes not being controlled than with the bloody vomit. The doctor was impressed with the printout of Felix's spreadsheet and the data gathering that went into it (he whipped out his phone and took photos). He was not impressed with Felix's dose, which he said is way too high and he should go back to 4 units starting tonight. He's also not impressed that my regular vet isn't the one changing the dose based on curves every couple weeks. He told me that human meters run lower than pet meters and that results diverged more in higher numbers, so the low numbers really bothered him but he was aware of not being oriented to them. But he suggested nadirs should be 150, and below 100 is scary bad.

I took Felix's test kit, thinking I could monitor his bg, too, while we were there since my numbers have the ss as context, but he spent all his time in the back, not in the exam room. On their meter, they got 86 (around +2) and on their Catalyst (more accurate?) a 91 (some time between +3 and +6). That seems low under the circumstances. Felix has gone into hiding and I haven't gotten another test, but I think I'll try now that he's had a little quiet time to himself.

Again, many thanks for all the vines. It meant a lot on this worrisome day.
 
Some cats do low after a vet visit. Do get a few tests in.

I hope the sucralfate works. However, sucralfate is sucrose and aluminum hydroxide. https://www.petrescuerx.com/index.cfm/product/96_136/sucralfate.cfm

http://chealth.canoe.com/drug/getdrug/sulcrate
Diabetes: People with diabetes have reported high blood sugar levels while taking this medication because the liquid form of sucralfate contains carbohydrate. It is important for people with diabetes to monitor their blood sugar levels while taking sucralfate liquid.

Taste a tiny bit and see if it is sweet. If so, expect Felix's numbers to rise. You may want to contact your vet and ask if there is something similar that can be tried.
 
I asked if it would affect his glucose ("Sucra-" was a tip off!) and they said no. But yes, I'm thinking what you're thinking.
 
I'm considering 5 units tonight, but I want to understand back-to-back reductions. :bookworm:

He got back up to 200 by about an hour ago (+8.5).
 
I think I'd go with the 5.5

We don't do "back to back" reductions because of the depot......His depot was up to 6U when you reduced this morning so it's still "draining" ....You won't see the full effect of the 5.5U dose until the depot is stabilized at that dose again.
 
Found this info on sucralfate. Did the vet say they suspect an ulcer?

Susan&Felix said:
He told me that human meters run lower than pet meters and that results diverged more in higher numbers, so the low numbers really bothered him but he was aware of not being oriented to them. But he suggested nadirs should be 150, and below 100 is scary bad.
Click to expand...
He's correct about the difference between human and pet meters, but as long as you stick to the same kind of meter, you can still monitor safely. Did he mean 150 and 100 on a pet or human meter? I have found most vets feel that way. You might consider printing out the Roomp/Rand paper on TR and giving it to him to read, if he hasn't already seen it. Just because he isn't used to clients that monitor and handle their cats' FD at home doesn't mean it can't be done safely and successfully. I think we have proven that here!

Sending more healing vines.
 
Thank you, Chris, that makes sense. Plus he may start running higher since I'll be giving him sucrose the next few days. The vet got me a little jumpy with how emphatic he was about going down to 4 units. But I've realized, since we were at 4 units per the regular vet in early July and were being raised 1 unit every three weeks based on a fructosamine test, we'd have gone higher than 6u by now ... and think what could've happened.

Tricia, yes, the vet thought either a damaged esophagus from the heaving to bring up a little bit of liquid several times in the morning or possibly an ulcer. There were other possibilities, too (scary stuff), but they would take more extensive testing, so we're hoping the simplest approach works through the weekend and will pursue it with Felix's regular vet if necessary.

I think he meant a pet meter for the 150 nadir, with 100 feeling to him maybe how 30 would feel to me. As an ER vet, he's not Felix's regular doctor (nor anyone's regular doctor). Maybe our regular vet would take an interest in the protocols, though. Felix says thanks for the extra dose of vines.
 
It helps to realize that most caregivers of diabetic cats do not home test. I suspect it's for that reason that vets are apprehensive when it comes to seeing a diabetic cat that's in normal numbers. Since they likely are assuming a liability, they want the cat to run in higher numbers for safety's sake. However, we all home test and everyone learns how to steer lower numbers with food. It puts everyone here in a special class of caregivers. It also takes a bit of wrangling with some vets about our following dosing methods that push for a cat to be at the least, tightly regulated. I really do wonder how a vet tells someone that a diabetic cat can go into remission but the cat shouldn't be in normal numbers. It makes me scratch my head!

I really do hope that all that happened was that a capillary broke from Felix's retching.
 
Tricia Cinco(GA) & Harvey said:
You might consider printing out the Roomp/Rand paper on TR and giving it to him to read
Click to expand...
This is what I did, when I changed vets from my old one to my current one. I think it really helped him, not only to understand what I was doing with Squallie's treatment, but to ease his mind that I was actually following a published protocol and not just "winging it" as I go! He has never actually treated Squallie for his diabetes, and when he was there last week his vet admitted that the low numbers scare him, but not to change a thing in my treatment, it was working great and Squallie was doing amazingly well!
 
Thanks again, all. Felix does seem to be feeline better today. We'll hope that means he truly is better--but a cheerful kitty is always a wonderful thing.

Sienne and Gabby (GA) said:
... vets are apprehensive when it comes to seeing a diabetic cat that's in normal numbers.....I really do hope that all that happened was that a capillary broke from Felix's retching.
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Thank you so much for mentioning a possible broken capillary. I'd been skeptical about the too-much-retching explanation because I was imagining blood from retching would be more like streaks from an abrasion, and it was more than that. But broken capillaries, those little dickens can really bleed sometimes. This will help me withhold my frantic worrying until/unless I find out there's something bigger to worry about.

As for the vet, being at the ER, most diabetics he sees are probably DKA or hypo, so he sees the result of uncontrolled FD but not the process. Maybe if he studies the spreadsheet he took pictures of, he'll see how only a curve run one day would have made him prescribe to reduce the dose by two units, but had the curve happened to have been run just the day before, he'd have prescribed to increase by a unit. Maybe it'll dawn on him how much is hidden between curves.

Squalliesmom said:
I think it really helped him, not only to understand what I was doing with Squallie's treatment, but to ease his mind that I was actually following a published protocol and not just "winging it" as I go!
Click to expand...

Excellent point.
 
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