Questions for newly-diagnosed Stan

[Kshoopla]

Hi everyone! Thank goodness for this site…I’ve been reading as much as I can this past week but have a few questions about the direction we’re headed. Need advice!

Stan-the-Man is 14 and was diagnosed last week after almost dying :-( On day 2 of barely eating and being very weak and wobbly, we took him to the vet on 11/8 who palpated a lump in his stomach. An x-ray showed what looked like a foreign object in his colon. They drew some blood, gave him an IV, and had us come back the next morning for re-X-ray.

No change in the blockage, and they were alarmed at his blood results…the vet said she had never seen electrolyte numbers all over the place like that in her 17 years of practice. Basically his potassium was severely low, glucose was 311, cholesterol 490, other things high, some low. They told us to take him to the ER, so we drove the 4 hrs to one that wasn’t full.

They put him first after triage. They saw NO blockage in the X-ray, which they said was poor quality on the CD, and he hadn’t even pooped since the first one. Ultrasound showed constipation and a very inflamed pancreas. They diagnosed fatty liver disease and severe pancreatitis, inserted a feeding tube, decided to keep him overnight, and supplemented him with IVs and potassium. They also got him to eat Tiki Cat.

As we were driving home, they called at 10pm to say a UA showed sugar in his urine, he’s diabetic, and that we would have to decide if we could commit to treating this long-term serious disease. I was obviously freaked out and confused by the whole string of events. We also have 5 other indoor rescues that just free-feed dry food.

We were able to pick him up the next day after his eating and glucose levels stabilized. A new vet tech who was very nervous gave us a quick “air tutorial” with no props …just inject 1 unit into the tented skin between his shoulder blades twice per day, 12 hrs apart.

We were able to pick up Fancy Feast classic on the way home (I had already started studying this website!), some Glargine and needles, and I ordered a Glucocard Vital meter with lancets and test strips. Oh, and just yesterday on 11/17, a vet from the ER called and said they found E-coli in his urine (this is 8 days later!), so we picked up a liquid…so he Stan has to be tortured with awful-tasting 1 mL doses, clumsy ear pricks as we slowly improve, and shots (the easiest of the bunch!) :-( We now feed all the cats wet food at 10am and 10pm.

Here are my questions so far (We do have a vet appt on Monday 11/20, and I now know that we should present our own mini-curve to them):

1. He is only eating maybe 3/4 of a can of Fancy Feast each meal, which doesn’t seem like enough calories? He’s 9.6 lbs. And if he were to only eat 1/3, for example, how the heck do you give only part of an already small dose? We stick the needle into the rubber end of the Glargine “pen”, and one unit is already so tiny.

2. Since he doesn’t eat much, can we give him a snack in the middle of the day? The vet said two meals only, no snacking. We do give him maybe two bites around 4pm while we give the other cats more food. We haven’t been doing insulin afterwards. Today we’re tracking all the numbers and will see what his nadir is around 4pm before his snack. I’m also wondering if that antibiotic we give him is altering the numbers…it smells fruity and sweet.

3. We’ve been giving him his shot 15 min after he eats. I’ve seen everything from giving the shot during feeding, all the way up to an hour. I haven’t seen a clear answer anywhere.

4. Finally here are the numbers we have so far. I haven’t found a chart anywhere that clearly shows when to test, what the ranges should be, and how much insulin to give accordingly.

11/17 10:15 pm test (15 min after eating and before his shot): 256

11/18 10am (before eating): 345 (high-stress event trying to get blood)
15 min after eating/antibiotic: 307, gave 1 unit insulin
An hour after his shot: 276

We’ll test the rest of the day also. Any feedback is truly appreciated!

 

[Sienne and Gabby (GA)]

Welcome to FDMB!

It really sounds like you've made progress getting Stan set up for success. A request to keep you heading in the right direction -- This is a link to a post on helping us to help you. It contains instructions for including information in your signature so we don't keep asking you the same questions over and over again as well as how to set up a spreadsheet. We're very numbers driven as you've probably noticed. Most of us are very cautious about giving dosing assistance if we don't have a spreadsheet to guide us. If you need help with getting Stan's spreadsheet, Bhooma (@Bandit's Mom) can lend a hand.

First, great job on changing over to a low carb food. Second, ignore the vet's instructions about feeding only twice a day. If all of your cats are now eating low carb food and are used to grazing, it's fine to let Stan eat when he wants. The only snag is you don't want him to eat 2 hours prior to shot time. You don't want the pre-shot numbers to be influenced by food.

As for the timing of meals, the reason you're confused is that when you provide food depends on the insulin you're using. With short acting insulin (e.g., Vetsulin/Caninsulin), you have to feed your cat 20 - 30 min before you give a shot. This is because the insulin starts working almost immediately and if food isn't on board, numbers will drop hard and fast. Glargine (Lantus) is different. It doesn't start working (onset) for approximately 2 hours after a shot. Most of us will test, feed, and shoot all within about 5 to 10 min.

Basing a diagnosis of diabetes solely upon a UA makes me a bit nervous. Urine glucose tests are at best, unreliable. You will know more from your own home testing. However, since you have a vet visit scheduled, please ask the vet to get a fructosamine test. The sample will need to be sent out since vets typically do not have the equipment to do the test in-house. A fructosamine test is the equivalent of a hemoglobin A1c which is what is done for humans. It gives you what amounts to an average of blood glucose levels over the course of several weeks. Blood glucose levels can be sensitive to infection or inflammation so if your cat had other things going on plus the stress of spending 4 hours in the car, there's no way to be certain what was causing higher BG levels. What I would say, though, is the numbers you're seeing at home are in a diabetic range.

Another question: Did either your vet or the emergency vet say anything about diabetic ketoacidosis (DKA)? Typically, electrolyte values are out of whack -- low potassium, phosphorus, and magnesium, the cat is dehydrated, and ketones are present. It would be helpful to ask the vet about this since it's important to make sure your cat is getting enough calories to prevent ketones from redeveloping. If Stan isn't eating his usual amount of food and especially if he had ketones, you might want to ask about an appetite stimulant.

You don't measure the amount of your insulin dose based on how much Stan ate. The dose is the dose so you either need to stick to 1.0u or consider lowering the dose. Will Stan continue to graze if you leave food out? (FWIW, I would feed my diabetic cat 3 - 4 small meals over the first several hours of the 12-hour cycle.) If he will eat, then it's fine to give the 1.0u dose.

It is entirely possible that the antibiotic is in a sugar solution base. You may need to check with the vet's office to see how the antibiotic was compounded. Some meds are bitter and will make a cat foam at the mouth so the vets/pharmacy will use a sweet base. If it is a sugar base, it's going to have an effect on Stan's numbers.

 

[Wendy&Neko]

Hello and welcome to you and Stan the sugar man. I started typing, then I noticed Sienne had answered pretty much what I was going to say.

Just one additional comment, it'll take you some time to gather the data to know when exactly the best time to test is. But generally speaking ( and ECID, every cat is different ), a test two hours after the shot is a good indicator if there is going to be downward blood glucose (BG) action during the cycle, especially if that +2 number is lower than the test before the shot. Nadir, or lowest point of the cycle, is on average mid way or around 6 hours after. Saying that, Sienne's Gabby was more like 2-3 hours after the shot and my Neko was 7-9 hours after. We do decide how to change the glargine dose based on how low the dose takes the cat, so it helps to get those tests in the 4-7 hours after the shot time frame. And note, from cycle to cycle, there can be variability.

 

[Kshoopla]

Welcome to FDMB!

It really sounds like you've made progress getting Stan set up for success. A request to keep you heading in the right direction -- This is a link to a post on helping us to help you. It contains instructions for including information in your signature so we don't keep asking you the same questions over and over again as well as how to set up a spreadsheet. We're very numbers driven as you've probably noticed. Most of us are very cautious about giving dosing assistance if we don't have a spreadsheet to guide us. If you need help with getting Stan's spreadsheet, Bhooma (@Bandit's Mom) can lend a hand.

First, great job on changing over to a low carb food. Second, ignore the vet's instructions about feeding only twice a day. If all of your cats are now eating low carb food and are used to grazing, it's fine to let Stan eat when he wants. The only snag is you don't want him to eat 2 hours prior to shot time. You don't want the pre-shot numbers to be influenced by food.

As for the timing of meals, the reason you're confused is that when you provide food depends on the insulin you're using. With short acting insulin (e.g., Vetsulin/Caninsulin), you have to feed your cat 20 - 30 min before you give a shot. This is because the insulin starts working almost immediately and if food isn't on board, numbers will drop hard and fast. Glargine (Lantus) is different. It doesn't start working (onset) for approximately 2 hours after a shot. Most of us will test, feed, and shoot all within about 5 to 10 min.

Basing a diagnosis of diabetes solely upon a UA makes me a bit nervous. Urine glucose tests are at best, unreliable. You will know more from your own home testing. However, since you have a vet visit scheduled, please ask the vet to get a fructosamine test. The sample will need to be sent out since vets typically do not have the equipment to do the test in-house. A fructosamine test is the equivalent of a hemoglobin A1c which is what is done for humans. It gives you what amounts to an average of blood glucose levels over the course of several weeks. Blood glucose levels can be sensitive to infection or inflammation so if your cat had other things going on plus the stress of spending 4 hours in the car, there's no way to be certain what was causing higher BG levels. What I would say, though, is the numbers you're seeing at home are in a diabetic range.

Another question: Did either your vet or the emergency vet say anything about diabetic ketoacidosis (DKA)? Typically, electrolyte values are out of whack -- low potassium, phosphorus, and magnesium, the cat is dehydrated, and ketones are present. It would be helpful to ask the vet about this since it's important to make sure your cat is getting enough calories to prevent ketones from redeveloping. If Stan isn't eating his usual amount of food and especially if he had ketones, you might want to ask about an appetite stimulant.

You don't measure the amount of your insulin dose based on how much Stan ate. The dose is the dose so you either need to stick to 1.0u or consider lowering the dose. Will Stan continue to graze if you leave food out? (FWIW, I would feed my diabetic cat 3 - 4 small meals over the first several hours of the 12-hour cycle.) If he will eat, then it's fine to give the 1.0u dose.

It is entirely possible that the antibiotic is in a sugar solution base. You may need to check with the vet's office to see how the antibiotic was compounded. Some meds are bitter and will make a cat foam at the mouth so the vets/pharmacy will use a sweet base. If it is a sugar base, it's going to have an effect on Stan's numbers.

Thank you SO much for taking the time to write this! You’re amazing. I’ll digest this and read the link about how to make posts…along with checking which tests were done and answering those questions!

 

[Kshoopla]

Hello and welcome to you and Stan the sugar man. I started typing, then I noticed Sienne had answered pretty much what I was going to say.

Just one additional comment, it'll take you some time to gather the data to know when exactly the best time to test is. But generally speaking ( and ECID, every cat is different ), a test two hours after the shot is a good indicator if there is going to be downward blood glucose (BG) action during the cycle, especially if that +2 number is lower than the test before the shot. Nadir, or lowest point of the cycle, is on average mid way or around 6 hours after. Saying that, Sienne's Gabby was more like 2-3 hours after the shot and my Neko was 7-9 hours after. We do decide how to change the glargine dose based on how low the dose takes the cat, so it helps to get those tests in the 4-7 hours after the shot time frame. And note, from cycle to cycle, there can be variability.

Thank you so very much!!! Taking all of this in

 

[Kshoopla]

Welcome to FDMB!

It really sounds like you've made progress getting Stan set up for success. A request to keep you heading in the right direction -- This is a link to a post on helping us to help you. It contains instructions for including information in your signature so we don't keep asking you the same questions over and over again as well as how to set up a spreadsheet. We're very numbers driven as you've probably noticed. Most of us are very cautious about giving dosing assistance if we don't have a spreadsheet to guide us. If you need help with getting Stan's spreadsheet, Bhooma (@Bandit's Mom) can lend a hand.

First, great job on changing over to a low carb food. Second, ignore the vet's instructions about feeding only twice a day. If all of your cats are now eating low carb food and are used to grazing, it's fine to let Stan eat when he wants. The only snag is you don't want him to eat 2 hours prior to shot time. You don't want the pre-shot numbers to be influenced by food.

As for the timing of meals, the reason you're confused is that when you provide food depends on the insulin you're using. With short acting insulin (e.g., Vetsulin/Caninsulin), you have to feed your cat 20 - 30 min before you give a shot. This is because the insulin starts working almost immediately and if food isn't on board, numbers will drop hard and fast. Glargine (Lantus) is different. It doesn't start working (onset) for approximately 2 hours after a shot. Most of us will test, feed, and shoot all within about 5 to 10 min.

Basing a diagnosis of diabetes solely upon a UA makes me a bit nervous. Urine glucose tests are at best, unreliable. You will know more from your own home testing. However, since you have a vet visit scheduled, please ask the vet to get a fructosamine test. The sample will need to be sent out since vets typically do not have the equipment to do the test in-house. A fructosamine test is the equivalent of a hemoglobin A1c which is what is done for humans. It gives you what amounts to an average of blood glucose levels over the course of several weeks. Blood glucose levels can be sensitive to infection or inflammation so if your cat had other things going on plus the stress of spending 4 hours in the car, there's no way to be certain what was causing higher BG levels. What I would say, though, is the numbers you're seeing at home are in a diabetic range.

Another question: Did either your vet or the emergency vet say anything about diabetic ketoacidosis (DKA)? Typically, electrolyte values are out of whack -- low potassium, phosphorus, and magnesium, the cat is dehydrated, and ketones are present. It would be helpful to ask the vet about this since it's important to make sure your cat is getting enough calories to prevent ketones from redeveloping. If Stan isn't eating his usual amount of food and especially if he had ketones, you might want to ask about an appetite stimulant.

You don't measure the amount of your insulin dose based on how much Stan ate. The dose is the dose so you either need to stick to 1.0u or consider lowering the dose. Will Stan continue to graze if you leave food out? (FWIW, I would feed my diabetic cat 3 - 4 small meals over the first several hours of the 12-hour cycle.) If he will eat, then it's fine to give the 1.0u dose.

It is entirely possible that the antibiotic is in a sugar solution base. You may need to check with the vet's office to see how the antibiotic was compounded. Some meds are bitter and will make a cat foam at the mouth so the vets/pharmacy will use a sweet base. If it is a sugar base, it's going to have an effect on Stan's numbers.

I hope I'm replying correctly...I'm working on the spreadsheet and signature lineas we speak. In the meantime, we had a big scare for one of the numbers that we've since corrected, but I wanted to ask about it sooner than later! Stan's nadir number 6 hrs after his morning shot was 42 with no symptoms! A re-test 6 minutes later (that's how long it took us to get a good sample) was 46. I grabbed some maple syrup, rubbed a little bit on his gums, poured about a tsp onto his Fancy Feast, and he successfully ate about 3/4 of the 3oz can. We retested after 15 min and it was 89. We just retested an hour after that and it was 172. Are we ok? I'm assuming he's stabilized and I can finish my chart

 

[Wendy&Neko]

Yikes, good catch on that 42/46. Yes, you should be OK now, though technically higher carbs can last two hours after given, but it does sound like Stan is trending up. Maybe a little overdone on the sugars, but everyone does that the first time. And by the way, 1 unit is too much insulin. You need to reduce the dose.

 

[Sienne and Gabby (GA)]

Nice job of checking on Stan and managing the low numbers. You may have been a bit aggressive with the syrup but no harm done!! This is a post from the Lantus forum on handling low numbers. It will offer some direction if you run into this situation again. Also, you can post. There is usually someone around either on this board or the Lantus board pretty much 24/7 who will walk you through what to do so you have support. I would get another test in 30 min. The syrup will raise numbers fairly quickly but can wear off. You want to make sure that numbers stay propped up.

Given the drop into lower ranges, you want to reduce Stan's dose by 0.25u. So his new dose would be 0.75u.

This is information on dosing methods with glargine. You were asking about ranges, dosing, etc. There are two approaches to dosing. They vary with regard to when a dose should be reduced, how long doses are held, etc. I wouldn't suggest wading into this information tonight. I suspect you were feeling a bit panicky when you got that 46. You really handled the low numbers well.

 

[Sienne and Gabby (GA)]

Wendy and I keep cross posting!!

Also, do not be surprised if Stan's numbers skyrocket. When numbers drop low, your cat's liver and pancreas may have a defensive response and release counterregulatory hormones and a stored form of glucose as a means of getting the numbers back up. We refer to this as a "bounce."

 

[Kshoopla]

Yikes, good catch on that 42/46. Yes, you should be OK now, though technically higher carbs can last two hours after given, but it does sound like Stan is trending up. Maybe a little overdone on the sugars, but everyone does that the first time. And by the way, 1 unit is too much insulin. You need to reduce the dose.

Thank you again!

 

[Kshoopla]

Nice job of checking on Stan and managing the low numbers. You may have been a bit aggressive with the syrup but no harm done!! This is a post from the Lantus forum on handling low numbers. It will offer some direction if you run into this situation again. Also, you can post. There is usually someone around either on this board or the Lantus board pretty much 24/7 who will walk you through what to do so you have support. I would get another test in 30 min. The syrup will raise numbers fairly quickly but can wear off. You want to make sure that numbers stay propped up.

Given the drop into lower ranges, you want to reduce Stan's dose by 0.25u. So his new dose would be 0.75u.

This is information on dosing methods with glargine. You were asking about ranges, dosing, etc. There are two approaches to dosing. They vary with regard to when a dose should be reduced, how long doses are held, etc. I wouldn't suggest wading into this information tonight. I suspect you were feeling a bit panicky when you got that 46. You really handled the low numbers well.

Thank you!

 

[Kshoopla]

Yikes, good catch on that 42/46. Yes, you should be OK now, though technically higher carbs can last two hours after given, but it does sound like Stan is trending up. Maybe a little overdone on the sugars, but everyone does that the first time. And by the way, 1 unit is too much insulin. You need to reduce the dose.

Nice job of checking on Stan and managing the low numbers. You may have been a bit aggressive with the syrup but no harm done!! This is a post from the Lantus forum on handling low numbers. It will offer some direction if you run into this situation again. Also, you can post. There is usually someone around either on this board or the Lantus board pretty much 24/7 who will walk you through what to do so you have support. I would get another test in 30 min. The syrup will raise numbers fairly quickly but can wear off. You want to make sure that numbers stay propped up.

Given the drop into lower ranges, you want to reduce Stan's dose by 0.25u. So his new dose would be 0.75u.

This is information on dosing methods with glargine. You were asking about ranges, dosing, etc. There are two approaches to dosing. They vary with regard to when a dose should be reduced, how long doses are held, etc. I wouldn't suggest wading into this information tonight. I suspect you were feeling a bit panicky when you got that 46. You really handled the low numbers well.

Hello, I finished my spreadsheet and signature line...is this where I can ask you to take a look at the SS for me? It's limited so far, but I'd like to get an idea of what you all think before his vet visit tomorrow afternoon 11/20, as I suspect they may not be very knowledgeable in our small town And thank you again for helping me with yesterday's hypo event!

 

[Sienne and Gabby (GA)]

Your spreadsheet looks good. You will want to try to get a test before you head off for bed every night. The drop from 418 to 256 is a big drop in 2 hours. It looks like the insulin was kicking in and without another test, you don't know if the numbers were continuing to drop. Based on the previous cycle, which is not a lot of information, Stan's nadir (low point in the cycle) was at +5. His numbers could have continued to drop. Getting another test or two would have let you know if that was the case. If so, giving him some food may have slowed things down.

I would ask the vet a couple of things that I mentioned above in my post that's right below your first message.

• Did the vet get a fructosamine test and if not, could they get one?
• Were there ketones present when the vet ran labs? What about when you took the cat to the emergency vet? The emergency clinic should have sent labs and other paperwork to your vet.
• Did your vet think your cat was diagnosed with diabetic ketoacidosis? (That would account for why the electrolyte values were off.)
• If Stan isn't eating well and especially if he's not eating well and ketones were present, ask for an appetite stimulant (e.g., something like mirtazapine).
• Remember to ask whether the antibiotic is in a sugar base. However, I think this is unlikely given what Stan's numbers are looking like.

 

[Kshoopla]

Thank you! I will add those questions to tomorrow’s visit since I don’t know the answers. I appreciate you taking the time to look at the spreadsheet. I also donated to the site today because this website & forum are amazing! Thanks again—Ali.

 

[Kshoopla]

Your spreadsheet looks good. You will want to try to get a test before you head off for bed every night. The drop from 418 to 256 is a big drop in 2 hours. It looks like the insulin was kicking in and without another test, you don't know if the numbers were continuing to drop. Based on the previous cycle, which is not a lot of information, Stan's nadir (low point in the cycle) was at +5. His numbers could have continued to drop. Getting another test or two would have let you know if that was the case. If so, giving him some food may have slowed things down.

I would ask the vet a couple of things that I mentioned above in my post that's right below your first message.

• Did the vet get a fructosamine test and if not, could they get one?
• Were there ketones present when the vet ran labs? What about when you took the cat to the emergency vet? The emergency clinic should have sent labs and other paperwork to your vet.
• Did your vet think your cat was diagnosed with diabetic ketoacidosis? (That would account for why the electrolyte values were off.)
• If Stan isn't eating well and especially if he's not eating well and ketones were present, ask for an appetite stimulant (e.g., something like mirtazapine).
• Remember to ask whether the antibiotic is in a sugar base. However, I think this is unlikely given what Stan's numbers are looking like.

Oops…one thing I just realized…I’m pretty sure that the antibiotic liquid has sugar in it because it smells fruity. And I stupidly made the mistake of checking his sugar AFTER his food and antibiotic—but before the shot—thinking at the time that you test what the meal did to him. So the 418 was after all that sugar.

 

[Wendy&Neko]

Is Stan showing any signs of nausea? Sniffing the food and walking away, licking his lips or teeth grinding, drooling, only eating gravy or picky? If so, you might want to ask the vet for an anti-nausea drug. Ondansetron is my go-to, that is a human med and the vet just writes a prescription for you. Cerenia might be what the vet offers. Warning, it's a bitter pill best given in a blank gelcap. You don't want to give an appetite stimulant to a cat that has nausea, and sometimes solving nausea will mean they eat more.

Antibiotics can have side effects causing nausea. It can disrupt the flora in the gut. Giving a probiotic, a couple hours apart from the antibiotic, can help with that.

 

[Sienne and Gabby (GA)]

Just to be sure you're aware, the pre-shot test is before food. The pre-shot test shouldn't be influenced by food so you're certain that it's safe to give a shot.

The 418 may not mean the antibiotic was in a sugar solution. When Stan's BG dropped to 42, if you recall, I mention to not be surprised if his numbers skyrocket. Because he dropped low, his liver and pancreas overreacted. As a result, they release a stored form of glucose plus counterregulatory hormones that spike numbers up. We refer to this as a "bounce." I wouldn't assume that the 418 was a result of the antibiotic. It may be that the antibiotic contains a sugar solution but the numbers may also be the way Stan's system is reacting to low numbers.

 

[Kshoopla]

Just to be sure you're aware, the pre-shot test is before food. The pre-shot test shouldn't be influenced by food so you're certain that it's safe to give a shot.

The 418 may not mean the antibiotic was in a sugar solution. When Stan's BG dropped to 42, if you recall, I mention to not be surprised if his numbers skyrocket. Because he dropped low, his liver and pancreas overreacted. As a result, they release a stored form of glucose plus counterregulatory hormones that spike numbers up. We refer to this as a "bounce." I wouldn't assume that the 418 was a result of the antibiotic. It may be that the antibiotic contains a sugar solution but the numbers may also be the way Stan's system is reacting to low numbers.

Is Stan showing any signs of nausea? Sniffing the food and walking away, licking his lips or teeth grinding, drooling, only eating gravy or picky? If so, you might want to ask the vet for an anti-nausea drug. Ondansetron is my go-to, that is a human med and the vet just writes a prescription for you. Cerenia might be what the vet offers. Warning, it's a bitter pill best given in a blank gelcap. You don't want to give an appetite stimulant to a cat that has nausea, and sometimes solving nausea will mean they eat more.

Antibiotics can have side effects causing nausea. It can disrupt the flora in the gut. Giving a probiotic, a couple hours apart from the antibiotic, can help with that.

Is Stan showing any signs of nausea? Sniffing the food and walking away, licking his lips or teeth grinding, drooling, only eating gravy or picky? If so, you might want to ask the vet for an anti-nausea drug. Ondansetron is my go-to, that is a human med and the vet just writes a prescription for you. Cerenia might be what the vet offers. Warning, it's a bitter pill best given in a blank gelcap. You don't want to give an appetite stimulant to a cat that has nausea, and sometimes solving nausea will mean they eat more.

Antibiotics can have side effects causing nausea. It can disrupt the flora in the gut. Giving a probiotic, a couple hours apart from the antibiotic, can help with that.

Is Stan showing any signs of nausea? Sniffing the food and walking away, licking his lips or teeth grinding, drooling, only eating gravy or picky? If so, you might want to ask the vet for an anti-nausea drug. Ondansetron is my go-to, that is a human med and the vet just writes a prescription for you. Cerenia might be what the vet offers. Warning, it's a bitter pill best given in a blank gelcap. You don't want to give an appetite stimulant to a cat that has nausea, and sometimes solving nausea will mean they eat more.

Antibiotics can have side effects causing nausea. It can disrupt the flora in the gut. Giving a probiotic, a couple hours apart from the antibiotic, can help with that.

Gotcha! All makes sense, thank you. He actually isn’t showing any signs of nausea. He’s a small guy and has never eaten tons, and I did give him an appetite stimulant yesterday (the Mirataz)…I forgot to mention that. And it worked…he ate a full can of food this morning…but he was also banging on our bedroom door all morning! We didn’t feed him then since he gets his shot at 10am. I feel like we’re getting on the right track

 

[Kshoopla]

Just to be sure you're aware, the pre-shot test is before food. The pre-shot test shouldn't be influenced by food so you're certain that it's safe to give a shot.

The 418 may not mean the antibiotic was in a sugar solution. When Stan's BG dropped to 42, if you recall, I mention to not be surprised if his numbers skyrocket. Because he dropped low, his liver and pancreas overreacted. As a result, they release a stored form of glucose plus counterregulatory hormones that spike numbers up. We refer to this as a "bounce." I wouldn't assume that the 418 was a result of the antibiotic. It may be that the antibiotic contains a sugar solution but the numbers may also be the way Stan's system is reacting to low numbers.

I will definitely do the tests pre-food! It made more sense to me once I filled out the SS. I do remember you talking about the bounce. Thank you!!