threw up after Lantus given, +5 at 112, further testing?

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PeteandCourt

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Peter threw up tonight after Lantus was given\after he ate a few bites of dinner. At +5 he was at 112. He has had diarrhea twice. Got subq fluids tonight too. I was careful and gave insulin at a site far away from the fluids. Should I do a +6 or +7? Tonight's shot was only his 3rd ever, I don't have a spreadsheet started yet. Ketones are negative. Thanks!
 
Looks like no one was around when you put this up last night. 112 is not that low a number at +5, so hopefully he was doing ok if you did more testing. Throwing up is what cats do, at least once in a while. ;-)
 
I didn't figure anyone would be up. I did end up doing a +6 (96) and kitty is purring this morning but not interested in eating. :cry:

Vet's instructions were to skip a shot if he skips a meal, so that's what I may do unless he starts to chow down.
 
So Peter wasn't interested in breakfast so I didn't shoot. I just got back from work but husband reports that he ate 1 treat while I was gone but threw it up pretty soon afterwards. I just gave 300 mL fluids. Peter is purring and playing (he is quite "helpful" to my stepdaughter as she is making a quilt.)

There is food out, he is not interested. Can starting insulin cause nauseau? If it comes 7 pm and he is still not eating, what then, oh wise diabetic cat masters? Here is my plan, please critique:

Offer fresh stinky low carb pate with tuna and tuna water on top. If that doesn't work then
Offer low carb treats. If that doesn't work then
Offer high carb treats, a few on top of his low carb pate. If that doesn't work then
Offer the gravy based canned food. If that doesn't work then
I saw instructions on catinfo.org for syringe feeding, so try that, I guess. And call the vet first thing Monday.

Does this logic make sense? I think I've heard of people dosing human OTC prevacid for cats, would that apply to this situation?
 
Thank you! At 7 pm I put out fresh low carb pate with tuna and he perked up and smelled it but was not interested. He did eat about 15 pieces of Wellness dry kibble (the 11% one). I have not moved on to any other options yet, I want to see if he keeps this down. I did not shoot.
 
If he isn't eating, then you would be better off not giving the insulin. Better too high for a day than too low for a minute. Before you cat was diagnosed, he did not have insulin for months. A missed shot will be ok.

At this point, it's more important that your cat eat something, then not eat at all. High carb, medium carb, low carb, dry or canned doesn't matter. Get some food into him. Assist feed if you need to.

Your feeding options look feasible. You just need to find something that your cat will eat.

Meat baby foods can be tempting.

How is his appetite now?

If he is vomiting, you want medication to take care of the vomiting first. You'll probably need something from your vet. Do not give Pepcid AC for the nausea until you have the vomiting under control.
 
Thank you Deb! No I didn't shoot. All he has kept down in the last 24 hrs is 10 pieces of wellness dry. I've got my fingers crossed but that's only stayed down for 30 minutes so far. I can't get him to eat anything else (high, low, tuna, gravy, etc). I will try assisted feeding after we finish our dinner. Might be able to get a couple more calories that way. He did not want meat baby food. And he's growly right now. Poor guy, he's not acting like himself at all. I know insulin will help him but he's got to be keeping food down first.
 
If his stomach is upset - maybe due to something like pancreatitis - it may help to give 1/4 tablet of 10 mg Pepcid AC (with nothing else added). Give it about 15-30 minutes before feeding.

If he keeps vomiting up food, he may need to see a vet and get something to reduce nauseau/vomiting.

If yout try baby food, make sure there are no onions in it.
 
Ok, Operation Syringe Feeding was successful in that 20 cc of food (a bit more than 1/4 can Fancy Feast) went into Peter. Please send healing thoughts that it stays down. If it stays that that would mean in the last 30 hours he's had the 20 cc of FF, plus 15 pieces of Wellness dry. No insulin.

I'm not hearing from you guys that I need to think about the emergency clinic as this point, right? At what point *would* I need to think about the e-clinic? Obviously a call to the vet is in order first thing Monday morning.
 
Knowing when to go to a vet - some possibilities:

If his breath smelled fruity (possible DKA), like nail polish remover (possible DKA) , like urine (renal disease), or 'rotten' (possible mouth infection), that would be a reason to go to a vet.

If you test for urine ketones and get more than a trace (possible DKA - diabetic ketoacidosis), that would be reason to got to a vet.You canot treat DKA at home.

If he is moderatly-severely dehydrated (many causes). Pull up the scruff of skin at the neck and let go. If the skin stays pulled up ("tented"), going to the vet is a good idea. You may need to learn how to give subcutaneous fluids at home.

If he can't keep food down or won't eat anything for 2 or more days, go to a vet asap. Fat breakdown for calories may overwhelm the liver and cause hepatic lipidosis, which can be fatal.
 
Some things that would make me consider a visit to the emergency vet in this situation.

1. elevated ketones - so keep checking at least once a day. More than a trace means a vet visit asap
2. persistent vomiting - may need medications to help control this
3. blood in the vomit - to check for other issues.
4. food intake - if you can't get enough food into him, you may need more help with medications, anti nausea, anti vomiting meds
5. blood glucose levels - I'd want to be taking these several times a day. Just to see how the BG levels are doing with his poor appetite
6. dehydration - with the vomiting, he may need sub-q fluids.
7. hepatic lipadosis - if he can't eat enough, even with the assist feeding, fatty deposits can build up in the liver in a couple of days. Not good for the liver.

Any history of DKA? (diabetic ketoacidosis) or ketones?

(BJM types quicker than I do! ohmygod_smile )
 
Have I ever said you guys are the best? :-D

To address some concerns...and to get my thoughts out of my head and into an organized form...
Ketones: I will try to get a ketone test tonight. But I last night, no ketones. No history of DKA, either.

Dehydration: Thursday, Friday and today he got 300 mL sub q fluids each day. He's still got some fluid flopping around near his armpit, so we're covered in this department. I've got 100 mL left in my bag and although it's not a ton, I will push that tomorrow.

Vomit: Was not any blood on Friday's vomit. He has only vomited once today, very small amount containing one treat, no blood. And his Fancy Feast and Wellness are (praying still) staying down.

Food intake, Nausea, and hepatic lipidosis concerns: This is where I will need help from a vet. Even though I got something in him today it's not enough to sustain him for any length of time and I really don't want to have to syringe feed him regularly. It worked, but didn't go over so hot. I'm feeling like these issues can wait 'til Monday, instead of paying the outrageous e-clinic fees. (Don't get me wrong, they're great when you need them, but I don't feel like it's necessary at this point.)

Blood Glucose: Ugh, I'm afraid to look. He's been off insulin for a day and eating the Wellness dry.

Unless he takes a turn for the worse, my plan is to leave a message on my regular vet's answering machine first thing tomorrow (they check it on the weekends). I will see if she advises e-clinic or seeing her Monday.
 
That's reasonable. Good luck with the syringe feeding.

Also watch for signs of jaundice - yellowing of the skin or the whites of the eyes - that points to a liver problem.
 
You do not skip a shot because a cat is not eating much.... that is a great way to end up with a cat even sicker.

You are syringe feeding and Lantus/Levemir don't need to have food in the cat's stomach to give a shot. Dangerous advice for someone to tell you to withhold the shot. High BG and not enough insulin plus not enough food can lead you to the ER with a sick cat.

For the fluids, 300ml/day.... are you giving that much all in one sitting? It's too much for at one time; hard on the heart. If you need to give a fair amount of fluids, it's easier on the cat and heart if you split the amount giving some AM and PM.
Please note that fluids will bring down the BG, so be sure to test a few times.

Gayle
 
You skip a shot when this is only the 3rd shot ever, cat has persistent vomiting, can't keep food down, won't eat much, has negative ketones and you have little data to base a shot on. There were many factors involved in my suggestion to skip the next shot.

Now, since the assist feeding is helping and your cat is keeping most of the food down, I think it's time for some more insulin.

Please, test your cat and let us know what the BG number is. No ostriches with their heads in the sand, ok ? Better to know what the BG is than be afraid of what it is. It will be ok.

If you don't have a SS (spreadsheet) yet, you can list the numbers in your post like this.

If you are not able to do a spreadsheet set up right now, providing your data in this format would be helpful.
Date, pre-shot test, Units of insulin given, + hour since pre-shot given, BG number.
e.g. 6/1 AMPS 293 1U +1 289 +3 150 +6
PMPS 350 1U +2 340 +6 200
6/2 AMPS 400 1U +6 203
PMPS 189 0U +3 289 +6 458 +9 590

Would you do that list of numbers for us please?
 

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Sigh, being an ostrich seems so appealing... But it won't keep Pete healthy so I will pull my head out of the sand.

BG taken and posted on my brand spanking new spreadsheet. It's noted that the reading was about 1/2 hr after eating Wellness dry. Just syringe fed 1/2 can FF, then found (stepped in, actually, as I was walking out of the syringe feeding room) vomit that is most likely the Wellness. I don't think we can safely say that he is keeping food down.
 
Thank you so much for the SS and the signature. Those little bits of data are so helpful to us.

From the SS comments, it looks like Peter is still throwing up his food. How much? All of it or is he keeping down some?

I think you may need to syringe feed less food at each sitting. Spread out the syringe feedings a bit more. Did he keep down that 1/4 can of FF you fed last night at 9:30? Maybe that quantity is enough for him at one sitting.

Please test for ketones today.

Do you feel like you can give him some insulin this evening?
 
What do yoy think about picking up some 10 mg Pepcid AC and giving 1/4 tablet to see if it helps him keep food down better.
 
He is keeping some down but throwing up some. He kept down the FF 1/4 can I fed last night. And so far the FF 1/2 can from the morning. Just not this morning's Wellness kibble. (I had fed Wellness first, then the FF.) I can go to 1/4 can FF at a time, for sure.

I can get the pepcid today and start that.

I will also test for ketones today.

Hey...about the ketones...is there a way to test from pee clumps in the box? I know which clumps are his because of the size. I tried just pressing a stick to the clump but that just made the stick gray and hard to tell color. It would be a billion times easier than following him around to the box, especially as he's now suspicious that I will give him fluids, jab his ear, or force feed him.

I'm up for doing insulin if you guys agree to it! Are you suggesting that if he keeps down food today to shoot regular dose tonight?

ETA: Wendy, my gut (ha!) is telling me pancratitis, too. I've left a message on my vet's cell phone and will definitely follow up with her Mon if I don't hear from her today.
 
I'm up for doing insulin if you guys agree to it! Are you suggesting that if he keeps down food today to shoot regular dose tonight?
Click to expand...
The insulin dose for tonight depends on the BG number, the PMPS test. Here are the options.

1. give insulin if BG >200. this may be the full 1U or a reduced 0.5U. Monitor during the evening.
2. stall. If BG <200, do not feed, do not give insulin. Retest in 30 minutes and post here for help while you are waiting. We want to see a rising number
3. skip the shot. Not an option if ketones are present.

It's your call, you hold the needle and know your cat better than we do. You can always ask for clarification of any of these options. Or any other suggestions we give for that matter.

Ok, I see you were going to try the 1/4 can at a time assist feeding. I'd do that in combination with a 1/4 dose of the Pepcid A/C (regular strength 10 mg, not the complete formula or extra strength), 30 minutes before 2 of the meals, roughly 12 hours apart.

I'd like to see at least a 3oz can of the FF in before this evening. Don't feed within 2 hours of that pre-shot test. We want to see a non-food influenced number.
 
He's had about 3 oz of food today, no vomiting but diarrhea. Talked to vet and gave 1u with her blessing and he will be seen tomorrow to eval the lack of appetite, diarrhea, and vomiting (though hopefully the vomiting instances will continue to decline.)

SS updated with PMPS.

Mean cat mommy trick: at the end of syringe feeding, smear cat's forelegs with food, causing cat to lick it off. hey! It's calories!
 
I would suggest a test at +2 tonight. And maybe one more later this evening.

Pete dropped pretty low on that 1U a few days ago.
 
That +2 was not much different than the PMPS. Usually means a normal active Lantus cycle. ECID. I would not expect any steep drops, but you never know.

Is it possible for you to get a 'last test before you head to bed' test? Would that be a +4, 5 or 6 for you?
 
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