? Wheezly breathing in post DKA post Hypo cat

Status
Not open for further replies.

Tanya and Ducia

Member Since 2017
My post DKA & fatty liver cat girl Ducia is currently at the clinic under stabilization treatment after Hypo. She was admitted yesterday BG 22, low temperatures, convulsions. Dextrose drop catheter was given and at 2am pacific today her BG was 409, dextrose cancelled, glucose taken out of her food, they monitor. She responds well to the treatment, at about 3am was sitting, interested in her food and reacted at nurses.
Ducia was on Lantus 1unit. Possible that we accidentally overdosed her giving 10 units instead of one. I have questions as to home recovery and in particular about the dose adjustments.
Image below is what we are using at home. Hypothetically, if Ducia will require frequent tests and then dose adjustments by 0.25 increment how can one make sure where 0.25 is on the syringe shown below? That is what I don't understand. The 0.50 increment would be easier but again not perfectly precise simple aim at half the measure, it's not precise. But how to measure 0.25 if there is no marks? We went thru horror of Hypo yesterday and I am no longer confident in human TRUEplus lancets. Are there any better products for not very experienced tester to use at home? Her little years were almost shredded after endless testing.
img_4302-jpg.26726
 
If you are using Lantus you need to use the syringes with the orange cap which are for U100 insulin which Lantus is. The syringes with the red cap are for U40 insulin such as Vetsulin/Caninsulin. You can get the U100 3/10ml (this holds up to 30 units in total) with the 1/2 unit markings.

This link shows the BD brand syringes and there are links on the left that show how to do smaller doses.

http://steverapaport.com/jock/SyringeFineGradations/


ETA It is VERY important that you use the correct syringe with different types on insulin
 
Last edited:
Ok here is what we use. The smallest mark is one unit, right? But if 0.25 adjustment required, do I measure it with my naked eye for the best of my ability? My vision isn't too good, I may over shoot and if so will it mess up the numbers again?
upload_2017-3-1_5-20-41.jpeg
 
Ok here is what we use. The smallest mark is one unit, right? But if 0.25 adjustment required, do I measure it with my naked eye for the best of my ability? My vision isn't too good, I may over shoot and if so will it mess up the numbers again?
View attachment 26728
The smallest mark is one unit unless these are syringes with half unit marks. It doesn't seem so from this photo. Many brands of syringe will have U100 printed on the barrel on addition to the orange cap. The box that the syringes came in should say U100 on it. Later on it would be a good idea to buy some U100 syringes with half unit marks. You would have to eyeball 0.25 u on those but you could measure 0.5 u using the marks.

Have a look here: www.adwdiabetes.com.
 
The orange cap syringes are the correct ones for Lantus. Do your syringes have the 1/2 unit markings on them? There should be marks on the right side and marks in between on the left side if they have 1/2 unit marks. It would look like this:

http://steverapaport.com/jock/SyringeFineGradations/

When using the syringes with 1/2 unit markings you can measure a 1/4 unit dose by "eye-balling" between the 1/2 and 1 unit marks. Some people use calipers but I am not familiar with their use, though I am sure someone will be by and explain how to use calipers.


ETA In the photo I posted the marks on the left (bottom)are 1/2 unit and the ones on the right (top) are 1 unit markings.


ETA Sorry it won't post directly to the correct photo. If you click on these photos it will give you a larger image

Exactly 1 unit.


Exactly a half-unit


It will give you a larger image of these
 
Last edited:
The smallest mark is one unit unless these are syringes with half unit marks. It doesn't seem so from this photo. Many brands of syringe will have U100 printed on the barrel on addition to the orange cap. The box that the syringes came in should say U100 on it. Later on it would be a good idea to buy some U100 syringes with half unit marks. You would have to eyeball 0.25 u on those but you could measure 0.5 u using the marks.

Have a look here: www.adwdiabetes.com.
Thank you! We didn't buy our Lantus nor the syringes. They were kindly shared with us so I don't know yet how it works or what available. I thought that Lantus comes with syringes, it didn't ossure to me that it is two separate items to buy. Will know now. I hope they can stabilize her to the point that we wont be needing adjustments too often. I haven't spoken to the dr as yet so at the moment there is no treatment/maintenance plan.
 
The orange cap syringes are the correct ones for Lantus. Do your syringes have the 1/2 unit markings on them? There should be marks on the right side and marks in between on the left side if they have 1/2 unit marks. It would look like this:

http://steverapaport.com/jock/SyringeFineGradations/

When using the syringes with 1/2 unit markings you can measure a 1/4 unit dose by "eye-balling" between the 1/2 and 1 unit marks. Some people use calipers but I am not familiar with their use, though I am sure someone will be by and explain how to use calipers.


ETA In the photo I posted the marks on the left (bottom)are 1/2 unit and the ones on the right (top) are 1 unit markings.


ETA Sorry it won't post directly to the correct photo. If you click on these photos it will give you a larger image

Exactly 1 unit.


Exactly a half-unit


It will give you a larger image of these
No need for larger, THANK YOU!! Got it. My syringe is one unit only marks. When I asked about 0.25 increase I was speculating as to "what if", we do not if Ducia will require any of it but need to restore my confidence after Hypo. Thank you so much.
 
It would be a good idea to try to get some U100 syringes with the 1/2 unit markings. Dose changes are usually done by 1/4 unit increases or decreases and it is much easier to eye-ball "for example a 0.75" unit dose if there are 1/2 unit markings rather than only 1 unit markings.
 
It would be a good idea to try to get some U100 syringes with the 1/2 unit markings. Dose changes are usually done by 1/4 unit increases or decreases and it is much easier to eye-ball "for example a 0.75" unit dose if there are 1/2 unit markings rather than only 1 unit markings.
We will buy. I just hope SO much that they can figure out her dosage in the clinic before discharging her!
 
We will buy. I just hope SO much that they can figure out her dosage in the clinic before discharging her!

Poor Ducia has been through DKA and a hypo so close together. With all the other problems such as the tube feeding it will be difficult to set a good dose. Home monitoring is going to be so important especially in the early days once she is home. But there are lots of very experienced people here, who have dealt with the same issues you are facing that can help you along the way. :bighug: :bighug:
 
Poor Ducia has been through DKA and a hypo so close together. With all the other problems such as the tube feeding it will be difficult to set a good dose. Home monitoring is going to be so important especially in the early days once she is home. But there are lots of very experienced people here, who have dealt with the same issues you are facing that can help you along the way. :bighug: :bighug:
That's exactly what worries me so much now. I am not experienced tester with exception for the past week. Can you recommend any brand/size for a novice tested with not very good vision/aim? We currently use human needles between 23-28 gauze but they are too long. We also use TruePlus lancets but they proved a disappointment yesterday during Hypo when I need to test every 20 - 30 minutes. Human needles are ok except their length but are not sold without Rx, I am correct?
 
All these have half unit markings and are the correct syringes for U100 insulin and are available from ADW online:
UtiCare
Monoject
Carepoint
Sure Comfort
BD Ultra-Fine

They're also available at WalMart if you have one near you..Their Relion Brand 3/10ml, 3o or 31 gauge, 8mm insulin syringes all come with half unit markings and are only $12.58 for a box of 100 (although it seems a lot of WalMart employees don't realize that they DO come with half unit markings!!)
relion insulin syringes.PNG
 
All these have half unit markings and are the correct syringes for U100 insulin and are available from ADW online:
UtiCare
Monoject
Carepoint
Sure Comfort
BD Ultra-Fine

They're also available at WalMart if you have one near you..Their Relion Brand 3/10ml, 3o or 31 gauge, 8mm insulin syringes all come with half unit markings and are only $12.58 for a box of 100 (although it seems a lot of WalMart employees don't realize that they DO come with half unit markings!!)
View attachment 26732
I will get one later on this week, thank you for the info. I talked to a nurse who looks after Ducia and asked if 1U is too much for her weight and size but she was firm in her opinion to stick to what Dr said. It was expected. Ill try to discuss it with the discharging Dr but she is a witch.
 
I talked to a nurse who looks after Ducia and asked if 1U is too much for her weight and size

How much does she weigh? (they should be able to tell you)

Also, if you were using the U40 syringes with the Lantus and gave 1U, that's 2.5 times as much which is a HUGE overdose.....we do increases in .25 unit increments because it can be the difference between a "good" dose and a bad one....2.5x as much is a BIG difference and could very well explain the hypo
 
She was 7.6 over the weekend but ate very little. I will most questions abpout her propose food plan as I have a feeling 5.5 total for the day isn't enough. It was most likely an accidental overdose. She is stable as the the clinic said, was BG 345 at AM. The Dr insists on starting with 1U Lantus. I post below picture of what we have currently but will definitely get the half unit marked syringes from Walmart. At least I should keep them in HYPO TOOL BOX which I wish I had yesterday.
The biggest hope is that she responds well to 1U. We are picking her up tonight.
 
1 unit is a pretty normal "starting dose", but for Ducia, at 7.6lbs, the starting dose would be a little lower

If she's only getting low carb food, I think I'd start her at .5 instead (the "official" starting dose for Tight Regulation is "weight in kgs x .25", so that would be .86 (which you can't do) so we'd probably suggest starting at .75....but you have to have syringes with half unit markings to do that too
 
I wont have syringes at least not until Friday. The home adjustment by 0.25 is scary proposition. I doubt my abilities all together after Hypo. Cannot read symptoms. Not skilled at the testing when fast and frequently needed.
The shots and adjustments (god forbid we ever need them) are to be done by my husband, human medic who at work all day long.
How unsafe is it for to be on 1U?
I'd hate to play with shots after Hypo. If there was an overdose (maybe not) I don't think we should be trusted with it at home, no vet supervision, no car to go to the emergency if trouble during the day. I am still shaky/mind numb.
Can the food intake be manipulated? All I have at home is low carbs.
There is some dry food in the freezer Royal Canine adult but that I thought what get her in to trouble. I
am too new at it to understand the entire picture.
We'll see a Dr at the clinic. What kind of questions should I be asking about her food? They firmly believe that 1U is good for her.
please check out Ducia's spreadsheet the number are close.
 
I have, but they are without half unit marks. No way we can eyeball precisely 0.25 decrease. I will buy half mark from Walmart tonight. They are just $13.
Do you think we SHOULD give decrease?
 
Nobody can get exactly .75 unless they're using calipers

The best ANY of us can do is eyeball it

The important thing when dosing is to make it as consistent as you can do it, not that it's exactly .75.......just that every time you give that dose, it's as close to the same as the last one as you can get it. A lot of people will use some colored water and pull up a "sample" where they decide .75 is going to be so they have something to compare to when they giving the real thing

As for what you should do, I wish we had a crystal ball and could see into her future......we're not vets....just people who've been doing this dance every day ....some of us for many years and we've just learned what work and what doesn't.

The 1U dose may be fine....it may be too much....it may not be enough.....Only testing will answer that question, but as long as you're able to test, you should be able to keep her safe.
 
@Chris & China

I am wondering if after that severe hypo at 1 unit of Lantus whether that it would be safe to give 1 unit again. Ducia has been through the mill with DKA and then the hypo last night so my concern is it is very hard to say what is a safe dose.
 
I am wondering if after that severe hypo at 1 unit of Lantus whether that it would be safe to give 1 unit again. Ducia has been through the mill with DKA and then the hypo last night so my concern is it is very hard to say what is a safe dose.

It depends......I believe she was using U40 syringes instead of U100 when she gave the 1U

The ER vet is giving the shot before she leaves so we don't have a lot of say in it :(
 
It depends......I believe she was using U40 syringes instead of U100 when she gave the 1U

The ER vet is giving the shot before she leaves so we don't have a lot of say in it :(

Thanks Chris . I didn't see where she had used the U40 syringe last night. I thought she had used the U100 that came with the Lantus. If the U40 was used that would definitely have made a big difference. The ER vet would be aware of all the problems and hopefully the 1 unit will be a safe dose.
 
I think most vets only think in 1 unit increments for some reason. It's like they have never heard of syringes with 1/2 unit marks on them. It must be part of their training.
I wonder if the person who sent you syringes to work with the Lantus could verify or confirm that the ones you used were the U100 syringes.
I am keeping you in my thoughts and prayers. Please test tonight, especially about 4 to 5 or 6 hours after the shot is given. Post here for any concerns. I hope you have lots of test strips. It is recommended to keep an extra box of 50 with your hypo kit, as you never know when you will go through a bunch and the last thing you need is to run out of strips in the middle of the night or during the day when you have no car.
 
Updated info from PM's to keep it public.....I have asked her to start a new thread in the Lantus forum

Back home from the clinic
PMPS BG 368 Lantus 1U
+1hour BG 308
not very interested in eating on her own
going to tube feed if does not whithin one hour

All they gave was another antibiotic, I had to request that the meds she was Rx on her prior stay ARE RETURNED TO US because Dr thought they were too much for her.
We are trying to trick her to eat but it does not work. She ate very little at the hospital. Should offer anothertype of meal? Or should I go ahead and tube feed right away. SHe is tiny.
The DR WANTED TO GIVE HER 2 UNITS!!!

The Dr at ER said that she needs nothing but Amoxicillin. Even cancelled her potassium( I know she is depleted), Denamarin, vitamin K and the rest. I really do not understand her new treatment plan. It just didn't sound right.
We gave a little too much of water with the meal. Can we overwater her?
She sleeps quietly and I am worried that she is lethargic, like just before

I also do not understand that the Dr cancelled her Potassium. I spoke in the am with another dr and she told me that Ducia needs potassium.
 
I also do not understand that the Dr cancelled her Potassium. I spoke in the am with another dr and she told me that Ducia needs potassium.
Do you have a regular vet?
Who tested her and said the potassium was low enough to need a supplement to start with?
Did they do bloodwork at the ER?
If you don't already have it, request a copy of any labs that were run, both at the ER and at your prior vet visits. There is a tab on your spreadsheet where you can enter the values. We have people here that are very experienced at reading them and interpreting them. If her potassium is indeed low, it is important that she get the supplement. Low potassium can make her feel lethargic and unwell, and she won't eat.

What food was she eating before she was diagnosed with FD?

Sorry, a lot of questions, I know, but just trying to get a handle on what is going on and how we can help.
 
I will get the copy of her latest blood work later on by email - it wasn't ready wehen we checked out.
I know some detailed because I spoken to another dr earlier on the phone and she said that potassium and phosphorous are down. Needs supplement. My current is an orally gel - almost impossible to give and not suitable for the etube.She will get some if she eats but it'll take time.
All my data is from the ER doctors. We have a vet to whom we went to be diagnosed on the 1st place. We'll be back with him to check the blood work and find acceptable potassium supplement.
 
Ok, the latest is at 12am the BG was 168 (down from 308 at 9pm), then she ate on her own more than 1/4 can of 5.5 Friskie. She is alert, grooming. We need to get her to eat more. If she shows no interest in the food I left in her bowl than it's going to be flushed via etube. 25-30 ml slurry.
 
she ate on her own more than 1/4 can of 5.5 Friskie. She is alert, grooming.
This is great news!!! I know you need to get more calories in her, but these are signs she's feeling much better! Let's take our encouragement where we can.
My current is an orally gel - almost impossible to give and not suitable for the etube.She will get some if she eats but it'll take time.
I'm a little concerned about a gel - possibly sugar in it? But right now, if her potassium really is low, it's more important that she gets her supplement.
I will get the copy of her latest blood work later on by email - it wasn't ready wehen we checked out.
Great! When you get it, post the numbers on that tab in the SS - then we can get Marje to look at it. She's awesome with labs.
All my data is from the ER doctors. We have a vet to whom we went to be diagnosed on the 1st place. We'll be back with him to check the blood work and find acceptable potassium supplement.
Sometimes when you are dealing with several vets and they are not communicating, you can get conflicting info/advice and just don't know what to do (we sometimes have that happen here with different members giving input). It will be good when you can see just one vet who will get to know Ducia and work with you consistently. For now we just have to try to make the best out of what you have so far.

Great job getting today's numbers in the spreadsheet. When things calm down, it would be helpful if you can go back and add lines for all the days for which you have readings, so it's easy to see what's been going on. We can help you with that if you like - I know you said you aren't super tech savvy.

That is a significant drop from +2 to +5. Not alarming, but it would be a good idea to get a +6.

You mentioned Ducia's poor ears earlier. Did anyone tell you to get some Neosporin with pain relief gel? If you rub a bunch of it on her ears every night, then wipe it off in the morning, it will help them heal. You can get a generic at Walmart that'll be cheaper, just make sure it's the gel and has pain relief. It also makes it easier for the blood to pool on her ear for testing.

How are you and DH holding up? This has been an insane couple of days for you - very stressful. You've done a wonderful job.:bighug:

 
Thank you Tricia Cinco,
I thought of getting +* but will do +7. I read about neosporin and will get one. But would it make tests contaminated? I had a horrible roller coaster at the hypo - when the honey was all over the placing the readings went from 484 to 43.
I gave Ducia a little water after she ate >1/4 Friskie, about 4 ml via tube. The tip of her nose is soo dry. I can't overwater a cat, can I? She had >10ml with her meal at 10pm and that's it. The meal was watered too.
I'd love to see a good vet. I supposed he has to be a D specialist? Or is it an endocrinologist? We have no insurance for her and the costs must be scary. Do you have any idea how much a visit like that may cost?
 
I read about neosporin and will get one. But would it make tests contaminated?
Not if you wipe it off before testing. Lots of people here use it and none has reported an issue. I used it on Harvey's ears all the time.
I can't overwater a cat, can I?
Well, you can give her too much via the tube. I had a cat with a tube once and I had to learn the hard way to give small amounts at a time and let him process it before giving more - otherwise he would just throw it up, which made everything worse. That was four years ago and I was still learning a lot about cats and their health. Wish I'd known then what I know now!
I'd love to see a good vet. I supposed he has to be a D specialist? Or is it an endocrinologist? We have no insurance for her and the costs must be scary. Do you have any idea how much a visit like that may cost?
It doesn't necessarily have to be an endocrinologist or even an IM that specializes in FD, although sometimes that is what you need. As long as you find a vet that is open minded and hopefully has some experience with FD. Younger vets tend to be less set in their ways, too. Specialists can be very expensive. I am fortunate to live about 40 minutes away from UC Davis, and their Veterinary Teaching Hospital is rated #1 in the country. We spent a lot of money there from early 2014 to late last year - four cats diagnosed with cancer, two had FD, one went blind, two Hyper Thyroid, etc. We saw oncologists, ophthalmologists, dermatologists, dentists, Internal Medicine Specialists, Integral Medicine specialists and one awesome endocrinologist. But for good basic care, my regular every day vet is just fine. It's too bad UCSD's Vet School doesn't have an Internal Medicine department. A typical visit, with bloodwork, would usually cost several hundred dollars. When we get our next cats, we are definitely going to get insurance!

You could ask on the Board if anyone in the San Diego area would recommend their vet. I'm pretty sure there are other members there.
 
As long as you find a vet that is open minded and hopefully has some experience with FD
well, that would be ideal. However last night when I was checking Ducia out I had surreal experience of talking to a vet who wanted to shot my girl with large amount of Lantus while prescribing her to eat anything even dry food high on carbs. As if she was holding a bucket of water - Lantus in one hand and fanning the fuels with another hand - by giving more dry food. I will ask around about good vet. we met one at the ER, creative, attentive, competent all you wish in vet and doctor, but he is critical care, not the long maintenance. Our vet is a good one I know. But he had to consult specialist to read our results.
 
Our vet is a good one I know. But he had to consult specialist to read our results.
That might not be a bad thing. It indicates he is aware he doesn't know everything. A lot of vets seem to have a "god complex", where they think they know it all, and won't listen to what you say. I have one that is just fascinated by all the studying I have done, and when I ask about something she isn't familiar with, she goes and researches it. That is a really good vet. She told me that when she is talking to me, she forgets I'm not a vet, as I understand everything she tells me. I take that as a compliment to the Board. I've learned so much here.

I see Ducia is headed back up, so I think it's safe to go to bed. I'm sure you're exhausted. I've had a hectic day, too. Unless there's something else I can do for you? I'm going to turn in.
 
no, she had in the hospital.
When she was admitted with BG 22 and low temps her breathing not wheezy but like drums, bangy, very odd. I asked right away what it was but she just into her cage and they didn't start anything. When I was picking her up I heard it but thought that she tries to purr. The water from feeding thru tube could not get into her lungs , it goes straight in her tummy. What could it be? Maybe tubes? Sounds a lot like bronchitis but without cough.
 
But, she had it before and then it stopped for a while and now it's back, or has she had it since the hypo?
I hope the tubes are in place. My cat had a tube down his nose, so I don't know about E Tubes. J.D. is a DKA survivor and came home with a feeding tube because he wouldn't eat the entire 8 and 1/2 days that he was hospitalized.
Can you get a video of the breathing and post it?
I need to leave for work, but others should be around to help. I don't see your posts in the Lantus forum, yet. You could try posting there, too.
 
But, she had it before and then it stopped for a while and now it's back, or has she had it since the hypo
after we took her home hospital after the hypo.
Seems its only when in upright position. Mow is laying down flat, sleeps I hope not lethargic, and the sound is as of a human with severe cold or bronchitis.
 
Hello,
my post DKA, who has Pancreatitis and fatty liver/ probably jaundice cat girl Ducia is recovering from Hypo.
Her breath when is laying down sounds like of someone who had severe cold. But when her upper torso is in upright position or when she interacts with me - head bangs- she makes odd wheeze noises.
She has been fit with E-tube. She had amoxicillin in her system. She is been fed and given water thru tube today.The tubes goes straight in her tummy, nurse at the clinic assured me that no water could have gotten in to it. I heard the noises in her when I checked her in with Hypo and when was picking her up but not so obviously. The sounds seem to increase when she is in upright position. When she lays down flat, like now, she sounds like someone with severe cold. The breathing rate is normal. Gums neither blue, grey nor purple, pale plight pink moist.
Does anyone has any idea what it could be?
She is post DKA, post hypo, possible pancreatitis and possible jaundice. BG at 2 am 235. She receives Lantus 1 U
There is a human medic in the house, has stetoscope but no experience with feline health.
We appreciate any thoughts.
Thank you
 
Hi Tanya, I am sorry that I don't have an answer for you I hope that someone who does will weigh in . My best advice would be to call the clinic and tell them your concerns and especially since it has gotten worse since you picked her up from the cinic. I would think that if it were an upper respiratory infection the AB she is on would help.
head bangs
What does that mean?
 
If your medic listens to her lungs does he hear any unusual sounds? I would definitely call the clinic; if the sound is loud enough, maybe you can hold the phone near her and they can hear it.
 
the human medic with no feline health knowledge said that if she was human than she might be having an acute bronchitis, and that the sounds or noises are on the"upper level" not from the deep. If it explains anything. The cover around her neck that protects the tube entrance is not too tight.
 
Status
Not open for further replies.
Back
Top