? 3/9 Ducia +11 372, AMPS 405, 0.75U need help to monitor her jumpy BGs

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I think I found what I was looking for, but I'm still hoping experienced users can help determine if this is even a factor here to consider. This is something @Amy&TrixieCat posted in another member's thread:

Amy&TrixieCat said:
ECID for sure, but my Trixie is one of those cats whose BGs plummets when she got fluids while on insulin (she's OTJ now). The only thing that prevented the drop was separating her shot and fluids on her body - I did fluids over her shoulder and her insulin in her flank. Even doing fluids and her insulin 4 hours apart didn't prevent the drop in BGs if I did both in the shoulder area. So it's just something to be aware of if you do fluids at home.
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Nan & Amber said:
I'm also curious about this, it would be good to know if there was evidence for that kind of interaction between sub-Q and insulin. The only thing I've been told is that they should be separated by at least 45mins-1hr.
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We can give SQf first, an hour before AMPS , and then do the usual routine @AMPS. I wish someone knows details and will post them here.
 
Hmmm... I hadn't heard of that kind of reaction, but if Ducia is like Amy's cat Trixie, it could explain a lot. Had you given sub-Q on the morning of the hypo event?

I know you got a ketone test in this morning and have been getting several each day (yay!), but if her appetite is still a little off, please do make sure to get another test whenever you have the opportunity.
 
I honestly don't know what to say about this. We're valiantly trying to guide Tanya through a maze that she's still in after she's had to deal with both DKA and a hypo episode in a kitty who responds dramatically. I understand that if there are ketones in the picture sufficient insulin is needed. The recent hypo event needed measures at odds with that. It would seem that the simplest remedy to address both at home is to feed a high carb diet for now and raise the dose of insulin (1 u? more?). The BG has to be monitored and kept at a higher value at nadir for as long as it takes to have many readings of negative ketones.

Just thinking out loud and trying to mentally sort out the variety of concerns addressed over the last few days. We're doing the best we can as non medical people in a complex medical situation that's happening outside a clinic setting.
 
Nan & Amber said:
I'm also curious about this, it would be good to know if there was evidence for that kind of interaction between sub-Q and insulin. The only thing I've been told is that they should be separated by at least 45mins-1hr.
Click to expand...
Nan & Amber said:
Hmmm... I hadn't heard of that kind of reaction, but if Ducia is like Amy's cat Trixie, it could explain a lot. Had you given sub-Q on the morning of the hypo event?

I know you got a ketone test in this morning and have been getting several each day (yay!), but if her appetite is still a little off, please do make sure to get another test whenever you have the opportunity.
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No, we didn't give SQ on the hypo day.
I try to take ketones test as often as I can. Ducia 's been cooperative in that regard.
 
Tanya and Ducia said:
What exactly is nadir? The lowest BG during the day? Ducia can be on very low numbers, safe green lows, for several hours in a row. Check the SS. Can nadir be as long as several hours? Forgive my ignorance
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Nadir is the lowest BG of the cycle and it can last a while sometimes as well as moving to different times in different cycles.
 
Kris & Teasel said:
Nadir is the lowest BG of the cycle and it can last a while sometimes as well as moving to different times in different cycles.[/QUOTE
I am not sure I can point out Ducia's nadir. It seems from +3 thru +9. Would you please look at her SS and tell me if my guess is OK, or if not why? It's very difficult to understand for me.:eek:
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Nan & Amber said:
I'm also curious about this, it would be good to know if there was evidence for that kind of interaction between sub-Q and insulin. The only thing I've been told is that they should be separated by at least 45mins-1hr.
Click to expand...
Amy&TrixieCat said:
ECID for sure, but my Trixie is one of those cats whose BGs plummets when she got fluids while on insulin (she's OTJ now). The only thing that prevented the drop was separating her shot and fluids on her body - I did fluids over her shoulder and her insulin in her flank. Even doing fluids and her insulin 4 hours apart didn't prevent the drop in BGs if I did both in the shoulder area. So it's just something to be aware of if you do fluids at home.
Click to expand...
Both of these statements can be true... it depends on the cat. Every cat is different. For example, I could give Alex sub-q fluids in one shoulder and then immediately test, feed, and shoot in the other shoulder... as long as the fluids and insulin shot were given on separate sides of her body. One of the perks is that some cats tend to be hungry/eat immediately after fluids. Aex was one of them so I took advantage of it when she wasn't eating. Amy found otherwise with Trixie. This is simply another one of those "Know thy cat" things.
Kris & Teasel said:
I understand that if there are ketones in the picture sufficient insulin is needed. The recent hypo event needed measures at odds with that.
Click to expand...
There was only one hypo event. It *sounds like* it was was an over dose of 10u given on 02/28. On 03/08, the dose was reduced from 1u to 0.75u after a low number event, not a hypo. There is a difference. Between excellent coaching and Tanya's steering, Ducia never came close to earning a reduction. One can expect to have to steer numbers with food when treating ketones at home. The reason being one has to address the issue of an "insufficient amount of insulin" to get rid of ketones... one way or another.
Kris & Teasel said:
It would seem that the simplest remedy to address both at home is to feed a high carb diet for now and raise the dose of insulin (1 u? more?). The BG has to be monitored and kept at a higher value at nadir for as long as it takes to have many readings of negative ketones.
Click to expand...
This is what I was trying to get across last Sunday. Feeding high carb food may allow for dosing a sufficient amount of insulin, but Tanya was told not to feed HC except for when steering low numbers.
Tanya and Ducia said:
What exactly is nadir?
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Tanya, here's some terms that we use a lot. They refer to a kitty's response to insulin (you can click on the links in blue font):
  • Onset - the length of time before insulin reaches the bloodstream & begins lowering blood glucose
  • Peak/Nadir - the lowest point in the cycle
  • Duration - the length of time insulin continues to lower blood glucose
  • Carryover - insulin effects lasting past the insulin's official duration
  • Overlap - the period of time when the effect of one insulin shot is diminishing and the next insulin shot is taking effect

Hope this helps a little bit...
 
Kris & Teasel said:
I understand that if there are ketones in the picture sufficient insulin is needed.
Click to expand...
I agree with your post.
However, we have seen some Blues in her PM cycle yesterday on 0.75U. Her ketones are regularly checked and keep at Trace.
I understand how bad for DKA insufficient insulin is but I think I didn't give 0.75 dose enough time to be observed. Too many Why?s in her numbers for me. That's why I appreciate every post in here.
 
Jill & Alex (GA) said:

Both of these statements can be true... it depends on the cat. Every cat is different. For example, I could give Alex sub-q fluids in one shoulder and then immediately test, feed, and shoot in the other shoulder... as long as the fluids and insulin shot were given on separate sides of her body. One of the perks is that some cats tend to be hungry/eat immediately after fluids. Aex was one of them so I took advantage of it when she wasn't eating. Amy found otherwise with Trixie. This is simply another one of those "Know thy cat" things.

There was only one hypo event. It *sounds like* it was was an over dose of 10u given on 02/28. On 03/08, the dose was reduced from 1u to 0.75u after a low number event, not a hypo. There is a difference. Between excellent coaching and Tanya's steering, Ducia never came close to earning a reduction. One can expect to have to steer numbers with food when treating ketones at home. The reason being one has to address the issue of an "insufficient amount of insulin" to get rid of ketones... one way or another.

This is what I was trying to get across last Sunday. Feeding high carb food may allow for dosing a sufficient amount of insulin, but Tanya was told not to feed HC except for when steering low numbers.

Tanya, here's some terms that we use a lot. They refer to a kitty's response to insulin (you can click on the links in blue font):
  • Onset - the length of time before insulin reaches the bloodstream & begins lowering blood glucose
  • Peak/Nadir - the lowest point in the cycle
  • Duration - the length of time insulin continues to lower blood glucose



    • Carryover - insulin effects lasting past the insulin's official duration
    • Overlap - the period of time when the effect of one insulin shot is diminishing and the next insulin shot is taking effect
Hope this helps a little bit...
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Jill,
Thank you for caring.
I really do not know what to tell you.
At the moment I don't know what will we do.
But I am grateful you shared it here and gave us food for thoughts.
In the past weeks we made so many mistakes so all I truly want is to see her stable withing acceptable range. No extremes of green to red. Yes, it is true that I am scared of hypo and very low numbers and that that fear might have played role in the reduction decision. But there are also some positives in 0.75U.
 
Tanya, it is a very big learning curve with Feline Diabetes alone and when you throw DKA into the mix and a hypo, things get tricky . But the info Jill gave you about DKA supersedes a hypo event without a doubt. You now know how to handle the hpyo event and what was proposed for Ducia who has fast early drops was giving HC food right out of the starting gate ( or in the very beginning of the cycle ) that will allow you to get more insulin into Ducia to rid the ketones and prevent a hypo event .

I hope you will consider the method and I will tell you this : My Bubba had ketones and had I not followed the great advice from Jill, I am sure my cat would not have made it. For what ever it's worth......
 
Most likely we will increase tomorrow AMPS.
Can you recommend good pate style HC canned food that I can make into a slurry for the tube use?
Something easily available at night?
 
Hi Tanya, hope all is going well with you and Ducia. When you get a chance, could you please give us an update? How is Ducia doing with eating, now? From what I could see on her spreadsheet, it doesn't look like she is eating very much. Is she eating on her own or are you still using the e-tube?
 
Since most of the carbs in gravy food os in the gravy, you could buy a chunky gravy food (like fancy feast gravy lovers) pop the top and push down to squeeze out the gravy and just feed that. If it's too thick you could dilute with a little water for etube feeding.
Tanya and Ducia said:
Most likely we will increase tomorrow AMPS.
Can you recommend good pate style HC canned food that I can make into a slurry for the tube use?
Something easily available at night?
Click to expand...
 
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