New to Lantus

Status
Not open for further replies.
Victoria & Buttons

Victoria & Buttons

Member Since 2012
Hey.
Long story short haha. My baby is 11. Diabetic for five years. Was on prozinc. Went DKA and just got home on Monday. He sent me home on one unit of lantus. She was doing well on it in hospital but I can't seem to get anything working and I'm scared I'm killing her :(
She is on an antibiotic for UTI. Powder once a day for kidney health/potassium and vitamin b12 shot once a week.

Vet also said to put her on hills metabolic and urinary care wet food. Vegetable stew. Already figured out, too high for her so I've gone back to fancy feast.

Any help would be appreciated :)
 
If you put the blue question mark icon on your thread title (icon menu is at the left end of the bar where you type in your title) it'll attract attention more easily.
 
Some low carb/low phos options:

upload_2017-7-26_22-32-11.png

upload_2017-7-26_22-32-32.png

upload_2017-7-26_22-32-49.png

upload_2017-7-26_22-33-16.png

upload_2017-7-26_22-34-4.png

upload_2017-7-26_22-34-21.png

upload_2017-7-26_22-34-48.png


Some can get expensive but Soulistic is one of the more affordable brands.
 

Attachments

  • upload_2017-7-26_22-31-49.png
    upload_2017-7-26_22-31-49.png
    5.2 KB · Views: 93
  • upload_2017-7-26_22-32-27.png
    upload_2017-7-26_22-32-27.png
    31.5 KB · Views: 101
  • upload_2017-7-26_22-33-44.png
    upload_2017-7-26_22-33-44.png
    24.2 KB · Views: 95
Here's your previous post from the ProZinc Forum with all the details

Since Buttons was on 2.5 of ProZinc, I think the ER vet has just started you too low on the Lantus

I'd increase her to 1.5 (or 1.75 if you have syringes with half unit markings and can get "in between" the lines) and hold that dose for a couple of days and let's see how she's doing

We take into consideration the dose the cat was on before so I think you've just started too low and need to go up soon
 
It was too low when she went into hospital, when she left a bit too high. They gave me a few packages of syringes. They're u100 (I have u40) and they don't have half markings. I'll try 1.5. I'm guessing 2 is too high right now? The vet actually did say 2 but then changed his mind.


Is sticking to fancy feast okay or should I switch? All those foods are not in store near me.
 
Hello and welcome. Waving at you from North Vancouver. :)

First thing, when you enter text in the spreadsheet cells in the World SS, it doesn't translate to the US sheet properly, so you may have to re-enter things there. Of specific interest is the day you started Lantus.

I see that Buttons got to green on her second cycle on Lantus. That caused her to bounce the second day, giving you those ugly blacks. I would NOT increase to 1.5 right away. You have a comment on the SS about an issue with the meter. Do you have a backup one around you can test with? Also a good idea to have a second meter around for these cases. And I see no tests in this he PM cycle after the first couple of days. We strongly recommend either a before bed test or at least a +2 test. If the +2 is lower than the preshot, then more testing may be required that night. Many kitties go lower at night, and we evaluate the Lantus dose based on how low it takes kitty, hence the interest in those night time values. Between a working meter and night time tests, we will get a better idea how low Buttons is going on this dose.

Are you testing daily for ketones? You should put ketone test results on the spreadsheet, maybe the Remarks section, or we will keep asking about it. ;) It is very important to test regularly after DKA.

How is Button's appetite? If she has kidney issues, the FF is rather high in phosphorus and there are better commercially available foods for kidney cats. Adrian listed some of them that are low carb too.

In Canada you can get the BD Ultrafine II syringes (purple and yellow box) at pretty much any pharmacy. They have half unit markings.
 
I did do 1.5 tonight. Her numbers have not moved at all since she's come home from the vet.
She's eating rather good. Except for tonight. She didn't gulp down as much as normal. Vet said her kidneys are fine, functioning at 30-40%.
He gave me these needles to use for now because he doesn't know if lantus will work or if she's insulin resistance is what he said.
I am checking for ketones. I don't need to worry when it's trace...do I worry about small amount?
 
With the insulin drip, that's why I put 2ml/HR. Thought that made it clear, sorry


R? What's that?

Also she just puked everywhere. Vet said that could be pancreatitis flair ups or is it just her sugars are too high? I feel so bad.
 
Did you get her labs from the vet? What values for creatinine, BUN, urine USG? If kidneys are at 30-40% I suspect now is the time to gradually find lower phosphorus foods. Did they test for pancreatitis? If her appetite tanks you might need nausea medication as that's a common symptom of pancreatitis. Pain is also common for many but often hard to detect as they hide it well.
 
Yes test said pancreas abnormal. He sent for a test for numbers to see if moderate/severe etc.

What would be the best low phosphorus foods that work for diabetics?
I did get her labs. I'll look and post
 
Hey and welcome to Lantus Land. So glad your baby is home again after a DKA event. Scary for sure.

How is the poops? Sometimes antibiotics can cause diarrhea and or vomiting but then so can a pancreatitis flare up.

Some mentioned getting ketone tests. That will be very important since she just had DKA. The recipe for developing DKA is a systemic stress ( like P'titis) not enough insulin and in appetence. So, you want to get her BG's down as quickly and safely as possible and keep her eating.

What was her AMBG today? What does # value mean in the AMBG and PMBG cell mean?

Also, call the hospital and find out if they also gave her Novolin R insulin along with the Lantus while she was in the hospital. That is what is usually done in DKA times to bring them down faster. If she were, that would explain the green number on the PM cycle of 7.22.17.
 
Ugh thats frustrating that they dont say they did the R insulin as well. Yea, on her chart is says norm r + insulin.
Sorry Bobbie, if you go into the World tab it shows you, the value one usually means shes HI, above 33.
Her poops are normal. Her AM was HI again.
Tiff, do I post all the values from her labs for the days, or just the one before she left?
 
Victoria & Buttons said:
Ugh thats frustrating that they dont say they did the R insulin as well. Yea, on her chart is says norm r + insulin.
Click to expand...

Well that explains the drop in numbers at the vet...R is very strong and commonly used in DKA's....that's why I asked about it. It's a "rapid" insulin

Did you follow the directions exactly on the ketone strips and check the strip color at the right time and in a good light? (they have to be read at the exact right time or they get darker and darker after their "time limit"...usually 15 seconds)

Anything over "trace" usually needs to be treated by a vet.
 
Yes, in the living room with day light and it was right after. So i should go back to the vet?
I may go to the one closer and see as the vet i was just with was saying if there is ketones to not panic and not rush to the vet :/
 
okay i called and of course theres nothing available today (small town, not an emergency hospital). So I have her booked in at 1pm tomorrow. With the small amount, is it okay to wait until tomorrow and just keep testing?
 
Better than "HI", that's for sure!!

Did you tell them she was just in DKA a few days ago and she's throwing ketones again?

Will they give you some fluids to give at home? Is she eating OK?
 
yes i did tell them. she is eating okay. yesterday night not so much but this morning normal. i do have saline solution from before. should i give her some or wait?
 
Victoria & Buttons said:
i do have saline solution from before. should i give her some or wait?
Click to expand...

If she were mine and the fluids were OK, I'd go ahead....not only will it help flush ketones, it will help her to pee again sooner so you can get another test...but I also might call the ER vet back....they usually change vets all the time and the one there today may tell you something different than the last one

We don't like to mess around when there are ketones in the picture
 
Shes doing okay at the moment. Hanging out, alert, drinking. Normal. Vet at the er clinic said i can wait until tomorrow. Gonna try give her some IV fluids a bit later.
 
Victoria & Buttons said:
Shes doing okay at the moment. Hanging out, alert, drinking. Normal. Vet at the er clinic said i can wait until tomorrow. Gonna try give her some IV fluids a bit later.
Click to expand...

Hoping everything goes well! Is her bg down any more? I see it dropped a little bit for you.
 
It is finally!! So happy! :)

I've been looking up foods in the charts with less phosphorus in them. Correct me if I'm wrong, but it seems the more high end brands have less phosphorus like wellness, Purina, evo, innova, blue, nature's variety. Is that right?
 
Victoria & Buttons said:
it seems the more high end brands have less phosphorus like wellness, Purina, evo, innova, blue, nature's variety. Is that right?
Click to expand...

Yeah, unfortunately....You can also use the food chart in the "Sortable" view.....you want less than 10% carbs and I think it's less than 200mg Phosphorus....there are also phosphorus binders you can use with other foods

Victoria & Buttons said:
Also is it okay to feed her more than twice a day? Or does that screw up her sugars?
Click to expand...

It's actually better for her to eat more frequent, smaller meals....less stress on the pancreas than 2 big meals per day. The only time it's really important to take food up is the 2 hours immediately before Pre-shot tests
 
Victoria & Buttons said:
i did feed her after that, so wont her sugars go up now?
Click to expand...

Her numbers could go up due to feeding, but that's not the main thing at this point.....since you're on the last half of the cycle, the Lantus will be starting to wear off soon either way

It will be helpful if you'll report your numbers in US numbers.....most of us are used to seeing them instead of World numbers....all you have to do is multiply your number by 18 to get US numbers

Nice to see some yellow today!!!!
 
Let's back up a bit. No insulin is given in a drip. Typically, when a cat is diagnosed with DKA, dextrose is given in an IV line. Sometimes, Lantus is used in DKA but not typically. Usually, an insulin like Novolin/Humulin N is used as a basal insulin and Humulin R which is fast acting is used as a bolus insulin to force numbers down. Giving dextrose is a way for the vet to be aggressive with managing BG but not cause a hypoglycemic event. It's a tightrope walk.

I would not necessarily make any conclusions about any other conditions until you see labs once the DKA is history. DKA disrupts electrolytes, especially potassium and phosphorus. Hopefully, these levels were stable when your vet sent Buttons home.

Given that the starting dose of Lantus was likely too low as others have noted and your kitty is post-DKA, I would suggest that we be very attentive to Button's dose and we may push increases more quickly than is typical. However, the higher numbers you've been seeing may be a "bounce." Buttons drop into blue numbers on Sunday. From what's on your SS, this may be a range your kitty isn't used to spending time in. As a result, her liver and pancreas thought this was dangerous and kicked in with a stored form of glucose and counterregulatory hormones which cause a rise in numbers. The bounce can last for 3 days/6 cycles. What you may be seeing today is the bounce breaking. We'll need to be attentive to Button's dose and numbers in order to determine if this dose is OK or not.

I would encourage you to get a ketone test whenever you can. I didn't catch if you're testing for urinary ketones or if you have a meter that tests for ketones. The latter is easier but the strips are expensive. NovaMax and Precision Xtra make blood ketone meters.

 
Thank you for your input Sienne. Makes sense and thank you for caring enough to expain it all.

I am testing for ketones. Did get a small amount today, she has a vet appointment tomorrow.
I did ask for all the labs, Should i post them?
 
Yeah for yellow!

There is a labs tab on the spreadsheet. You can just enter the values there. You may have to change the reference ranges to what ever your lab uses. If nothing else, they won't be in US numbers.

By the way, whenever you enter a non number into the spreadsheet cells that expect numbers, it'll not show up properly on the US tab. You have to go to the US tab and manually enter the "Hi" values.
 
Hello and Welcome, you have some very experience folks looking at your post. I am still new, but just a quick heads up. My Marvin was sick once and throw-up when I got home from work. At that time I didn't test enough, I had just joined this forum so was brand new. The next morning his BG was really low for the first time (he was alway high), him being sick caused his BG to dive a bit, so keep an eye on that (he only dived to a yellow, but he had never seen a yellow before so for me was a big dive ;) ...)

BTW with Lantus as it's a long acting insulin, the low point is mid cycle, so the Pre-shot will be higher, it's the BG test you do after the shot that tells you how well your baby is doing :)... (took me forever to really get and understand that).
 
Hey sorry! Everything is still going okay. She's done antibiotics. Sugars are still good. I'm gonna try do another curve in the next day or so to see if I need to up her dose. Not sure when I should go back to vet for checkup. Will update SS asap
 
Victoria & Buttons said:
Hey sorry! Everything is still going okay. She's done antibiotics. Sugars are still good. I'm gonna try do another curve in the next day or so to see if I need to up her dose. Not sure when I should go back to vet for checkup. Will update SS asap
Click to expand...

I'm glad to hear this. Was really worried. Would love to see her progression on the SS :)
 
Status
Not open for further replies.
Back
Top