? Post hypo dosing advice needed

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Just rechecked. BG is now at 69. :) And he's eating with a bit more gusto. We just keep giving him small amounts of Fancy Feast and the doggy kibble. We also did give him more honey at the last recheck.
 
Trying to keep the information summarized for new members to have a quick view of the situation. If you see any erros let me know.

Summary

Lantus 3 units human meter

DKA episode in 2016

PMPS not done
+8 20 honey &LC food
+8.5 48 honey&kibble
+9 90 no food
+9.5 45 honey & kibble
+10 69 LC&kibble
 
Okay, it's okay to take the 911 down. Post when you get the next test. And when it's time for shot time again, add a question mark to the title thread and ask for help with the dose. Since he went so low and because of the past DKA episode, he should get insulin , but not sure how much. I am going to copy and paste Mary Ann's summery along with the recent number for peeps to see

DKA episode in 2016

PMPS not done
+8 20 honey &LC food
+8.5 48 honey&kibble
+9 90 no food
+9.5 45 honey & kibble+10 69 LC&kibble
+10.5 357
 
Though I’m not versed well enough in dosage suggestion, dka, you are in best of company to help through this., Rusty. Keep posting and testing etc as suggested.
Bumping this condo, too, please thank you.
 
Recheck: 69. Is it normal to be jumping and dropping like this? And what should we do next? He's due for his breakfast at 9:30.

EDIT: I may have not gotten the full sample size of blood on the strip. Could that cause a low reading?
 
It is possible that the reading at +10.5 hours after the shot was not correct. Sometimes you can get a "wonky" test strip. That is why Bobbie suggested retesting that number since it was so far out of line with the other numbers. I don't know if you should worry about the breakfast or not. Smokey has had lots of extra food the last few hours. Wait an hour and see where the numbers are at that point. You can change your title to ? Post hypo dosing advice needed and get some opinions/advice on whether or when to shoot next.

You said you were not testing on a regular basis. This hypo today is a good example of why testing is so very important. Testing should always be done before each shot and if possible at least once in between. Lantus usually will have a nadir (lowest number) around +5-+7 hours after shot so trying to get a reading somewhere around that time will be useful. If you have not been testing it is possible that Smokey has been hitting lower numbers before...maybe not as low as today, but enough that the dose needs to be adjusted.

Summary

Lantus 3 units human meter

DKA episode in 2016

PMPS not done
+8 20 honey &LC food
+8.5 48 honey&kibble
+9 90 no food
+9.5 45 honey & kibble
+10 69 LC&kibble
+10.5 357 no food Possible bad reading?????
+11 69


ETA Just saw your extra comment. If the last test was a very small drop it is possible that it could have given a lower reading than was accurate.
 
Rusty & Smokey said:
Recheck: Gave him half a can of FF. BG is now at 188.
Click to expand...

Summary

Lantus 3 units human meter no regular monitoring no spreadsheet

DKA episode in 2016

PMPS not done
+8 20 honey &LC food
+8.5 48 honey&kibble
+9 90 no food
+9.5 45 honey & kibble
+10 69 LC&kibble
+10.5 357 no food Possible bad reading?????
+11 69
AMPS 188 low carb

It really looks like that 357 reading was a bad reading...sometimes happens with the odd test strip. So this is your normal shot time I am assuming. With that very low hypo and the fact that you have no routinely been doing glucose tests, my advice would be to wait an hour, with no more food given and retest. Post the number when you test. My thoughts are leaning towards giving 1 unit at this point with the readings you have done so far. In some cases it might be advised to skip the shot and let the depot drain, but with Smokey having had DKA in the past it would be better to give some insulin. The numbers should be starting to shoot upward, which is normal after a bad hypo. Hopefully some others will be on soon and give their opinions on which is the best way to proceed.

@Kris & Teasel @Amy&TrixieCat
 
Tuxedo Mom said:
Summary

Lantus 3 units human meter no regular monitoring no spreadsheet

DKA episode in 2016

PMPS not done
+8 20 honey &LC food
+8.5 48 honey&kibble
+9 90 no food
+9.5 45 honey & kibble
+10 69 LC&kibble
+10.5 357 no food Possible bad reading?????
+11 69
AMPS 188 low carb

It really looks like that 357 reading was a bad reading...sometimes happens with the odd test strip. So this is your normal shot time I am assuming. With that very low hypo and the fact that you have no routinely been doing glucose tests, my advice would be to wait an hour, with no more food given and retest. Post the number when you test. My thoughts are leaning towards giving 1 unit at this point with the readings you have done so far. In some cases it might be advised to skip the shot and let the depot drain, but with Smokey having had DKA in the past it would be better to give some insulin. The numbers should be starting to shoot upward, which is normal after a bad hypo. Hopefully some others will be on soon and give their opinions on which is the best way to proceed.

@Kris & Teasel
Click to expand...

So, should I give the 1 IU shot now or should I wait until we retest?
 
Rusty & Smokey said:
So, should I give the 1 IU shot now or should I wait until we retest?
Click to expand...


Wait an hour to let the food influence wear down and retest. If the number is still going up then my thought is 1 unit at that time. I tagged a couple of other members so hopefully they will give their opinions shortly.


ETA Poor Smokey has really had his poor ears worn out this morning
cat.gif
And you did a great job too
113.gif
 
Tuxedo Mom said:
Summary

Lantus 3 units human meter no regular monitoring no spreadsheet

DKA episode in 2016

PMPS not done
+8 20 honey &LC food
+8.5 48 honey&kibble
+9 90 no food
+9.5 45 honey & kibble
+10 69 LC&kibble
+10.5 357 no food Possible bad reading?????
+11 69
AMPS 188 low carb

It really looks like that 357 reading was a bad reading...sometimes happens with the odd test strip. So this is your normal shot time I am assuming. With that very low hypo and the fact that you have no routinely been doing glucose tests, my advice would be to wait an hour, with no more food given and retest. Post the number when you test. My thoughts are leaning towards giving 1 unit at this point with the readings you have done so far. In some cases it might be advised to skip the shot and let the depot drain, but with Smokey having had DKA in the past it would be better to give some insulin. The numbers should be starting to shoot upward, which is normal after a bad hypo. Hopefully some others will be on soon and give their opinions on which is the best way to proceed.

@Kris & Teasel
Click to expand...
This is a tough call. The 3 u depot is still acting. I understand the concern about ketones but it was in 2016 so my opinion is that the threat ranks lower than the symptomatic hypo in the last 24 hours. BG was hard to bring up. I think skipping the AM dose to allow some draining of the depot is wise. Now is a good time to get a testing routine started along with the very valuable spreadsheet so we can give the best advice.

Getting some BG tests today will be useful in deciding on an evening dose. My two cents.
 
Kris & Teasel said:
This is a tough call. The 3 u depot is still acting. I understand the concern about ketones but it was in 2016 so my opinion is that the threat ranks lower than the symptomatic hypo in the last 24 hours. BG was hard to bring up. I think skipping the AM dose to allow some draining of the depot is wise. Now is a good time to get a testing routine started along with the very valuable spreadsheet so we can give the best advice.

Getting some BG tests today will be useful in deciding on an evening dose. My two cents.
Click to expand...

I've already downloaded the spreadsheet and have been recording his numbers throughout this episode. How often should we be testing him? And should those readings still be recorded in the +hours post shot entries?
 
Kris & Teasel said:
This is a tough call. The 3 u depot is still acting. I understand the concern about ketones but it was in 2016 so my opinion is that the threat ranks lower than the symptomatic hypo in the last 24 hours. BG was hard to bring up. I think skipping the AM dose to allow some draining of the depot is wise. Now is a good time to get a testing routine started along with the very valuable spreadsheet so we can give the best advice.

Getting some BG tests today will be useful in deciding on an evening dose. My two cents.
Click to expand...


Thanks for weighing in Kris. I was thinking the same, since the DKA was in 2016, but wanted some other opinions.

Skipping the AM shot sounds like a good plan with some testing thrown in.
 
Rusty & Smokey said:
I've already downloaded the spreadsheet and have been recording his numbers throughout this episode. How often should we be testing him? And should those readings still be recorded in the +hours post shot entries?
Click to expand...
Good! Are you going to skip the dose this AM? If so, you might want to grab at least 2-3 tests before this evening to see if the depot is doing anything - maybe every 3 hours?

Re spreadsheet: you'll need to put a link to it in your signature (the light grey text under a post). Here's how:
  • click on your name in the upper right corner of this page then click on "signature" in the drop down menu
  • give some details about your kitty in the text box: date of diagnosis, age, insulin used, glucose meter used, what he eats, any other health issues/meds he has
  • open your SS and copy/paste its URL into the signature text box
  • make sure you've clicked on the "share" button on the SS and "anyone with link can view" so we can see it.
 
Kris & Teasel said:
Good! Are you going to skip the dose this AM? If so, you might want to grab at least 2-3 tests before this evening to see if the depot is doing anything - maybe every 3 hours?

Re spreadsheet: you'll need to put a link to it in your signature (the light grey text under a post). Here's how:
  • click on your name in the upper right corner of this page then click on "signature" in the drop down menu
  • give some details about your kitty in the text box: date of diagnosis, age, insulin used, glucose meter used, what he eats, any other health issues/meds he has
  • open your SS and copy/paste its URL into the signature text box
  • make sure you've clicked on the "share" button on the SS and "anyone with link can view" so we can see it.
Click to expand...

Does my signature look right? And does the link work?
 
Rusty & Smokey said:
Does my signature look right? And does the link work?
Click to expand...


YAH FOR YOU!!!
c23_rah.gif



Do a few tests through the day to see how Smokey's numbers go. As far as dosing tonight goes it is a wait and see game at this time. I personally would consider starting back at a lower dose and doing some regular testing to see where the dose should be. But let's see what others weigh in with when you get closer to dosing time. Great job keeping Smokey safe today!!
 
Tuxedo Mom said:
YAH FOR YOU!!!
c23_rah.gif



Do a few tests through the day to see how Smokey's numbers go. As far as dosing tonight goes it is a wait and see game at this time. I personally would consider starting back at a lower dose and doing some regular testing to see where the dose should be. But let's see what others weigh in with when you get closer to dosing time. Great job keeping Smokey safe today!!
Click to expand...

How often do you suggest we test?
 
Retest: BG is now 350. He is very unhappy with the frequent testing, and has been noisy, so he's definitely feeling much better.
 
Rusty & Smokey said:
Retest: BG is now 350. He is very unhappy with the frequent testing, and has been noisy, so he's definitely feeling much better.
Click to expand...


Looks like the HC, honey, bouncing and no shot have all caught up. You can give Smokey's ears a break and maybe test in about 5 hours and then 1/2 hour before your shot time. If you want to change your normal shot time a bit back or forward this would be a good time to do it, if a different time makes it easier for you. With the evening shot it is good to be able to get a test in a few hours after the shot to make sure he is not going to dive like he did last night.

Still not sure what the best dose to shoot for the evening shot is, but let's see what he is doing before it is time.
 
Hey Rusty! You did awesome today with those low numbers. I am sure you and Smokey could use a pokey break and rest. I think skipping to drain the depot is a good idea especially for how late in the cycle the hypo occurred. Like the others said, a test in what would be the mid cycle if you had shot. All data is good data.

Just wondering, how long has Smokey been on 3 units? And did you recently change anything with his diet like lowering the carbs?
 
Bobbie And Bubba said:
Hey Rusty! You did awesome today with those low numbers. I am sure you and Smokey could use a pokey break and rest. I think skipping to drain the depot is a good idea especially for how late in the cycle the hypo occurred. Like the others said, a test in what would be the mid cycle if you had shot. All data is good data.

Just wondering, how long has Smokey been on 3 units? And did you recently change anything with his diet like lowering the carbs?
Click to expand...

He's been on 3 units since January 4th. And there have been some changes in diet. We have stopped feeding him kibble altogether and he now only gets Fancy Feast and a few Temptations treats. We have also removed seafood flavors from his diet, as I read that those can be hard on the kidneys, especially for diabetics. And Smokey has some very very slight kidney damage from his DKA episode in 2016, so that was of greater concern that we remove fish flavors.
 
Rusty & Smokey said:
We have stopped feeding him kibble altogether
Click to expand...


How long has it been since the kibble was removed completely? Many kitties end up with a much reduced need for insulin once they are on a proper low carb wet food diet.

Do you have any other test numbers...either any you did or any done at the vet just to get an idea of where the numbers have been.


BTW Temptations are very high in carbs.
 
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Tuxedo Mom said:
How long has it been since the kibble was removed completely? Many kitties end up with a much reduced need for insulin once they are on a proper low carb wet food diet.

Do you have any other test numbers...either any you did or any done at the vet just to get an idea of where the numbers have been.
Click to expand...
It's been about a week or so since we removed kibble from his diet.

Unfortunately we dont' have exact numbers but from his last BG curve at the vet his numbers were mostly in the 300-400 range, as far as I remember
 
Rusty & Smokey said:
------

It's been about a week or so since we removed kibble from his diet.

Unfortunately we dont' have exact numbers but from his last BG curve at the vet his numbers were mostly in the 300-400 range, as far as I remember
Click to expand...


It can take a few days to a week to see glucose levels drop once kibble has been removed from the diet. That quite possibly could be one of the reasons for the hypo this morning.

This is important information and good thing @Bobbie And Bubba asked this question. This can have a bearing on what dosing you may want to use tonight.
 
Bingo! I had a sneaky suspicion that with a hypo that low and that late in the cycle that something significant had changed. I think the absence of the dry food is a game changer for dosing. My 2 cents worth says to do a restart at 1 unit and start tracking the BG's , one at pre shot, mid cycle and one before bed time in the PM cycle and see where 1 unit takes him. ( of course more testing if numbers drop again)

Let's see what others think.
 
Bobbie And Bubba said:
Bingo! I had a sneaky suspicion that with a hypo that low and that late in the cycle that something significant had changed. I think the absence of the dry food is a game changer for dosing. My 2 cents worth says to do a restart at 1 unit and start tracking the BG's , one at pre shot, mid cycle and one before bed time in the PM cycle and see where 1 unit takes him. ( of course more testing if numbers drop again)

Let's see what others think.
Click to expand...


I was already thinking about 1 unit before this information about the diet change came up, since there has not been any monitoring going on up until now. With finding out about the recent diet change I think restarting at 1 unit is prudent. Regular monitoring will tell whether this is a workable dose.
 
Hi Rusty,

Just wanted to check in and see how Smokey is doing. Great job getting him into safe numbers! Thanks for getting your signature and spreadsheet set up. One more piece of info it would be helpful to put in the signature is where you live. You can be as vague as you want - State, region, or whatever - what we really need to know is what timezone you are in.

Rusty & Smokey said:
a few Temptations treats
Click to expand...
As Mary Ann mentioned, Temptations are pretty high carb, best to only give in a hypo situation where kitty won't eat anything else. For testing treats, most of us use either plain cooked chicken cut into bite-sized pieces, or freeze dried meats (chicken or turkey is usually best, since Smokey doesn't get fish). You can get these at most pet stores. It's usually cheaper to buy the ones for dogs (just make sure there's nothing in it but the meat). To keep Smokey cooperative about testing, always give a treat, whether you are successful in getting blood or not. You want him to associate testing with good things. Here is a post with more great tips, like warming the ear, etc.

How do Smokey's ears look? It's a good idea to get some Neosporin gel with pain relief and rub it on before bed. Just wipe it off in the morning and the ears will heal faster. It also helps the blood to bead better.

I don't know if you've seen it before, but here is a post we put together to help people get comfortable using this forum - kind of like an FAQ: http://www.felinediabetes.com/FDMB/threads/updated-tips-for-new-members.173572/

One other tip for you: now that you're testing (and that is WONDERFUL!), any time you get a number that doesn't make sense (like that 357), it's a good idea to retest immediately. Sometimes you get a bad strip, or too much blood, etc. You don't want to react to a number that is incorrect, so it's best to be sure it's right.

I'm so glad you posted this morning and that your sibling was sharp enough to catch that Smokey was in trouble. We like happy endings here!
 
Update time: So I conked out and was unable to do the +5 test. But we got a PMPS and his BG is at 428, which is pretty standard for him. I spoke to his doctor earlier and she suggested reducing his insulin to 2 IU, but some of you here are recommending I cut down to 1 IU. Which would be better?

Tricia Cinco(GA) & Harvey said:
Hi Rusty,

Just wanted to check in and see how Smokey is doing. Great job getting him into safe numbers! Thanks for getting your signature and spreadsheet set up. One more piece of info it would be helpful to put in the signature is where you live. You can be as vague as you want - State, region, or whatever - what we really need to know is what timezone you are in.


As Mary Ann mentioned, Temptations are pretty high carb, best to only give in a hypo situation where kitty won't eat anything else. For testing treats, most of us use either plain cooked chicken cut into bite-sized pieces, or freeze dried meats (chicken or turkey is usually best, since Smokey doesn't get fish). You can get these at most pet stores. It's usually cheaper to buy the ones for dogs (just make sure there's nothing in it but the meat). To keep Smokey cooperative about testing, always give a treat, whether you are successful in getting blood or not. You want him to associate testing with good things. Here is a post with more great tips, like warming the ear, etc.

How do Smokey's ears look? It's a good idea to get some Neosporin gel with pain relief and rub it on before bed. Just wipe it off in the morning and the ears will heal faster. It also helps the blood to bead better.

I don't know if you've seen it before, but here is a post we put together to help people get comfortable using this forum - kind of like an FAQ: http://www.felinediabetes.com/FDMB/threads/updated-tips-for-new-members.173572/

One other tip for you: now that you're testing (and that is WONDERFUL!), any time you get a number that doesn't make sense (like that 357), it's a good idea to retest immediately. Sometimes you get a bad strip, or too much blood, etc. You don't want to react to a number that is incorrect, so it's best to be sure it's right.

I'm so glad you posted this morning and that your sibling was sharp enough to catch that Smokey was in trouble. We like happy endings here!
Click to expand...

He's doing very well! All back to his normal self. :D His ears seem fine, though he's VERY vocal when it's time to test lol! Will look into getting some Neosporin.
 
Before Bed retest: 377. :) Looks like he's in the clear for now. WIll keep everyone updated. Should I just continue to post updates in this thread as we navigate the messy world of BG monitoring?
 
Good job getting into the testing routine and catching the low numbers.

You start a new thread tomorrow, and link back to this one so people can see the history.
 
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