Ricky PMS was 160, and he vomited today

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PamJV

PamJV

Member Since 2017
These last few days I have been again trying Ricky back on 5 units of Lantus. We had been trying 5 units one week, then 4 units one week, then 4-1/2 units one week and now back to 5 units again. On the 4 and 4-1/2 units he would have a straight curve staying in the 300's all day. Previous on 5 units he had a big curve that started at 220 dipped down to 80 at the low point. That 80 was a bit of a worry in that I don't intend to test him every day.. I was just giving the dose and then doing a glucose curve after a week to test out the result.

Well this week he's been back on 5 units again. I noticed that he had vomited today some of his food, and he vomited some other times that could have been from yesterday. So even though it's not been a whole week I just did a PMS test and the reading was 160 which is much lower than his usual Preshot test would be. So I didn't give any insulin yet, and am asking you guys what to do. He doesn't look interested in food, and since he vomited I can imagine that's why.

All these problems have started since they discontinued EVO and I've been trying him on other foods. Right now he's eating Glycobalance. He seemed to really like it at first but now it's just so so. I couldn't get him to eat YAZ or Wysong Epigen. I realize Glycobalance is higher in carb than those foods but it is supposedly balanced with the glycemic index. His blood sugar has been lower since switching to this than his blood sugar was on EVO. But he's just not eating as much as before so that might be why.

And tonight I offered him some other dry foods that are not for diabetics just to get him to eat something, but he didn't want those either.
 
I didn't give him insulin yesterday evening because I was afraid he wasn't going to eat. I probably should have given him a small dose. This morning his BG was 500 ! So I gave him 5 units again. My vet has been having me test the different doses 4 units, 4-1/2 units, 5 units etc. He hasn't vomited.
 
okarmae said:
I see you gave 5 ud again, he tested 260. Curious about the am shot, hope its a nice number!
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I gave 5 units in the AM however did not test. My vet had instructed me to do 5 units for a week then do a curve. So I have been working toward doing the curve on June 13th. But since Ricky didn't seem just right and he vomited on June 10th, that led me to doing some pre shot tests also.

But then today in the evening I thought Ricky seemed off and didn't notice him eating much so I did a PMS which again gave the number 160! This time instead of skipping the shot all together I decided to give 3 units. Before when I skipped the shot his AMS the next day was 500 ! I know that many here would think a pre shot number of 160 was good. That could be good if I knew that the nadir was not going too low and he was eating and looking normal. But working with a dose as large as 5 units, I am afraid of a big number drop. Any way it's always about how the cat looks and acts.

It's been hard because I've done a week at 5 units, a week at 4 units, a week at 4-1/2 units and now another week at 5 units.....nothing is working out. I think he was more consistent back when he was eating EVO because he liked that food so I could count on him eating regularly.
 
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Lesliejm said:
He needs to be on wet food.
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That's easy to say, but Ricky has refused wet food his entire life. He's not going to eat wet food, and I can't see making him starve several days in the attempt. So I can only work with what his situation is. I have 4 other cats that do eat wet food, but Ricky runs from it.
 
I know what you mean, it happened the same for us a couple of weeks back when we upped the units from 3 to 4. Im not sure why it happened but every three four days, his preshot number would be too low for me to give dose without being afraid of how it is going to be in nadir. I think it is best to give a smaller dose than to skip it altogether. My boy is also on kibble, because of his IBD, I cant seem to kep his loose stools under control with wet food. What I did is go lower on the dose, 3 again and up it slowly instead of 1 UD as my vet did before. Ill be uping 0.25 every 5-6 days depending on how he reacts. Maybe they need more time on a dose before uping to the next, although Ricky´s situation is a bit different, youve been into yellows a great deal of time and we still dont have that. Hope the curve turns out alright, fingers crossed.
 
okarmae said:
I know what you mean, it happened the same for us a couple of weeks back when we upped the units from 3 to 4. Maybe they need more time on a dose before uping to the next, although Ricky´s situation is a bit different, youve been into yellows a great deal of time and we still dont have that. Hope the curve turns out alright, fingers crossed.
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This vet of mine sees nothing wrong in jumping from 4 units to 6 units right away. That's what happened at one point, and going up to 6 units his plantigrade gait resolved right away! So I thought this vet must have good ideas. Ricky was doing well on 6 units for quite a while. But then complication came about when EVO food was discontinued and since then Ricky has not been eating like he used to. He got one day with his BG just going straight down, all the way to 40 by the evening, and I took him to ER. So we then started experimenting with these different doses. I think there has to be some dose that is right. Even if he is on dry food, there still has to be dose that works for him. What kibble are you feeding?
 
Oh, we are in Europe so the foods you have there, I dont have access to. I fed Purina MD and now I want to switch to RC gastrointestinal because of his IBD. But that will up the sugar in his BG because it has more carbs and the vet says we will have to up the dose...
As to changing so fast from one dose to another, I dont think is alright. Dont follow the vet blindly. In the beginning I was doing the same and switched doses too fast, I think. When we reached 4 UD, it was 3 days before he showed a really low preshot value (compared to the other before). So I was forced to start the dance of lowering dose before preshot and then go back to the dose before because by the next shot, his BG levels would rise a lot. Also, keep in mind the depot, Im still not 100% of how it works but from what I gather, it takes a couple of days for the body to store a depot of Lantus that is used when there is not enough insulin in his system. Dont quote me on that but to my logic, that is how it works.
The curve you will be doing today may not be on point so be careful. If your vet changes the dose again and adds or takes too many units, Id go slowly doing the change and give more time for a dose to work before going to another. Good luck!
 
Most of the time I've seen recommendations of .25 or .5 for changes in dosage. Sometimes, if their BG drops a lot, a larger change is necessary to prevent a hypo. This has happened with my Callie.
 
okarmae said:
Im still not 100% of how it works but from what I gather, it takes a couple of days for the body to store a depot of Lantus that is used when there is not enough insulin in his system. Dont quote me on that but to my logic, that is how it works. The curve you will be doing today may not be on point so be careful. If your vet changes the dose again and adds or takes too many units, Id go slowly doing the change and give more time for a dose to work before going to another. Good luck!
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Each time I am told to change the dose and keep on it for a week before doing another curve. So we do give it time before testing. But the vet does seem to think it is OK to change whole units at a time. Today I told him what has happened this week and he said I should go down to 4 units now. Yes, tried that before. I think it may be I have to accept higher numbers if he looks better and eats. Not sure.
 
donnalea said:
Most of the time I've seen recommendations of .25 or .5 for changes in dosage. Sometimes, if their BG drops a lot, a larger change is necessary to prevent a hypo. This has happened with my Callie.
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I have wondered how anyone can see a .25 difference with such a tiny syringe? I can't. I can detect a half unit difference but not a quarter.
 
AMS was 321, Gave 5 units..........and +5 was up to 359. Don't understand why. All he was doing was sleeping during this time.
 
PamJV said:
I have wondered how anyone can see a .25 difference with such a tiny syringe? I can't. I can detect a half unit difference but not a quarter.
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Here lower on the post you can find pictures with the plunger in small doses. I just increased last night with 0,25 and I placed the plunger in the middle of the unit, with the lower part of it right in the middle, like in the picture.
 
okarmae said:
Here lower on the post you can find pictures with the plunger in small doses. I just increased last night with 0,25 and I placed the plunger in the middle of the unit, with the lower part of it right in the middle, like in the picture.
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Thanks. My syringes don't have those mid marks. I will experiment to see if I can actually see a mid point myself. Tonight Ricky's PMS was 240. But today was abnormal day in that he went low last night and I gave him only 3 units, then this morning gave him the regular 5 units. He's been sleeping a lot.
 
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