Need help! Vet too nonchalant

[Lilly’s Mom]

Tiki Cat Ahi Tuna is zero carbs if that will help. Lilly doesn't like it as much as the Friskies Pate, which is pretty low. I get the ones that are 5 or less carbs. Lilly bounced around for a bit but I have finally settled at 2 units twice a day and it seems to be keeping her on a good track. I tried going lower and she crept up there. For her, even when her number is a bit lower, I keep her at the same dose. If I see a consistent trend to lower numbers, then I'll adjust but I don't make an adjustment based on one or two numbers. I tried that at first and she just kept bouncing around. The only time I would alter that is if she is below 50....then I'd probably delay her shot or skip one and watch her more closely. It took a couple of months to really get Lilly regulated. It was really scary at first.

 

[Moms2Tigger&Blu]

So last night went pretty well. No low number near his nadir (it was higher in fact :/) and his AMPS was 350 so we gave a 0.5 unit dose. However, as seems to be his unusual cycle, just now his PMPS was 75 (72 the first time). Its like he can't have twice a day dosing! Has anyone heard of this? I know its probably his insulin depot or a bounce or a carryover or any other word that doesn't make it any less confusing but still. What is it with this cat?! On the plus side his Ketone number was back down at 1.2. He is eating good, but not too good. His weight is stable/up a few ounces. No excessive urination. He still drinks more than we are used to but it's pretty stable since he got out of ICU. I just don't know what I am going to do with this cat. Gravy food and retesting I guess, but in the long run, I think we need a cat nanny

 

[Kris & Teasel]

Have you tried eyeballing a 0.25 u dose?

 

[Moms2Tigger&Blu]

just that one time on 7/24.
AMPS 482, +2 485, +4 418, +6 380, PSPS 58. Insulin stopped again at that point :/

update: BG 265 after half a can of HC wet food.

 

[Moms2Tigger&Blu]

Ok so here we are again. After last nights' low we feed some higher carb wet along with his normal FF. Got the BG up, but was not sure if it was too late to still shoot. Apparently he vomited all that food up sometime after 1am.(like a good 6 hours later). Demanded a snack at 4 am. Just now his AMPS was 480. Isn't that high for having vomited all the HC food? He has always been a puker so its hard to know when to worry. We have changed so many things in his routine after the ICU stay I'm sure its confusing his body. The fiber response dry was the best thing ever for his constipation/vomiting. Now he's back on the miralax and i don't think its fully working yet. Anyway he got his breakfast and shot this am - tried to eye a dose around 0.4 or 0.3. Girlfriend will be around to watch him most of the day. He seems to be drinking a little bit more than normal but again no other symptoms.

So I read and reread the SLGS directions several times, including the FAQ about holding a shot for a while if PSBG is too low. It says to wait, retest and give shot if too much time has not passed . . . but what is too much time? It also says you can try a smaller dose but I don't think I could eye much smaller. I'm sure if 6 hours have passed you just skip dose. 1 hour you'd probably give it (depending BG reading). But what about 2-4 hours? Any advice?

 

[Kris & Teasel]

Lantus does best on a fairly strict 12/12 schedule. You can stray from that maybe up to 30 minutes if you're stalling. If it's well beyond that (1 hour+) skipping the shot is best. Because it's a depot insulin changing the time between shots too much can increase or decrease the dose overlap to the point that it acts like an increase (doses too close together) or decrease (doses too far apart).

I suggest you spend some time practicing drawing up an eyeballed 0.25 u with coloured water. That might well be the dose that could be given consistently AM and PM. Microdosing is a technique many people have to use. That includes doses as tiny an (an estimated) 0.1 u or "a drop". No vet will ever tell you this. The smallest increment they can think about is 0.5 u because it corresponds to lines on the syringe. This image shows examples of tiny doses:

Pictorial guide using a U-100 syringe marked with half units:

These extreme ups and downs in BG can't make him feel good.

 

[Moms2Tigger&Blu]

These extreme ups and downs in BG can't make him feel good.

I agree, he definitely has days that seem ok but then the next he's really good - playful, talkative and I can see the difference. I'm wondering if all of this would be happening if the vet hadn't stopped his Insulin so early on. I know its only been a few weeks but if I knew then what I (sorta) know now I would have questioned it immediately. I wonder if a decrease was more in order instead of one reading deciding he was already in remission only 2 weeks after almost dying from DKA. When we spoke to his regular vet on Friday, just to update them, she couldn't believe they stopped it like that. It really makes me wonder if all the stopping and starting didn't just make things worse. I hope now that I am sticking to SLGS as best I can, he may do better - even though we already held a shot last night. He seemed to do ok with the am cycle. AMPS 486. Tried for a 0.4ish dose. 380 at +6. PMPS 222 just now - gonna try for 0.3 because we've never given him a shot with BG this low. Does that sound reasonable?

(and thanks for all the help)

 

[Kris & Teasel]

I agree, he definitely has days that seem ok but then the next he's really good - playful, talkative and I can see the difference. I'm wondering if all of this would be happening if the vet hadn't stopped his Insulin so early on. I know its only been a few weeks but if I knew then what I (sorta) know now I would have questioned it immediately. I wonder if a decrease was more in order instead of one reading deciding he was already in remission only 2 weeks after almost dying from DKA. When we spoke to his regular vet on Friday, just to update them, she couldn't believe they stopped it like that. It really makes me wonder if all the stopping and starting didn't just make things worse. I hope now that I am sticking to SLGS as best I can, he may do better - even though we already held a shot last night. He seemed to do ok with the am cycle. AMPS 486. Tried for a 0.4ish dose. 380 at +6. PMPS 222 just now - gonna try for 0.3 because we've never given him a shot with BG this low. Does that sound reasonable?

(and thanks for all the help)[/QUOTE

Try to keep the same dose AM and PM with Lantus. Changing dose and skipping dose interferes with the depot and can increase his volatility. That depot works to the kitty's advantage when it's stable. I suggested 0.25 u as a place to start. It's low enough (I think) that you'll have PSs high enough for insulin both AM and PM. Follow SLGS for the recommended number of days, including doing the curve at the end of that interval. Assess the dose then and decide if it needs to go up based on the SLGS guidelines.

 

[Moms2Tigger&Blu]

Hmmm, I thought I read to decrease the dose if PS # is way lower than normal. Considering his are usually in the 400's 222 seemed scary low. However his BG was 434 just now at +5 so I guess I didn't give enough . . . or any . . . can hardly tell with these tiny needles and miniscule amounts (sigh).

 

[Kris & Teasel]

I think you've posted on the Lantus forum before. I suggest you keep posting there. It's a large forum with a lot of very knowledgeable people to guide you. They can coach you step by step through the SLGS process.