2/28 Jasmine. PMPS 383/+2 243/+4 104/+5 83/+6 58/+7 104/+8 119/+11 277

flyingduster

flyingduster

Member Since 2019
Previous Day

Just starting Jasmines thread today while I have a moment. I txt my vet this morning to have a look at her spreadsheet and to check in with a dose decrease to 0.75 and she agrees (and also said “she’s had a good initial response.”) so I am feeling really good that my vet is on side with reducing right away and I’m not being torn between with two different opinions (here and my vet) haha.

So she’s due in 15 mins for her AMPS, breakfast, and reduced shot. I will be out later this morning but going by previous days she won’t hit nadir until this afternoon when I’m home anyway. I will check her +2 before going out.

I’m so excited to be progressing more than we were with caninsulin. Lol.
 
Hi Amy and Jasmine!!
Very cute video of your daughter and Jasmine.

She did have a good response to lantus, sometimes cat's have a strong initial response and then it settles down.
I understand your reasoning for taking the dose down, but I just wanted to highlight a couple of things.
On your signature I see she had DKA in January. So I would exercise caution in taking the dose down too quickly and I would avoid skipping shots if at all possible.
Once a kitty has developed DKA, they can be susceptible to developing ketones and DKA again.
One of the key 'ingredients' for ketones developing is not enough insulin, and as they can develop very quickly indeed, it's usually not advisable for a kitty that has had recent DKA to skip doses.
The basic recipe for DKA developing is
1)not enough insulin
2) not enough food
3)and infection or other systemic stress
So if Jasmine were to be off her food, or you suspected something was not well, she was vomiting, not eating enough, it becomes even more risky to reduce or skip insulin shots.

Just wanted to highlight that for you going forwards

I would also suggest keeping a check on ketones daily, maybe even more than once a day, if she were off, numbers were high or if you are skipping or missing shots.

Here's a link with some further reading
http://www.felinediabetes.com/FDMB/threads/ketones-diabetic-ketoacidosis-dka-and-blood-ketone-meters.135952/
 
Aww, you guys, my vet just sent me this txt:
“I just want to say I really appreciate working with you. I've been wanting to encourage more home monitoring and you're really helping me see what owners are capable of.“

ITS WORKING! Haha. My vet is on my side and we are working together and we are potentially helping future diabetic cats in my area too!!
 
Gill & George said:
Hi Amy and Jasmine!!
Very cute video of your daughter and Jasmine.

She did have a good response to lantus, sometimes cat's have a strong initial response and then it settles down.
I understand your reasoning for taking the dose down, but I just wanted to highlight a couple of things.
On your signature I see she had DKA in January. So I would exercise caution in taking the dose down too quickly and I would avoid skipping shots if at all possible.
Once a kitty has developed DKA, they can be susceptible to developing ketones and DKA again.
One of the key 'ingredients' for ketones developing is not enough insulin, and as they can develop very quickly indeed, it's usually not advisable for a kitty that has had recent DKA to skip doses.
The basic recipe for DKA developing is
1)not enough insulin
2) not enough food
3)and infection or other systemic stress
So if Jasmine were to be off her food, or you suspected something was not well, she was vomiting, not eating enough, it becomes even more risky to reduce or skip insulin shots.

Just wanted to highlight that for you going forwards

I would also suggest keeping a check on ketones daily, maybe even more than once a day, if she were off, numbers were high or if you are skipping or missing shots.

Here's a link with some further reading
http://www.felinediabetes.com/FDMB/...oacidosis-dka-and-blood-ketone-meters.135952/
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Thanks Gill! Yes I wasn’t really sure about skipping the dose too, nor do i want to be changing things around lots, but also I can’t just dose her when it’s likely to send her into hypo either. It’s like the problems we had with caninsulin initially too.

I haven’t been checking ketones daily as I have to try and pre-arrange it (she toilets outside in the yard and I have to catch it directly when she goes!) The times I’ve checked her ketones when we’ve been worried at her high levels or low appetite, it’s been negative. She is eating very well at the moment; possibly even better than she has since diagnosis. I guess I have become a bit blasé about the high numbers as it seems like that’s all she’s had for so long! But you’re right I should be wary still!! Thank you
 
Gill & George said:
The link to info about ketones, has links for blood ketone meters, might save you having to stalk her :)
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Yeah although the meters available here are different I believe, but I just did a quick google and there is one that’s about $40 that I could get some time. I just can’t really afford it right now as I need that $40 to buy a few more packs of strips!! I’m hanging out to get the vet bill paid off so I can afford more.
 
Hi @Gill & George good to see you. Hope you are well.
Just wanted to say why I suggested Amy skipped the shot last night. I was aware of the DKA as I have been helping Amy since she came on here...... and I know it is better not to skip. We had to skip a few times early on with the caninsulin when Jazz was too low to shoot and it was not safe. We encouraged ketone testing and eventually Amy was able to get a test which was negative, which was a relief. I thought about stalling and/ or reducing the dose for last night but I was very aware that Amy has three young children including a baby and she can’t usually test much at night. Also Jazz was eating well, so I thought the safer choice was to skip and drop the dose back to 0.75 as she had earned a reduction on the SLGS and also she would hopefully be able to shoot both times a day. Amy was just following my recommendation.
But in saying all that I agree it is really important to be aware that DKA can appear again and to take all the precautions to stop it happening. Thanks:):bighug:
 
Thanks Bron, I appreciate your support over the past weeks!

I’m intending to try and catch a urine sample again today to check her anyway. She’s still eating well but it doesn’t hurt to keep checking whenever I can too!

She’s still sitting high now at +6, but I figure she was skipped last night so it’s a bit of starting again. I also had to get her down off the roof of the house to test her.... I know she can get down from there herself, but I had to go up there and bring her down to test her cos she was being all meek about it. Lol.
 
flyingduster said:
Thanks Bron, I appreciate your support over the past weeks!

I’m intending to try and catch a urine sample again today to check her anyway. She’s still eating well but it doesn’t hurt to keep checking whenever I can too!

She’s still sitting high now at +6, but I figure she was skipped last night so it’s a bit of starting again. I also had to get her down off the roof of the house to test her.... I know she can get down from there herself, but I had to go up there and bring her down to test her cos she was being all meek about it. Lol.
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She could be bouncing from the low numbers yesterday or high from the skipped shot last night. Probably a bit of both. But she sounds fit and well if she’s up on the roof!! Her numbers will come back down. I’m glad you are getting another urine test.
Can you put in your signature that you are following SLGS if that is what you have decided please so everyone can see when they are helping you, thanks.
 
Ah yes! I have edited my signature for that.

I tested her ketones and it was definitely negative still. It makes me laugh that I can take her out to the bushes and just slip a jar lid underneath her once she squats and pees. Haha!! Such a tolerant kitty. Lol.

Anyway, I did that earlier and have done another BGL and while she hasn’t gone very low, she has stayed beautifully steady without swinging and bouncing around, which I call a win for the first round on this dose! She still has to build a depot to get a true level anyway. We will see what her PMPS is in a couple of hours.
 
Very very steady afternoon and evening for her. I will make sure to get a +2 before bed tonight. I can check her through the night, but I might just do around +6-8 ish? I’m not too worried about a big drop overnight so think that would be ok right?
 
flyingduster said:
Very very steady afternoon and evening for her. I will make sure to get a +2 before bed tonight. I can check her through the night, but I might just do around +6-8 ish? I’m not too worried about a big drop overnight so think that would be ok right?
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Be guided by the +2 as to when you get up. Probably a plus 6 is better than a +8 because if she’s getting low you can test again. Better than finding her really low at +8.
With the smaller dose she probably won’t drop as low as the depot was interrupted but you can’t guarantee that because she is a cat.
 
Haha. Yes. Can’t predict a cat! Ok I will set my alarm for 2am and do a +6 as well as the +2 which is just under an hour away.

If she’s dropped a bit at +2, that mean an active cycle and I should test sooner than +6 too, right? But if she’s fairly level still then +6 is probably fine? And play it by ear after the +6.
 
flyingduster said:
It makes me laugh that I can take her out to the bushes and just slip a jar lid underneath her once she squats and pees.
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The image gave me a giggle too:joyful:
flyingduster said:
I’m not too worried about a big drop overnight so think that would be ok right?
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You realize that they read their condo's, and then promptly mess with us:p
flyingduster said:
If she’s dropped a bit at +2, that mean an active cycle and I should test sooner than +6 too, right?
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Yes if you catch a sharp drop at +2 you may want to get another test before the +6 especially if she has been prone to sharp drops.

Bron and Sheba said:
Hi @Gill & George good to see you. Hope you are well.
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Thanks for the back round Bron.
 
Amy I would suggest that in your thread title, you use the US numbers, most of the members are not familiar with the mmol/l scale, so you'll get more folk looking out for you and stopping by if the numbers suggest that you might need a little extra support.
 
Thanks Gill!

So, of course, she has dropped sharply! *facepalm* so yeah, I will set my alarm for a midnight test as well as the 2am one and see how she’s going. I HOPE that while it’s sharp now it will level out, but of course we will see.

Thanks for the idea of putting the US numbers in the title too. I’ll go do that now. I’ll just ditch the daytime numbers though as they aren’t the relevant ones now (and can still be seen on my spreadsheet)
 
Hope you catch a nap. Getting a +4 (midnight) is good plan.

I don't know if you already did, but a little snack at that +2 could help slow her down. Slowing down the sharp drops can help reduce the resultant bounce.
 
She ate at +2. She pretty much eats every 2 hours while we are up.

It’s now +4 and sure enough she’s dropped lots now. Still safe, but big downward trend. She hasn’t eaten right now at +4 cos she wants to stay in bed.
 
When you follow SLGS you take action if the BSL drops below 90(5) so you need to give Jazz some high carb food to bring her up over 90.
You have also earned a dose reduction to 0.5 unit with the 4.2 (76). You have just taken a reduction yesterday and usually we don’t take back to back reduction because the depot is still in play but I doubt there is much depot there yet because of the skip last night. I’m going to tag @Wendy&Neko and see what she thinks. Get advise before you give the AMPS dose in the morning if Wendy hasn’t seen this. .
 
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Hi there! Your Jasmine looks just like a standard poodle, LOL !

She really is having a nice initial response to Lantus. That +5 of 83 would call for a reduction according to SLGS , but with her recent DKA I am not sure if that is a good idea. Then on the other hand she hit that number with only 2 doses of .75 and after a skipped shot. I am glad that Bron tagged Wendy for some dose guidance tomorrow morning and will be interested in what she thinks.

Should you grab another test tonight and she is still dropping, a little food to help slow her down. If she starts edging towards 50, you should give her some medium carb food to boost her up. With Lantus the take action number is 50.

You are so lucky to have such a good vet understanding how important it is to home test and is willing to work with you. :cat:
 
What do you think, Gill? Two doses on .75 and a drop down to 58. I think she should reduce tomorrow as long as Jasmines is eating well and feeling well.

Did you recently change her to low carb food? That could explain the sudden lower numbers.
 
To help us decide what a good course of action would be.
Can you tell us Amy if Jasmine is at a good weight? Is she eating well at the moment? She was up on the roof earlier so I guess she's feeling good and behaving normally?
Ketone test was negative, which is also good.
 
How are you getting on Amy? Did her BG come back up?
Important to remember if BG came up that's good but it's important not to become complacent, remember it can wear off completely so it's important to check that she doesn't dive again once that's happened so you will need to double check 2 hrs from when you gave the HC.
 
Amy just a thought, what syringes are you using? Did you get some u100 syringes? or are you using the same ones you used for caninsulin?

ETA I just read back through your posts, and found this
flyingduster said:
I only have u100 0.3ml syringes. I’ve not had any u40 syringes ever, so there’s none in the house. I bought my own, none supplied by the vet.
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So when you were shooting '1u' of caninsulin how were you measuring that on the u100 syrninges? Were you drawing up to the 1u line? or was it a different line that you were drawing up to?
 
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Ok, sorry I’m juggling baby here too. Just got a +7 check in and it’s back up. I won’t be complacent though and will check in at +8 as well.

I’ve only ever had u100 syringes (I was using the conversion of *2.5 to draw up caninsulin in them) and have never even had u40 syringes in the house to get mixed up with.

She was switched to wet food right on the first day of the chart like 5 weeks ago.

Jasmine is still somewhat underweight, but not at all drastic. Just a wee bit bony on her hips and lower spine. She’s never been fat and she lost this weight when she went in to DKA and just hasn’t regained it yet (but also hasn’t yet been regulated since then either!) But she is eating well *for her* as eating more than one 185g can a day, but less than two.
 
flyingduster said:
I was drawing up to the 2.5 line for 1iu of caninsulin. When I was doing the 0.8 dose I was drawing up to the 2iu on the syringe.
I used this link: http://www.felinediabetes.com/insulin-conversions.htm
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That's the correct conversion, I just wanted to double check, I thought maybe it might explain the change in BG since with the vetsulin she didn't see any green to speak of, though there are some gaps here and there and being a a cat who knows if she dropped when you weren't looking:rolleyes:
 
Up again at +8. Reckon it might be safe to try sleep until +10? That’ll be 6am and we tend to get up around then anyway.
 
flyingduster said:
Jasmine is still somewhat underweight, but not at all drastic. Just a wee bit bony on her hips and lower spine. She’s never been fat and she lost this weight when she went in to DKA and just hasn’t regained it yet (but also hasn’t yet been regulated since then either!) But she is eating well *for her* as eating more than one 185g can a day, but less than two.
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It would be advisable to get her weight up to what it was before the DKA, to do this you may need to be feeding more, that in turn will help with the BG.
How many calories a day is she getting?
Required calories per day = [13.6 X optimal lean body weight in pounds] + 70
Taken from Dr Lisas site
http://catinfo.org/?link=felineobesity#How_Much_Do_I_Feed

Because she is post DKA and needs to regain weight you should be aiming to get some more calories into her (aiming for 1.5 times more), this will help her recuperate and also keep ketones at bay, avoiding another expensive visit to the hospital.
With more food on board it should also mitigate some of those sharp drops you are finding.

flyingduster said:
Reckon it might be safe to try sleep until +10? That’ll be 6am and we tend to get up around then anyway.
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sounds like a plan, I was going to say get a +11, but if you are up anyways a +10 would be a good idea.

Good job.
 
She has total free access to food except when I remember to put the lid on it 2 hours before her preshot. I’m
Not sure how to make her eat more?? I’m not sure how many calories a day she gets. I’ll look at the cans in the day when we are up and see.

I don’t even know what her exact weight was prior, I only know her hips and lower spine are still a little bony. Not as bad as earlier, but still bonier than ideal.

I’m off to sleep. Thank you!! Xx
 
As for dose she did earn a reduction as per SLGS, so ordinarily, I would encourage you to take the reduction as per your protocol of choice. As I have expressed earlier my concern is for the ketones developing if we take things down to quickly, resulting in her not getting enough insulin for her needs and if shes not getting enough calories, it only takes one other thing like infection or systemic stress and that could be the tipping point for her developing ketones.

It would be good if you could figure out how many calories she is getting and we can take things from there.
If she is fee fed, do you find she goes looking for her food when she is dropping? George would park himself by his food bowl when he dropped fast.

I would encourage you not to skip, with the flipflopping of doses and skips, it becomes hard to see what the dose is actually doing, since any change in dose, skip has an effect on the depot that has built and that in turn affects the cycles, so the numbers don't behave like we expect them to.

If this were me I would probably stick with the 0.75u, mostly because I'm a TR sort of a gal, and DKA scares me more than green numbers. But I don't have a family to juggle in addition to a FD kitty diving.

If that option seems to 'aggressive' for your current situation, then you could try taking her down to the 0.5u. As I said I would avoid skipping. If she were to be below 90 at amps, then you would need to stall without feeding and wait till her numbers started to rise before shooting.
 
flyingduster said:
I don’t even know what her exact weight was prior, I only know her hips and lower spine are still a little bony. Not as bad as earlier, but still bonier than ideal.
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perhaps your vet might have noted what her ideal weight was, or have a record of it from earlier visits prior to the FD diagnosis?
 
Jasmine has never been to the vets here before her DKA, and when she last went to the vets anywhere was years ago. We’ve never really done random check ups for the sake of it and Jazz hasn’t ever been sick before. I would give her maaaaaybe as much as a lb more weight but no more for sure. She’s not skin and bones at all. I will go check that food for calories soon; stuck under a feeding baby right now and catching up on posts.

I just plugged in her +11 which is a nice yellow figure. I’m fairly happy to do more of a TR if that works, I still don’t really understand the difference, I just want my kitty better. I don’t really know what dose to do. I mean she is clearly heading for a perfectly shootable level already so could potentially do 0.75 again, I don’t know if that will drag her down TOO low though?? I don’t want to skip at all, it screws it all up and her level is ok to shoot, but what will her evening level be?? Hmm.
 
flyingduster said:
I’m fairly happy to do more of a TR if that works, I still don’t really understand the difference
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The difference between the two are how long you hold a dose. With TR the dose can be raised every 3 days where as SLGS the dose is held for 7 days. With DKA in the picture, it is usually a better choice to be more aggressive with the dosing and follow TR. If you are willing and able to, it would be best. Also, the difference between the two methods is the reduction point. On a human meter and following TR the reduction is 50. With SLGS it is 90. Kitty doesn't get to spend as much time in green numbers in SLGS.

You are doing a remarkable job balancing Jasmine and young children. ! :)
 
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