2/3 Sandy AMPS 168

[Liz & Sandy]

I’ve ran into Sandy’s numbers being in more normal range at shot time (200 and under). I feed, then give shot and his numbers have dropped below 60 sometimes.
He is 2 hours from his shot right now. He ate about 20 minutes ago so not going to give him anything else until he eats at his shot time.
He ate better today and has had about 3 oz total of food. About 100 calories so far which has been better than other days. Now at +10 his BG number is at 119. Hoping that number goes up a little with the food he ate. But if it stays under 150 I’m afraid to give insulin because I know his number will probably drop again. I know to stall and keep testing. But how long is it ok to stall what’s the max? I’ve heard 2 hours.
What is his BG doesn’t go up when I stall?
I’ve made the mistake of feeding so his number does up not realizing I wasn’t supposed to.

He went through DKA just about 3 weeks ago, so I’m told not to skip a dose.
Reason why I’m asking how long of a stall is ok?
Also how long should a cat stay on insulin after DKA if his numbers are staying in more normal range.
Should he stay on insulin for at least 4 weeks?
8 weeks?
I’m just trying to get an idea since I’m struggling to keep his numbers above 200 past few days.
I’m trying to feed higher carb food to raise his number some but he won’t eat much of the varieties I got. I’m having to mix the dry food he likes into it so he will eat some. But I know dry isn’t good.
I’m just trying to get an idea of how long after DKA can a cat go into remission?
Again asking because his numbers have improved a lot from where he was and it looks like he’s going into remission just on the change to fancy feast. But again numbers stay low, and the small amount of insulin he is on .25 unit has caused him to drop.

 

[Sienne and Gabby (GA)]

First, your cat is not in a consistently normal range. Normal blood glucose (BG) is 50 - 120. Sandy's getting there but isn't there yet.

With a history of DKA, you proceed VERY cautiously. Some cats can easily slide back into developing ketones so you are correct, you do not want to skip shots. You keep treating your diabetic cat until numbers are in a normal range for at least 2 weeks. This is a spreadsheet of a cat that recently went into remission. It will give you an idea of what you want your cat's spreadsheet to look like. There is nothing predictable about feline diabetes and DKA makes things even less predictable.

You can stall for up to 2 hours. The problem with stalling is that it throws your schedule off. You need to shoot every 12 hours. You can adjust the time by 15 min. at each shot of by 30 min. once a day.

It really sounds like you will need to get comfortable with lower numbers. It may also help to read the sticky notes at the top of the board. Since you've been using a bit of dry food, you will want to look at the Start Low Go Slow method for dosing. (You can't use Tight Regulation if there's any dry food available.) FWIW, I would shoot any number above 50. The mantra here is "Shoot low to stay low." As long as your cat is in good numbers, you're doing the right things.

 

[Wendy&Neko]

I'll try to answer you questions:

Reason why I’m asking how long of a stall is ok?

A lot can happen with numbers in two hours. He could still come up quite a bit. The issue with stalling is not so much how long you can stall, but that you have to stall without feeding. No food can cause a cat to drop after a while. So it's a balancing point. I suggest starting out with a 20-30 minutes stall, if that's what you think you need to do. That way if you shoot after 1/2 hour, you can still be relatively on time for the following shot.

Also how long should a cat stay on insulin after DKA if his numbers are staying in more normal range.
Should he stay on insulin for at least 4 weeks?
8 weeks?
I’m just trying to get an idea since I’m struggling to keep his numbers above 200 past few days.

Why are you trying to keep his numbers above 200? Regulation typically means numbers under 200. There is no answer to how long a cat should stay on insulin after DKA. The cat stays on insulin as long as needed. It is possible for a cat's pancreas to heal and for cats to go into remission. If a cat becomes regulated, then goes into remission, they go off of insulin. Some cats who've gone into DKA do not go off of insulin, but cat still live happy lives. I remember one cat in my time here who passed at age 20, after 11 years on insulin. I've also seen cats become regulated and go into remission after a couple months. There is no one answer. We have a saying ECID or each cat is different. Most of the people here following one of our dosing methods, which in your case would be the Start Low Go Slow Method. It helps to follow a dosing method to know when to increase the dose and when to decrease, as well as what to do when you see lower preshots than you are used. A dosing method will also help you get your cat regulated. Typically a cat goes down in dose until the next dose is zero units of insulin. At that point, their spreadsheet is usually mostly numbers under 100.

For continuity's sake, we ask that people include a link to their previous post here. Here is the link to your last post: https://felinediabetes.com/FDMB/thr...-9-year-old-sandy-recovering-from-dka.242346/

 

[Marje and Gracie]

I’ve ran into Sandy’s numbers being in more normal range at shot time (200 and under). I feed, then give shot and his numbers have dropped below 60 sometimes.
He is 2 hours from his shot right now. He ate about 20 minutes ago so not going to give him anything else until he eats at his shot time.
He ate better today and has had about 3 oz total of food. About 100 calories so far which has been better than other days. Now at +10 his BG number is at 119. Hoping that number goes up a little with the food he ate. But if it stays under 150 I’m afraid to give insulin because I know his number will probably drop again. I know to stall and keep testing. But how long is it ok to stall what’s the max? I’ve heard 2 hours.
What is his BG doesn’t go up when I stall?
I’ve made the mistake of feeding so his number does up not realizing I wasn’t supposed to.

He went through DKA just about 3 weeks ago, so I’m told not to skip a dose.
Reason why I’m asking how long of a stall is ok?
Also how long should a cat stay on insulin after DKA if his numbers are staying in more normal range.
Should he stay on insulin for at least 4 weeks?
8 weeks?
I’m just trying to get an idea since I’m struggling to keep his numbers above 200 past few days.
I’m trying to feed higher carb food to raise his number some but he won’t eat much of the varieties I got. I’m having to mix the dry food he likes into it so he will eat some. But I know dry isn’t good.
I’m just trying to get an idea of how long after DKA can a cat go into remission?
Again asking because his numbers have improved a lot from where he was and it looks like he’s going into remission just on the change to fancy feast. But again numbers stay low, and the small amount of insulin he is on .25 unit has caused him to drop.

It’s crucially important to keep his SS up-to-date and it’s not. We don’t look at just one cycle to help you determine what to do. Without data, I can’t tell if he’s been flat all day or he’s clearing a bounce, etc. That can change advice.

However, dropping numbers, whether they are from bounce clearing or a second dip, can be a great way to take advantage of carry over and overlap. You’ve handled lower numbers and you shot BGs in the 140s so, unless you get a green PMPS, or you cannot be there to test, I’d shoot the full dose on time.

I would suggest you check him about 15 minutes early, don’t feed, post his BG and ask for help shooting. Also, anytime you shoot a BG lower than you have before, you always want to get a +1 and a +2 to start because you can offer food which can keep those big drops like you saw from happening.

We would also appreciate it if you could follow the posting guidelines. That helps members keep an eye out for you all.

I see Wendy and Sienne have responded regarding DKA.

 

[Bron and Sheba (GA)]

Hi Sandy,
When Sandy dropped to 47 on 1/29 and earned a reduction down to a drop, I spoke to Marje and we thought it was too early for Sandy to drop to the drop of insulin so I told you to feed some higher lowcarb food (around 8% carbs) to try and keep the BG up a bit higher so that you could give the 0.25 units for a bit longer.
But the BGs have been creeping up higher and I think you might be feeding food higher than 10%. You don't need to keep his number up over 200. Try and stick to carbs around 8%. And you don’t need the dry food as Sandy eats the wet food ok. You have high carb wet food if needed.
Also you can shoot numbers lower than 200 ....you have done that before.
Don’t forget to start a new thread daily on the Lantus page so you can get advice from experienced people.
It’s really good the ketones are testing negative.

 

[Liz & Sandy]

First, your cat is not in a consistently normal range. Normal blood glucose (BG) is 50 - 120. Sandy's getting there but isn't there yet.

With a history of DKA, you proceed VERY cautiously. Some cats can easily slide back into developing ketones so you are correct, you do not want to skip shots. You keep treating your diabetic cat until numbers are in a normal range for at least 2 weeks. This is a spreadsheet of a cat that recently went into remission. It will give you an idea of what you want your cat's spreadsheet to look like. There is nothing predictable about feline diabetes and DKA makes things even less predictable.

You can stall for up to 2 hours. The problem with stalling is that it throws your schedule off. You need to shoot every 12 hours. You can adjust the time by 15 min. at each shot of by 30 min. once a day.

It really sounds like you will need to get comfortable with lower numbers. It may also help to read the sticky notes at the top of the board. Since you've been using a bit of dry food, you will want to look at the Start Low Go Slow method for dosing. (You can't use Tight Regulation if there's any dry food available.) FWIW, I would shoot any number above 50. The mantra here is "Shoot low to stay low." As long as your cat is in good numbers, you're doing the right things.

I realize that he isn’t there yet. I’m asking because at the moment I’m trying to get his number up because it’s happened a few times now that he has dropped. I’ve caught it because I’m staying up, hardly getting sleep and if I do it’s broken, and it got to me today that I completely slept through the alarm to wake up and give food and shot. I can’t put in the low numbers because the reading on the libre just says LO which is below 40 because that’s the lowest reading it will give me. Same as the 500, it’s the highest reading it will give me, if it goes past that will just say HI.
I’m not trying to get him into remission right away, I’m just wondering how long until it’s “safe” to skip a dose if he is low at the time.
I realize I need to get comfortable shooting low, but if he happens to drop after shot and I’m asleep I won’t catch it and I’m afraid it can go bad since he’s already been through DKA.
And asking about stalling realizing it can throw the schedule off. I’m in to super early am hours because I’ve had to stall few times now.
Again asking these questions so I’m informed, not to get him into remission right away, I know it will take some time.

 

[Liz & Sandy]

Hi Sandy,
When Sandy dropped to 47 on 1/29 and earned a reduction down to a drop, I spoke to Marje and we thought it was too early for Sandy to drop to the drop of insulin so I told you to feed some higher lowcarb food (around 8% carbs) to try and keep the BG up a bit higher so that you could give the 0.25 units for a bit longer.
But the BGs have been creeping up higher and I think you might be feeding food higher than 10%. You don't need to keep his number up over 200. Try and stick to carbs around 8%. And you don’t need the dry food as Sandy eats the wet food ok. You have high carb wet food if needed.
Also you can shoot numbers lower than 200 ....you have done that before.
Don’t forget to start a new thread daily on the Lantus page so you can get advice from experienced people.
It’s really good the ketones are testing negative.

He’s just not wanting to eat the food, I got him a few more flavors and brands and he’s just not eating it. Of course I’m trying and it would be ideal if he did so this would work out wonderful for us. But he’s refusing to eat the food. So then what do I do? I got him to eat a spoonful today of it but I had to mix in some dry food in it. And of course I don’t want to keep doing it.
And yes I realize that I’ve shot below that but as you know he has dropped and I’ve only caught it because I’m barely sleeping and when it happens I’m able to get him back up within a few hours but again I’m not sleeping. Lack of sleep finally got me today and I slept right through the alarm to feed and shot. And I don’t want this to keep happening or at least get an idea of when it will be ok that if I see a low number I can skip dose.
Again not looking to do it now, just wanting to know at what point will that be ok.

 

[Wendy&Neko]

If you get a LO on the Libre, you should retest with a BG meter. I have seen a paper that says Libre lows may not be accurate.

 

[tiffmaxee]

We had another cat hospitalized today with DKA. ketones were negative. Is there any food he will eat?

 

[Liz & Sandy]

I'll try to answer you questions:

A lot can happen with numbers in two hours. He could still come up quite a bit. The issue with stalling is not so much how long you can stall, but that you have to stall without feeding. No food can cause a cat to drop after a while. So it's a balancing point. I suggest starting out with a 20-30 minutes stall, if that's what you think you need to do. That way if you shoot after 1/2 hour, you can still be relatively on time for the following shot.


Why are you trying to keep his numbers above 200? Regulation typically means numbers under 200. There is no answer to how long a cat should stay on insulin after DKA. The cat stays on insulin as long as needed. It is possible for a cat's pancreas to heal and for cats to go into remission. If a cat becomes regulated, then goes into remission, they go off of insulin. Some cats who've gone into DKA do not go off of insulin, but cat still live happy lives. I remember one cat in my time here who passed at age 20, after 11 years on insulin. I've also seen cats become regulated and go into remission after a couple months. There is no one answer. We have a saying ECID or each cat is different. Most of the people here following one of our dosing methods, which in your case would be the Start Low Go Slow Method. It helps to follow a dosing method to know when to increase the dose and when to decrease, as well as what to do when you see lower preshots than you are used. A dosing method will also help you get your cat regulated. Typically a cat goes down in dose until the next dose is zero units of insulin. At that point, their spreadsheet is usually mostly numbers under 100.

For continuity's sake, we ask that people include a link to their previous post here. Here is the link to your last post: https://felinediabetes.com/FDMB/thr...-9-year-old-sandy-recovering-from-dka.242346/

I'll try to answer you questions:

A lot can happen with numbers in two hours. He could still come up quite a bit. The issue with stalling is not so much how long you can stall, but that you have to stall without feeding. No food can cause a cat to drop after a while. So it's a balancing point. I suggest starting out with a 20-30 minutes stall, if that's what you think you need to do. That way if you shoot after 1/2 hour, you can still be relatively on time for the following shot.


Why are you trying to keep his numbers above 200? Regulation typically means numbers under 200. There is no answer to how long a cat should stay on insulin after DKA. The cat stays on insulin as long as needed. It is possible for a cat's pancreas to heal and for cats to go into remission. If a cat becomes regulated, then goes into remission, they go off of insulin. Some cats who've gone into DKA do not go off of insulin, but cat still live happy lives. I remember one cat in my time here who passed at age 20, after 11 years on insulin. I've also seen cats become regulated and go into remission after a couple months. There is no one answer. We have a saying ECID or each cat is different. Most of the people here following one of our dosing methods, which in your case would be the Start Low Go Slow Method. It helps to follow a dosing method to know when to increase the dose and when to decrease, as well as what to do when you see lower preshots than you are used. A dosing method will also help you get your cat regulated. Typically a cat goes down in dose until the next dose is zero units of insulin. At that point, their spreadsheet is usually mostly numbers under 100.

For continuity's sake, we ask that people include a link to their previous post here. Here is the link to your last post: https://felinediabetes.com/FDMB/thr...-9-year-old-sandy-recovering-from-dka.242346/

Hi Wendy, thank you for explaining that more in detail. I’m new to all this and trying to follow what I’m told to do, as far as food, shots, dose, times, and BG numbers and what’s ideal.
I m running into a few problems.
Sandy is being very picky with food is one. Cant get him to eat unless I add some of his dry food or if I starve him the whole day. Because if the DKA I know it’s not best to starve him for 12 hours as he needs to gain his strength back.
Few times when I gave shot even though he was above 200 he dropped below 50. Thankfully I caught it and gave him food or syrup and brought his number up. He started on 1 unit, and this happened even when I dropped to .5 units. Two days ago even though he was above 100 his number still dropped to 60. When I saw that I gave him good and it took couple hours for him to go up. I guess I’m not understanding why he’s having these drops. I know it can be caused by the insulin, but it’s such a tiny amount, and I honestly can’t go lower on the syringe because than I’ll just be guessing.
This is why I’m afraid of giving shot when he’s low.
I have **** below that and his numbers drop into 80’s 90’s and I know that’s ok. But still I’m afraid it will drop like it has before and so I stay up and give him small amounts of food so that it doesn’t happen.
So I’m up constantly day and night worrying.
I know because of DKA it’s not good to skip doses.
I should have asked it differently I guess as it can come out confusing. I’m not trying to get him into remission ASAP I know it will take time. But when will it be safe to treat him like just a diabetic cat and maybe skip a dose when need be and not have to stall because I’ve already done it few times. Not trying to do it tomorrow or the next day. just trying to get an idea of when it will no longer be “because of recent DKA you can’t do that”. At what point will the DKA not be recent anymore?
I know his case is different because of it, but when will it just be treating diabetes and not the recent DKA?

 

[Liz & Sandy]

If you get a LO on the Libre, you should retest with a BG meter. I have seen a paper that says Libre lows may not be accurate.

I keep getting error codes when I try with the human meter I have but I don’t think I’m getting enough blood for the strip, still working on getting better at pricking so far hasn’t gone too great

 

[Liz & Sandy]

We had another cat hospitalized today with DKA. ketones were negative. Is there any food he will eat?

Besides the dry he likes, which is 14% carbs, he’s been eating fancy feast pate but not much. He’s averaging about 1 1/2 to 2 ounces

We had another cat hospitalized today with DKA. ketones were negative. Is there any food he will eat?

Besides the dry food that he likes that is 14% crabs that I have for the most part taken away. He will eat fancy feast pate but not much of it. He’s having if I’m luck 1 can a day. And I’ve had to either crush temptations or mix in few pieces of his dry food in for him to eat a little. I have looked at the list on here. Have found low carb, med card, high carb and gotten few different flavors of it and will lake some licks and leaves it. I know he needs to eat so then I have to give him some dry kibble so he has something in his belly. Not giving him full portions but about 10 pieces of it so he eats

 

[Wendy&Neko]

Have you tried freeze dried all meat treats for Sandy? I've had success crumbling them over food as a topping to get the real food down below eaten. It'd be a good goal to get him close to his pre diagnosis weight. Being underweight is one of the things to consider when deciding if he's still at risk.

 

[Liz & Sandy]

Have you tried freeze dried all meat treats for Sandy? I've had success crumbling them over food as a topping to get the real food down below eaten. It'd be a good goal to get him close to his pre diagnosis weight. Being underweight is one of the things to consider when deciding if he's still at risk.

I have given him freeze dried just haven’t tried crumbling in on his wet food but I’m going to get some tomorrow and try and see if it helps.
His weight is usually about 11 lbs. At his checkup last week he was at 10 so he’s gained some weight back. And that’s my worry with him not really eating much of the food. Going to keep trying stuff until I find something that works, it’s just getting frustrating because I know he’s got to eat more than he is.