? AMPS do I dose this morning??? Update: still needing guidance this evening

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I don't know what to do, so I put 911 because it's past +12, and Loki is hanging at 123, and was recently Dx with Pancreatitis and DKA in December. I don't want to skip a dose bc of this but he's too low. This is without any food influence. Please any advice! Thank you!
 
Deciding whether or not to shoot depends on if you can monitor, have a hypo kit on hand, and have data that helps you have an idea how Loki will react to the insulin. And of course kitty needs to eat a meal with the shot.


If you don't have much data and aren't comfortable, many people give a reduced dose or skip the shot all together but as you mention, he needs his insulin.


I am not giving advice here because I am not qualified to do so, just info.
 
Hendrick Cuddleclaw said:
Deciding whether or not to shoot depends on if you can monitor, have a hypo kit on hand, and have data that helps you have an idea how Loki will react to the insulin. And of course kitty needs to eat a meal with the shot.


If you don't have much data and aren't comfortable, many people give a reduced dose or skip the shot all together but as you mention, he needs his insulin.


I am not giving advice here because I am not qualified to do so, just info.
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I appreciate your input, expert or not! The reason I'm posting is because he has not reacted this way yet, this is the lowest he's been this close to pre-shot, and even after shot time. He's usually HI or in the 300s. Last couple times, he's been more in the 200s. Today he's in the low 100s, so I'm lost at this point.
 
@Wendy&Neko I saw you respond about a similar situation on another post earlier. Is Loki possibly breaking a bounce? I shared a link above to another post I also made tonight about his eating reluctancy, if y'all can look at that, it's short. So not sure if this is related to not enough food or bounce breaking...so many things at once making this hard to deal with. Loki just had DKA in December, and Dx pancreatitis at the same time.
 
I'm keeping the SS up to date as this goes along. Loki is reading 151 @ +13.5, I have not given a dose this morning. Not sure if I'm supposed to feed him, and if so, if it should be low or high carb. The complication of DKA & pancreatitis is making this impossible for me to figure out on my own. I feel like I should just give high carb food and see what happens. I really need some kind of guidance <3
 
@Suzanne & Darcy

with the history of dka he needs food and insulin. Since you skipped the shot, I think you need to feed him now and just see how his numbers progress. I don’t know much about prozync, but with Lantus I’d shoot Minnie as low as a 75 preshot if I could monitor her and she was eating. Id keep her from going too low with food throughout the day. I believe that the goal is to ultimately get comfortable shooting even those lower preshot numbers but I’ll let Suzanne correct me if I’m wrong
 
He needs to eat well and drink. We don’t skip if at all possible with dka in the past. Was it only at diagnosis? He runs higher than we like it seems but not much to go by on the ss. It says SLGS so provided you can monitor in the future you would shoot 90+. If not able to monitor even a reduced dose is better than no insulin. I too am not a Prozinc user so see what those more familiar have to say.
 
Ale & Minnie (GA) said:
@Suzanne & Darcy

with the history of dka he needs food and insulin. Since you skipped the shot, I think you need to feed him now and just see how his numbers progress. I don’t know much about prozync, but with Lantus I’d shoot Minnie as low as a 75 preshot if I could monitor her and she was eating. Id keep her from going too low with food throughout the day. I believe that the goal is to ultimately get comfortable shooting even those lower preshot numbers but I’ll let Suzanne correct me if I’m wrong
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Thank you for your response. This is what I was thinking, bc of the DKA, that I should just go ahead and feed him because he needs at least one of those. I just was not sure if I should dose. I have been told here that I shouldn't give the shot with the higher carb food without guidance from here first, so was trying to see what to do. First time going through this scenario. And yes, I do believe that is the goal about shooting in the lower numbers, but just not yet I suppose. I'm going to feed him now with higher carb food.
 
tiffmaxee said:
He needs to eat well and drink. We don’t skip if at all possible with dka in the past. Was it only at diagnosis? He runs higher than we like it seems but not much to go by on the ss. It says SLGS so provided you can monitor in the future you would shoot 90+. If not able to monitor even a reduced dose is better than no insulin. I too am not a Prozinc user so see what those more familiar have to say.
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Should I go ahead and give a reduced dose after/with feeding? We are +2 after he should've gotten his AM dose.
 
You don’t need higher carb food as since you did not shoot tge insulin will be wearing off and tge bg will naturally rise. Feed lc.
Lauren and Loki said:
Should I go ahead and give a reduced dose after/with feeding? We are +2 after he should've gotten his AM dose.
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I would skip this time unless you can be off schedule. You can only move shot time forward by 30 minutes every 24 hours.
 
tiffmaxee said:
You don’t need higher carb food as since you did not shoot tge insulin will be wearing off and tge bg will naturally rise. Feed lc.

I would skip this time unless you can be off schedule. You can only move shot time forward by 30 minutes every 24 hours.
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Ok, no, cannot really be off schedule..not this far anyway. Thank you for the guidance. We will see how he does the rest of the day until PMPS.
 
tiffmaxee said:
I’d shoot early since you skipped. I can’t find anything on getting back on schedule. Since you skipped get some insulin in when you see this.
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Loki’s numbers slowly worked back up to HI on his Libre. I’ll feed him and give insulin, but should I lower the dose? I’ve currently been giving 1.25U. I hope I get some responses about all this today from the others soon too. Thank you for being here in the mean time <3

Also, his diagnosis says Acute Pancreatitis, I’m not sure if it’s chronic. How do I know if it’s chronic? (Other than the doctor telling me of course), just not sure of the difference.
 
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Lauren and Loki said:
Loki’s numbers slowly worked back up to HI on his Libre. I’ll feed him and give insulin, but should I lower the dose? I’ve currently been giving 1.25U. I hope I get some responses about all this today from the others soon too. Thank you for being here in the mean time <3
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I can try tagging Suzanne and Melissa again for you
@Suzanne & Darcy

@FrostD

If you can please read what happened today starting with her post you will get a better idea of what's going on
Thank you ladies
 
Hi Lauren, yes you need to reduce the dose to 1 unit from1.25 units after that drop to 66 yesterday. Can you also please test for ketones asap after that skip please. I’m sorry we were not able to get to you sooner this morning.
Next time if you have a lower Preshot and noone answers, it is better to give a token dose or a half dose than skip with recent DKA.
Also make sure he is eating lots of food. Remember it is food and insulin that keep ketones at bay.
 
Bron and Sheba (GA) said:
Hi Lauren, yes you need to reduce the dose to 1 unit from1.25 units after that drop to 66 yesterday. Can you also please test for ketones asap after that skip please. I’m sorry we were not able to get to you sooner this morning.
Next time if you have a lower Preshot and noone answers, it is better to give a token dose or a half dose than skip with recent DKA.
Also make sure he is eating lots of food. Remember it is food and insulin that keep ketones at bay.
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Hi Bron! Ok great, I was going to reduce to 1U and then you posted, so glad I was thinking correctly. I just gave the 1U dose. Ok so, a token dose = a half of their usual dose?

I tested for ketones with a pee strip this morning. I held it under his pee stream for a couple seconds and checked 15 seconds later. It didn’t change color. Did I do this correctly? I will check again the next time he pees. The NovaMax ketone meter I ordered hasn’t come yet.

Regarding food, can you please read my thread from before this one? I posted the link below:

https://www.felinediabetes.com/FDMB...a-since-dose-reduction-feeding-issues.272562/

It’s where this all started last night, and I need some guidance on this. Thank you so much.
 
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Lauren and Loki said:
Also, his diagnosis says Acute Pancreatitis, I’m not sure if it’s chronic. How do I know if it’s chronic? (Other than the doctor telling me of course), just not sure of the difference.
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Chronic conditions usually don't cause symptoms but can gradually get worse...Acute means it's severe, sudden and requires treatment ASAP.

In pancreatitis, our kitties can have chronic pancreatitis for years without us even knowing until it becomes acute, causing severe and sudden symptoms that require treatment ASAP. Once the acute stage is over, they go back to chronic. It's important to learn the signs that can indicate an acute attack is coming so you can start treatment (and hopefully keep it from being as bad as it could be otherwise)

One way to describe it is like this....Osteoporosis is a chronic disease causing the gradual weakening of the bones which can lead to a broken bone, which is an acute problem. Once the bone heals, you still have the osteoporosis.
 
Chris & China (GA) said:
Chronic conditions usually don't cause symptoms but can gradually get worse...Acute means it's severe, sudden and requires treatment ASAP.

In pancreatitis, our kitties can have chronic pancreatitis for years without us even knowing until it becomes acute, causing severe and sudden symptoms that require treatment ASAP. Once the acute stage is over, they go back to chronic. It's important to learn the signs that can indicate an acute attack is coming so you can start treatment (and hopefully keep it from being as bad as it could be otherwise)

One way to describe it is like this....Osteoporosis is a chronic disease causing the gradual weakening of the bones which can lead to a broken bone, which is an acute problem. Once the bone heals, you still have the osteoporosis.
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Thank you, that's a great explanation! Should I update my signature to say "chronic pancreatitis" instead of "acute?" Or leave the acute with the diagnosis date there, but add chronic?
 
Lauren and Loki said:
I tested for ketones with a pee strip this morning. I held it under his pee stream for a couple seconds and checked 15 seconds later. It didn’t change color. Did I do this correctly? I will check again the next time he pees. The NovaMax ketone meter I ordered hasn’t come yet.
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That’s really good to know. Testing with the urine strips is fine and just as good as the blood ketone meter, as long as you can catch the urine!
Lauren and Loki said:
Ok so, a token dose = a half of their usual dose?
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A token dose is usually less than half.
Lauren and Loki said:
Regarding food, can you please read my thread from before this one? I posted the link below:
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I posted on the other thread.
tiffmaxee said:
@Bron and Sheba (GA) What is the best wet u to o get back on schedule with Prozinc? If she shot real late what’s the least number of hours she could’ve shot the next dose?
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Elise, I would rather defer that question to @FrostD as she has used prozinc. I know there is some leeway … more than Lantus.
 
Lauren I see you have given the pm dose at +22. Can you move that information to the PMPS column please? and just note that you gave it at +22. Then the next cycle starts in the right spot. Thanks,
 
Lauren and Loki said:
Should I update my signature to say "chronic pancreatitis" instead of "acute?" Or leave the acute with the diagnosis date there, but add chronic?
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I think you could leave it the way it is. Most of the people here who've dealt with pancreatitis know there's an acute phase and a chronic phase.

Or you could just put Dx: pancreatitis 12/12/22
 
Pancreatitis is a weird disease. No real defined symptoms until they really feel sick. Many say their cat seems off. Sometimes they get picky about what they will eat wanting treats or dry food and not wet. When that happens it’s often due to nausea although many never vomit. That was my Max. Then one Thanksgiving he refused to eat. I had recently lost my other cat to cancer and was thinking he might have it too. Never occurred to me he was nauseous since he was eating treats. We now know it’s very common in cats. Some cats do vomit or have diarrhea. Both acute and chronic pancreatitis can be very painful. I hope in your case it was an acute case and it never returns.
 
tiffmaxee said:
Pancreatitis is a weird disease. No real defined symptoms until they really feel sick. Many say their cat seems off. Sometimes they get picky about what they will eat wanting treats or dry food and not wet. When that happens it’s often due to nausea although many never vomit. That was my Max. Then one Thanksgiving he refused to eat. I had recently lost my other cat to cancer and was thinking he might have it too. Never occurred to me he was nauseous since he was eating treats. We now know it’s very common in cats. Some cats do vomit or have diarrhea. Both acute and chronic pancreatitis can be very painful. I hope in your case it was an acute case and it never returns.
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Thank you for writing this out, it helps. The symptoms are hard to recognize for sure. I guess just trying to make sure they eat well, and then stay on top of the nausea and pain, if any, is key. I am continuing Loki's anti-nausea meds, but not sure about the pain meds. He hasn't had any pain meds in 24 hours now, and seems okay. I guess I have to just gauge it. If he's happy and playing, how do I know if it's bc the pain meds are helping with that, or if he is actually just fine and I can maybe skip the pain med?
 
Sorry wasn't around to reply (I have 3 kids under 3, including a newborn, so my hands are full most of the day!)

What to shoot when that happens takes a bit of trial and error, and also depends on how well you can monitor (factoring in the Libre dying on you during that cycle as well). My suggestion would have been 0.25-0.5U depending on ability to monitor.

@tiffmaxee the technical answer is same as the depots, 15 mins each shot or 30 mins once a day. BUT more often than not you have more leeway than that, based on typical duration for that particular cat. For some cats this is an hour, and for others it can be more than that. In this case, given that Loki seems to be coming down the dosing scale and is throwing low preshots, the 15 mins/30 mins rule is safest.
 
Lauren and Loki said:
Thank you for writing this out, it helps. The symptoms are hard to recognize for sure. I guess just trying to make sure they eat well, and then stay on top of the nausea and pain, if any, is key. I am continuing Loki's anti-nausea meds, but not sure about the pain meds. He hasn't had any pain meds in 24 hours now, and seems okay. I guess I have to just gauge it. If he's happy and playing, how do I know if it's bc the pain meds are helping with that, or if he is actually just fine and I can maybe skip the pain med?
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This is the tricky part. Once the cat is acting pretty much normal, I usually pull one med at a time and see what happens. I remove appetite stimulants first and see how that goes for a day or two. Then pain meds, give it a day or two. Then I remove the nausea meds, see how that goes.
 
FrostD said:
Sorry wasn't around to reply (I have 3 kids under 3, including a newborn, so my hands are full most of the day!)

What to shoot when that happens takes a bit of trial and error, and also depends on how well you can monitor (factoring in the Libre dying on you during that cycle as well). My suggestion would have been 0.25-0.5U depending on ability to monitor.

@tiffmaxee the technical answer is same as the depots, 15 mins each shot or 30 mins once a day. BUT more often than not you have more leeway than that, based on typical duration for that particular cat. For some cats this is an hour, and for others it can be more than that. In this case, given that Loki seems to be coming down the dosing scale and is throwing low preshots, the 15 mins/30 mins rule is safest.
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It's okay @FrostD !! I know you have a newborn, and appreciate any time you can give! I may not have had your advice this morning but I can now know better next time.

This morning's dose was skipped, and I'll keep pee-testing his ketones. He got his PM dose early 3 hours ago, reduced to 1U, and has eaten fairly well. I have actually taken the week off after this incident so that I can give quality attention to Loki, get a better grip on things, and truly practice home BG/Ketone testing. The idea of the Libre failing scares me to death and I do not want to be out of control if it does.

FrostD said:
This is the tricky part. Once the cat is acting pretty much normal, I usually pull one med at a time and see what happens. I remove appetite stimulants first and see how that goes for a day or two. Then pain meds, give it a day or two. Then I remove the nausea meds, see how that goes.
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Thanks for the medication advice. He's not currently on any appetite stimulants, so I'm going to see how he does without the pain med. But he'll remain on anti-nausea for now.
 
@Diane Tyler's Mom @Bron and Sheba (GA) @FrostD @Sienne and Gabby (GA) @tiffmaxee @Wendy&Neko @Chris & China (GA)

Hello y'all, requesting a little more guidance today. If someone can take a look at Loki's SS, and help me understand what's going on. If you helped yesterday, then you know we skipped yesterday's AM dose because he was not high enough to dose, and I wasn't sure what to do. He went HI last night before/at PMPS, then remained in the 200s all night. He did not drop to a "normal" nadir for him by this morning's AMPS, and I was worried it was going to lag into this morning, and then occur soon after his morning dose, which is exactly what's happening. He's lower way earlier than he has been before. I fed some FF Gravy, and numbers are seeming okay right now. He seems good. He's been eating well in general. I'm sure skipping the dose affected this, but can someone kind of give thoughts? Thank you :cat:
 
Actually, I feel like we’ve been told not a lot of members are on that prozync forum and that it’s best to post here? When did you feed the gravy after you got the 97? And is the 97/77 from two back to back tests? He seems to be in a good range right now so I’d just keep monitoring. Blues are good
 
Ale & Minnie (GA) said:
Actually, I feel like we’ve been told not a lot of members are on that prozync forum and that it’s best to post here? When did you feed the gravy after you got the 97? And is the 97/77 from two back to back tests? He seems to be in a good range right now so I’d just keep monitoring. Blues are good
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now that you mention it when I went over there to copy the link, I was surprised at the lack of condos

I've only been around for a year and in that time members have always been told that the insulin-specific forums are a better place to post once you get your intro done, etc so this is a new development for me

my bad! Ignore my advice I guess @Lauren and Loki :(
 
I used to be checking the insulin-specific forums twice a day, but admit I haven't been able to lately. Suzanne has been doing a great job trying to keep an eye on things, but it's always best to tag. And for any time-sensitive advice, I'd stick with the main forum.

It appears to be a late nadir due to a bounce break (I suspect that high number was caused both by a bounce and the skip). I also suspect that's what happened on the 2nd as well. The data before that is a little muddied with his other issues going on.

When a late break happens, yes you often get a slight overlap of cycles like you're seeing today. He didn't climb as high as usual, therefore dropped lower. Without the food he probably would have continued down a bit.

I would have held off on higher carb food just a little longer, but no harm done, especially when trying to manage these things in your own and him being a little complicated at the moment. Either way, a reduction down to 0.75U now! If he was not so recently DKA I'd say 0.5U since he'd have gone lower without that food, so it's really up to you to weigh the options.
 
I’m glad you were around to help with the dose Melissa. Loki is in a hurry to get to the bottom of the dosing scale it seems.
I also think 0.75U considering the event DKA.
How often are you testing for ketones Lauren? would you mind putting the results of the ketones test in the remarks column but in bold so we can see easily please?
 
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