9/8 Smudge: AMPS 482 (after skip), +2 301, +4 192, +6 191, +8 225, PMPS 425, +3 268

allicatmeow

allicatmeow

Member Since 2023
AMPS 482
Gave full dose 2.25U.

Yesterday's mess: https://felinediabetes.com/FDMB/threads/9-7-smudge-pmps-139-need-guidance.281298/

Wendy&Neko said:
Sorry I was late to the party (out of town visiting DM). Anyway, with DKA so recently in the past, a skip should not have been one of the options suggested. Please test for ketones today if you have not done so already.

An important note from the SLGS guidelines description:

Sorry there wasn't anyone around to help. Rather than tagging, I find it best to change the subject line to tell people exactly what help you need. Something like "new to Lantus, low PS, recent DKA - help".
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Unfortunately I did change the subject line and no one was available. I had to take veterinary advice, as I am too new and not comfortable in these situations. I was even going through threads here in a panic trying to make a decision. Next time I'll be giving a nominal shot, like.0.5-1.0. But here we are.

Was unable to get BK yesterday. He will be getting a full urine test at the vet today if I am unable sooner.
 
JL and Chip said:
So the 165 is +14, correct? (We count hours since the last shot)

And that’s 45 minutes after eating?

So I believe this summarizes today:
AMPS 455 - 2.25u Lantus
+4 170
+6 124
+8 91
+10 122
+12 139 (stall)
+12.5 131
+13.25 139 (fed)
+14 165 (45 minutes after food)

I ask because I’m hesitant to completely skip given the recent history of DKA. And, the steep drop/lower numbers today might precipitate a bounce. I don’t typically give dosing advice, but if I were holding the needle, I would probably test again at approx two hours after he finished eating and, if BG still rising, give at least a token dose of 0.5u to 1u and then leave food down overnight. This is acknowledging that you won’t be able to get another test in tonight. I would, however, check on him and test first thing in the morning just to see where things stand. And of course, you’d be on a new shot time schedule (which you’ve already addressed as being ok). Just my two cents and not trying to muddy the.waters. :bighug:
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I edited that post to +14, it was just under an hour after eating. I should've done what you would've done. I am now a sobbing mess (again) because he's 482 and I feel like a failure.
 
allicatmeow said:
I am now a sobbing mess (again) because he's 482 and I feel like a failure.
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There’s no crying in baseball, er, FD!! (never mind me, just a bit of warped humor to lighten the mood :confused: ).

Seriously, though, take a deep breath. It’s ok. You can’t possibly know everything and as easy as it is to be hard on ourselves, this is a learning process. And you’re learning, so give yourself a pat on the back (and a very big break). When faced with uncertainty you took logical and reasonable steps—you reached out here, you reached out to the vet, and you took the offered advice and prioritized keeping Smudge safe.

Today is a new day. One step at a time, ok? :bighug:
 
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allicatmeow said:
I am now a sobbing mess (again) because he's 482 and I feel like a failure.
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I dont have experience with ketones, I’ll let someone more knowledgeable help you, but I do have lots of experience with feeling like I made the wrong call especially early on. Just sending my love and support, don’t beat yourself up. :bighug::bighug::bighug::bighug:
 
JL and Chip said:
Seriously, though, take a deep breath. It’s ok. You can’t possibly know everything and as easy as it is to be hard on ourselves, this is a learning process. And you’re learning, so give yourself a pat on the back (and a very big break). When faced with uncertainty took logical and reasonable steps—you reached out here, you reached out to the vet, and you took the offered advice and prioritized keeping Smudge safe.

Today is a new day. One step at a time, ok? :bighug:
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This! So well said!
 
JL and Chip said:
There’s no crying in baseball, er, FD!! (never mind me, just a bit of warped humor to lighten the mood :confused: ).

Seriously, though, take a deep breath. It’s ok. You can’t possibly know everything and as easy as it is to be hard on ourselves, this is a learning process. And you’re learning, so give yourself a pat on the back (and a very big break). When faced with uncertainty you took logical and reasonable steps—you reached out here, you reached out to the vet, and you took the offered advice and prioritized keeping Smudge safe.

Today is a new day. One step at a time, ok? :bighug:
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Are you my husband? (jk) He just came in the bedroom, where I'm sobbing holding Penny (my ckd cat) and said nearly all the same things. He also said had Smudge been in hospital, they would have skipped and he'd be monitored how I am now and he'd be okay.

JL and Chip said:
Not a crisis but would be great if they don’t go much higher. Push food and fluids. Do you have subQ available? I don’t recall if the vet sent you home with a bag but subQ can help flush ketones. @Bron and Sheba (GA) do you have any suggestions?
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I always have subq on hand because Penny gets 100cc daily at 4pm, so I can just steal from hers if I need to. I'm not sure if I should yet or try to control with food, since he got his AM insulin and this is probably skipped dose related. Also, he is going today at 2pm to the vet and will have a urine test/panel. He is eating like a champ and I'll be giving extra today.

Amy & Herman said:
I dont have experience with ketones, I’ll let someone more knowledgeable help you, but I do have lots of experience with feeling like I made the wrong call especially early on. Just sending my love and support, don’t beat yourself up. :bighug::bighug::bighug::bighug:
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Thank you. It is very hard so early on, not knowing what to do even though you've read all the stickies 10 times each. The real life application of the knowledge there is hard. Thank you so much for supporting me. :bighug:
 
1.2 ketones on the blood ketones meter is ok but I would get Smudge to eat more if he will.
Are you offering him snacks every couple of hours?
And another trick is to add a teaspoon of warm water to each snack to increase the fluids he is getting.
When a kitty is recovering from DKA it is not a good idea to skip the dose of insulin as it is insulin and food that will help keep ketones at bay. If necessary, you can feed some higher carb food so you can shoot the dose. I’m sorry I was not around to help. Shooting low means close monitoring but keeping up with the insulin doses is very important post DKA.
 
I just wanted to add it is very normal to be upset and emotional after having your beautiful kitty in hospital with DKA. I would be exactly the same…probably moreso!
Making sure your subject line reflects what you want to know helps us to be able to help you.:bighug:
Keep testing at least daily for ketones.
And I would ask the vet if he is agreeable for you to give Smudge some subQ fluids.
 
Bron and Sheba (GA) said:
1.2 ketones on the blood ketones meter is ok but I would get Smudge to eat more if he will.
Are you offering him snacks every couple of hours?
And another trick is to add a teaspoon of warm water to each snack to increase the fluids he is getting.
When a kitty is recovering from DKA it is not a good idea to skip the dose of insulin as it is insulin and food that will help keep ketones at bay. If necessary, you can feed some higher carb food so you can shoot the dose. I’m sorry I was not around to help. Shooting low means close monitoring but keeping up with the insulin doses is very important post DKA.
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Yes, he is getting lots of FF classic pate spread out throughout the day, his auto feeder does every 4 hours broken down as:

AMPS: full can
+4: half can
+8: half can
PMPS: full can
+4: half can
+8: half can

With today's situation, I just gave him a half can 1.75hrs early and he got his shot with it, so I have a schedule adjustment today/this weekend (which is fine). Going to offer more at +1.

He also gets freeze dried chicken bites every test he gets.
 
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allicatmeow said:
Yes, he is getting lots of FF classic pate spread out throughout the day, his auto feeder does every 4 hours broken down as:

AMPS: full can
+4: half can
+8: half ca
nPMPS: full can
+4: half can
+8: half can

With today's situation, I just gave him a half can 1.75hrs early and he got his shot with it, so I have a schedule adjustment today/this weekend (which is fine). Going to offer more at +1.

He also gets freeze dried chicken bites every test he gets.
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I think I would maybe give a snack every 3 hours at say +3 +6 and +9 both cycles so you can get in another snack each cycle. The aim is to get them to eat 1 and a half times as many calories as he would normally eat. What do you think about changing the times?
 
allicatmeow said:
always have subq on hand because Penny gets 100cc daily at 4pm, so I can just steal from hers if I need to. I'm not sure if I should yet or try to control with food,
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I’d just add extra water to his food for now, given you’re going to the vet today. I would also talk to the vet about subQ for the future—conditions, how much, etc., so you have that option in your hip pocket if needed.
 
Bron and Sheba (GA) said:
I think I would maybe give a snack every 3 hours at say +3 +6 and +9 both cycles so you can get in another snack each cycle. The aim is to get them to eat 1 and a half times as many calories as he would normally eat. What do you think about changing the times?
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He usually doesn't eat the full given amount at once and will graze it for about 1hr til it's gone, which actually puts him at every 3 hours, because he's eating every 4 for one full hour. Does that make sense? I know it sounds strange when I type it out. The feeder has built in ice packs, which allow me to do this. He loves it too, hearing the beep after it turns, he jumps up and goes to it, it's very cute.

JL and Chip said:
I’d just add extra water to his food for now, given you’re going to the vet today. I would also talk to the vet about subQ for the future—conditions, how much, etc., so you have that option in your hip pocket if needed.
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I always do this because I do with Penny for he kidneys, but I've added extra water today, washed his water fountain and refilled it, as well as washed his two bowls and refilled them to encourage.

DEFINITELY talking to him about subq today. I see my vet that I've seen for 20 years (not the on call I get if I call in) and I know he will be on board and trust me with it.
 
Staci & Ivy said:
Alli, just want to send hugs and support your way. You’re getting great advice for Smudge :bighug::bighug::bighug::bighug:
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Yeah I am! I feel very lucky people here care enough to help guide me.

I see your Ivy has fd AND ckd? Wow, I have those but in 2 separate cats, I cannot imagine together. You're amazing to do so much for her!
 
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allicatmeow said:
Yeah I am! I feel very lucky people here care enough to help guide me.

I see your Ivy has fd AND ckd? Wow, I have those but in w separate cats, I cannot imagine together. You're amazing to do so much for her!
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We all just do what we must. One day at a time. Love my girl.
You’re doing great!
 
Bron and Sheba (GA) said:
1.2 ketones on the blood ketones meter is ok but I would get Smudge to eat more if he will.
Are you offering him snacks every couple of hours?
And another trick is to add a teaspoon of warm water to each snack to increase the fluids he is getting.
When a kitty is recovering from DKA it is not a good idea to skip the dose of insulin as it is insulin and food that will help keep ketones at bay. If necessary, you can feed some higher carb food so you can shoot the dose. I’m sorry I was not around to help. Shooting low means close monitoring but keeping up with the insulin doses is very important post DKA.
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Thank you Bron, I do see the importance now and that's why I've been beating myself up. @Hendrick Cuddleclaw was helping me so much (so thankful for you sticking with me, Kyle!!!) and it just came down to a decision I wasn't ready to make - my gut said nominal dose, but the vet said skip, and I had to follow that in my panic. Never again unless hypo low/critical situation with delay and monitoring being unsuccessful. I have learned this lesson the hard way and I just hope Smudge is okay.

And yes, lots of snacks and added water all day.
 
Bron and Sheba (GA) said:
When a kitty is recovering from DKA it is not a good idea to skip the dose of insulin as it is insulin and food that will help keep ketones at bay. If necessary, you can feed some higher carb food so you can shoot the dose. I’m sorry I was not around to help. Shooting low means close monitoring but keeping up with the insulin doses is very important post DKA.
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dammit I know this. Hendrick was a DKA kitty

I screwed up :banghead: :( :( :(
 
I should not have even popped my head in here last night I was having the worst day at work in literally years (I'm an Escalations Manager for a Fiber Telecom)

I was juggling about 10 different C-level escalations on down circuits to hospitals and government agencies. Patient care impact, etc. Was not thinking straight at the end of a day where I got beat up badly

I think I might step away from the FDMB a while. probably should
 
Hendrick Cuddleclaw said:
I should not have even popped my head in here last night I was having the worst day at work in literally years (I'm an Escalations Manager for a Fiber Telecom)

I was juggling about 10 different C-level escalations on down circuits to hospitals and government agencies. Patient care impact, etc. Was not thinking straight at the end of a day where I got beat up badly

I think I might step away from the FDMB a while. probably should
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NO!!!!! YOU DID NOT SCREW UP AT ALL!!!

You pointed me to the stickies as you should have. You didn't influence me at all. Your company saved my sanity. Please don't go.
 
Gill & George said:
Don't step away, you tried your best to help, I'll bet you won't forget to consider DKA again, when someone e is considering a skip it's something I've learnt to double check with the CG, just in case it's not been noted or if I've missed it.



Looks like, Smudge is sliding back down. :cool:
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And staying steady apparently? 191 @ +6
 
What I said last night was not meant to be critical of what you did, but rather a lesson for going ahead. :bighug: Smudge's BG recovering nicely, as is quite common after a fur shot. :cool: He seems to be doing well, super happy to hear his appetite is good. I've seen too many post DKA kitties slide down and have to visit the ER vet again, so we'd like to prevent that with Smudge. Good luck at the vet today.
 
Wendy&Neko said:
What I said last night was not meant to be critical of what you did, but rather a lesson for going ahead. :bighug: Smudge's BG recovering nicely, as is quite common after a fur shot. :cool: He seems to be doing well, super happy to hear his appetite is good. I've seen too many post DKA kitties slide down and have to visit the ER vet again, so we'd like to prevent that with Smudge. Good luck at the vet today.
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I know you weren't being critical, it was an emotional morning. I apologize if my first post seemed upset. :bighug: I was upset, but not at you. At myself and worried for Smudge.

I am going to test him just before we leave for the vet, because that will be his +8. Will also bring my meter to show the history to them (and so they don't have to test his BG there since I'm on top of it). Going to ask for a urine test bc of the low blood ketones today. He will also need another convenia shot to keep the wound healing (looks much better, but we are at 2 weeks since the last now). Any suggestions for anything else?

I will also likely be microchipping him, in case he ever tries to sneak out. You can take the outside cat in, but can't take the outside want out of them. :banghead:
 
225 @ +8 (just before vet appointment).

Smudge had a great exam, he has gained back 1lb of the 2.2lbs he lost. He is physically great, wound is healing great, and they are thrilled with how alert and active he is in comparison to when he was hospitalized. Had a urine test done and sent out, results tomorrow. Convenia shot to help the wound heal further (looks great, just taking forever). She feels he will be fine with the ketones we measured this morning and that food and water should fix them. If not, she will tell me tomorrow with the results and I can do fluids if need be, but she doesn't expect he will need it.

She backed you guys up here (she was not who I spoke to last night), saying next time, shoot a 1U or so to keep him coasting vs. skipping. She also said not to beat myself up (that means you too, @Hendrick Cuddleclaw!) as this has been a rollercoaster these first couple of weeks and Smudge really is doing great.

And last but not least, switching to human meter! I will probably do this at AMPS.
 
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