3/27 Meat general dosing advice + trace ketones??

[Vasalisa]

Update 3/29 9:50am EST- my first ketone tests yesterday and then this morning are trace positive


Hello!
I'm hoping for some general dosing advice. I'm a beginner to caring for a cat with FD, we are just learning everything! My first post here was yesterday.

My sweet 15F cat Meat was diagnosed about a month and a half ago.
You guys have been our life line!! She was already eating Fancy feast classics (with a small amount of kibble) so switching her to the prescribed higher carb food would have been such a mistake! We gradually replaced her old dry food with Dr Elseys. I'm now in the middle of switching to the YoungAgain Zero carb kibble. I'm really just trying to get her off dry all together, even though the Zero is apparently no carbs. I got some more great suggestions for that in another thread so I'm hopeful about those!! She really likes the bonito flakes already so they may work!

I've made lots of mistakes since diagnosis, even after i began to learn what to do. I have been regularly testing AMPS but not PMPS, after some more reading today I see that shooting blind in the PM is not good at all, so we will change our ways and test BOTH as I should have been doing. I also wasn't consistently recording the numbers if they were similar to the previous days.

My vet says her numbers are good, but she is still very thirsty and pees a lot at times. She's lethargic. It seems like her feet hurt sometimes. I know from you guys that these symptoms may mean she is NOT managed.

After reading here I've purchased some syringes for more precise and incremental dosing, but I'm a little frightened of the human error aspect of them and may need a little help, just to be sure I'm measuring to the correct line and the ul is correct. I need more than my one set of woefully ignorant eyes on all this info to feel comfortable about changing doses and methods (and let's be honest, I won't be comfortable anyways, but I'll do it lol).

What other info can I provide to help you help me? I'm SO incredibly grateful for anyone's help and/or replies.

 

[Wendy&Neko]

OK, found your newer post. Here the link to your previous post for people who want history: https://www.felinediabetes.com/FDMB/threads/new-member-re-home-curve-costs.288084/

We do increases by 0.25 units at a time when following SLGS. Do you have syringes with half unit markings? Yes, we eyeball the in between doses. If after your curve tomorrow you don't see anything below 150, you'd go up to 1.25 units as the new dose. With SLGS, the ideal range is nadirs or low points between 90 and 149.

Here's a link to another of those Sticky Notes on the top of the Lantus forum (highly recommended to read all the Sticky Notes), including pictures of those in between doses.
Insulin Care & Syringe Info: Proper Handling, Drawing, Fine Dosing

 

[Vasalisa]

OK, found your newer post. Here the link to your previous post for people who want history: https://www.felinediabetes.com/FDMB/threads/new-member-re-home-curve-costs.288084/

We do increases by 0.25 units at a time when following SLGS. Do you have syringes with half unit markings? Yes, we eyeball the in between doses. If after your curve tomorrow you don't see anything below 150, you'd go up to 1.25 units as the new dose. With SLGS, the ideal range is nadirs or low points between 90 and 149.

Here's a link to another of those Sticky Notes on the top of the Lantus forum (highly recommended to read all the Sticky Notes), including pictures of those in between doses.
Insulin Care & Syringe Info: Proper Handling, Drawing, Fine Dosing

That was VERY helpful. I had read that sticky before, i know because the pros and cons list of using the pen was so familiar to me, I'm pretty sure it's the reason I started priming my pen a couple weeks after starting dosing. I must have forgotten the syringe info was there! Its true what it says in the FAQ, every time I read these I learn new info. Thank you! I'm excited to be more informed.

My syringes do not have whole markings unfortunately, I just put in an order for some that DO have half unit markings and I'll keep these around for when we have whole unit doses.

 

[JL and Chip]

One of the occasional glitches we see with newbies is incorrect syringes or misinterpreting the lines.

Out an abundance of caution, can you provide the info on the packages for both what you’re using now and the syringes you just ordered? For example, U-100, 3/10cc, 31 gauge, 8mm (5/16”) needle. It never hurts to have a reality check and we can help you make sure you’re using the correct syringes as well as drawing the intended amount.

 

[Vasalisa]

One of the occasional glitches we see with newbies is incorrect syringes or misinterpreting the lines.

Out an abundance of caution, can you provide the info on the packages for both what you’re using now and the syringes you just ordered? For example, U-100, 3/10cc, 31 gauge, 8mm (5/16”) needle. It never hurts to have a reality check and we can help you make sure you’re using the correct syringes as well as drawing the intended amount.

Hello JL!

Yes that is EXACTLY what I'm afraid of!! Thank you!! I just need more people to see what I'm doing to make sure I'm not totally @&#ing things up regardless of how many times I check! I read a few threads where the syringe WASN'T a u 100 and it resulted in a MUCH smaller dose (though it was good in at least one thread because otherwise kitty would have gotten way too many units due to another misunderstanding). I can completely see how easy it is to make a mistake, and I just want to do the best I can for Meat.


I am having trouble figuring out how to post pictures on my Samsung/android mobile, but here is an amazon link to the syringes I just bought: https://a.co/d/0L6aJfl
They are u100 3/10 31 8


And these are the ones I had NOT yet been using (using pen with pen needles till now) with no half unit markings: https://a.co/d/6YqmvcT also u100 3/10 31 8

 

[Vasalisa]

If after your curve tomorrow you don't see anything below 150, you'd go up to 1.25 units as the new dose. With SLGS, the ideal range is nadirs or low points between 90 and 149.

Here's a link to another of those Sticky Notes on the top of the Lantus forum (highly recommended to read all the Sticky Notes), including pictures of those in between doses.
Insulin Care & Syringe Info: Proper Handling, Drawing, Fine Dosing

I guess no insulin curve today; for the first time Meat got a 163 AMPS reading. I was very surprised! Since I wont have the half unit syringes until later today sometime, I opted not to shoot. I'm definitely a bit stressed about it, but it seemed like the right thing to do. I'm hoping to stalk her to the litter box to use the ketone strips for the first time today, too. Thank goodness I can work from home! Should I attempt to do the curve tomorrow, does this change anything? It's the first shot I've ever skipped!

Edit update: trace ketones in urine! (Squeems advice about the urine ladle in another thread did the trick perfectly)
And my +2 reading is 249.
What am I even doing, i feel really dumb, was the first number an error? I just saw my meter had lowish battery and i charged it then got the 249. Are low readings/low battery a thing that happens?? She was getting agitated and I had a hard time getting blood this morning, which is usually because shes feeling extra perky/good, so i had figured the number was right, I obviously should have retested but I didn't.

 

[Wendy&Neko]

I would not have increased, but you could have still given insulin - especially with trace ketones present.

Yes, low batteries can cause odd readings. I'm glad you thought to change it. However, it's also possible she went lower last night and was on her way up at AMPS and started bouncing.

We highly recommend getting tests before every shot - looks like some of the ones in the PM have been missing. Also, getting a test just before you go to bed will help you know if she's going lower overnight - which is very common in cats.

 

[Vasalisa]

I would not have increased, but you could have still given insulin - especially with trace ketones present.

On the guidance for slgs it said to skip or adjust dose if it was 150-200, and without the right measuring syringes I was just too unsure. I was only able to test for keytones around 30 minutes ago, (shot time was 4 hours ago) that info absolutely would have had contributed a lot to my internal debate!
Should I shoot now? I'm definitely hovering.

We highly recommend getting tests before every shot - looks like some of the ones in the PM have been missing. Also, getting a test just before you go to bed will help you know if she's going lower overnight - which is very common in cats.

100% on board with that, I mention it in the original post here, I feel bad for shooting blind when I didn't know. Last night (the first night of that new info) I just couldnt get blood and she was beginning to fight me. It was the wrong choice, but I didn't want her to develop fear when it's time to test. Of course, today really proves the lack of wisdom in that, doesn't it?? Sorry Meat!! Its hard when the kindest most compassionate thing to do for our cat hurts them and they don't understand

Edit: and I also suspect the few lower numbers over the last few days were just that meter battery getting drained. Boy I won't make that mistake again.

 

[Wendy&Neko]

With Lantus, shooting now would put you really off schedule for tonight. With SLGS, exceptions are made if ketones are present. Make sure she eats well and is well hydrated today. Test ketones again if you can.

 

[Vasalisa]

Make sure she eats well and is well hydrated today. Test ketones again if you can.

Thank you for the advice, i encouraged her a lot last night and she drank well and ate 2x her usual fancy feast Pate. Because she was happily eating that I gave just a tablespoon of her dry YoungZero food (instead if her usual 2 table spoons) for her AM shot feeding.

Trace ketones again this morning. I still can't figure out pictures on mobile (i think the issue is my phone) and the test square looks like it is somewhere between trace and negative, but maybe that's just wishful thinking? Logically it seems like there is no "in between" trace results or negative results!

Do you think I should do a full curve today or give her time with a constant dose again since I muddled things up and skipped a dose cycle?

 

[Wendy&Neko]

When you skip a dose, could you put either "skip" or "NS" for no shot in the units cell. That way we know it wasn't just a forgotten entry.

A curve today won't be as useful because of Lantus's depot nature - it'll takes some for the depot to rebuild. You can get a couple spot checks in the middle of the cycle between, say, 4-7 hours after the shot. That might still be interesting.

 

[Vasalisa]

When you skip a dose, could you put either "skip" or "NS" for no shot in the units cell. That way we know it wasn't just a forgotten entry.

A curve today won't be as useful because of Lantus's depot nature - it'll takes some for the depot to rebuild. You can get a couple spot checks in the middle of the cycle between, say, 4-7 hours after the shot. That might still be interesting.

Should I wait a full 7 days/14 cycles after the missed shot to do a full curve? That's my instinct after reading the SLGS guidance and what I'll do unless anyone has different advice.

Thank you for your advice about keeping Meat drinking and eating for the trace ketones. After some more reading on threads here I am planning on feeding her at least 6 times a day for now, as much of the LC WF as she wants. She IS obese, so I just want to make sure this is still the right thing to do, even if we hadn't found trace ketones? She *needs* the extra food for her uncontrolled diabetes, right?

Sorry if this is extremely basic, I'm trying but sometimes my understanding of these things is vague at best.

Right now she is on my bed next to a literal silver platter holding her food and water- she is so good to me though, she deserves it!