05/13 - small kitty amps : 442.80 pmps : 583.2 +2 358.2 +4 256 +6 227 -NO KETONE !!!

[Photorecon]

Good Friday the 13th

Yet, rising again this morning. I don't know if I'm dreaming, but sounds Small Kitty is
''eating himself'' during the night. I could feel the bones this morning witch was not the case for what
I remember. I tried to get a weight but he simply didn't want, was always moving but
I was able to catch a 3.94kg, same weight as usual. He's either cooperating for urine sample,
he's always releasing when I'm either sleeping or when I'm at the office. Sure he's doing it
on purpose !!

What kink of dose / actions before I should increase it up ? He's been 7 days on 2.0/2.0.
I have 1 unit incremented seringe. Coudl a ''generous'' 2.0 help bringing heavy mornings ?

Thanks for your help !!!

Sébastien

http://www.felinediabetes.com/FDMB/...577-80-2-608-40-4-489-60.157619/#post-1674980

http://www.felinediabetes.com/FDMB/...-40-pmps-415-80-2-370-80.157641/#post-1675607

 

[Photorecon]

Oups, just went on to read the ''rules'' of the Lantus forum and found one that says not to reply to previous
threads.

Here is a reply to Julie on yesterday's post regarding KDA and reason for this to happens :

@@Julie,

That is very useful information you're giving here. What I think happened before and into the DKA is the following :

Small Kitty was under the following :

- Antibiotic to fix urinary infection
- Too little Lantus Dose
- Lack of food / Water (was eating / drinking very little, had to feed him manually during DKA)
- Was depress and affected by my own ''fear'', frustration of getting nowhere.

He's now kind of depress again but for different reason. Small Kitty and Big Brother have been
cats allowed to go outside and play all night at the back of the building and those nearby for
their entire life. They are not confined and I see a difference in mood, their faces shows cats
feeling sad.

Also,
In the : LANTUS & LEVEMIR - TIGHT REGULATION PROTOCOL (TR)
(http://www.felinediabetes.com/FDMB/threads/lantus-levemir-tight-regulation-protocol-tr.1581/)

I found the following :
INCREASING THE DOSE:

• Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) : it's going to be 7 days at 2.0 / 2.0
• After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit : it's the case (over 300)

This protocol seems to have proven itself to be right in the past.

There is a day this week-end where I will do a 3h interval testing for 12h.

Can someone give his opinion, last time we had that kind of pattern we ended up in DKI ?

Don't like these numbers (for this week).

Thanks

Sébastien

Spread sheet
Lab tests results

 

[Bobbie And Bubba]

Hi Sebasten ~ I would say that you need to increase SK's insulin by .25 You do not want to increase by a full unit and the reason being is that you could go past the correct dose. It would be helpful if you could get syringes that are U100 with increments of .25 to help you with the increases. With the previous DKA is important to get her in lower numbers. How is her food intake and her water consumption? Are you testing for ketones? When my Bubba had ketones, he got so thin. Luckily he has gained back what he lost.

It is hard sometimes to get them weighed. Do you have human scales for yourself? Weigh yourself holding SK and then weigh yourself with SK and subtract to get her weight. That is what I do with my pets.

 

[Sienne and Gabby (GA)]

With a history of DKA, especially if it's a recent history, you need to be aggressive about dosing. What that means is you need to be increasing the dose every 3 days, possibly sooner, until numbers are in a better range. You also really need to be testing for ketones. If you can't stalk SK to the litter box, then getting a meter that tests for blood ketones is your best option. The Precision Xtra and NovaMax are both meters that test for ketones.

If you are following Tight Regulation, as Bobbie noted, generally doses are raised by 0.25 units. This is the case if you are routinely seeing nadirs under 300. If nadirs are above 300, you can raise the dose by 0.6u. From your spreadsheet, I'm assuming that you work outside of the house. Thus, it's hard to know where SK's nadirs are.

If your cats are used to going outside, I'd really encourage you to get interactive toys and/or play with them a lot when you're home. They will adjust to a new routine but it may take a bit of time. It's lots safer for them to be indoor cats!!

 

[Photorecon]

Thanks for the Reply Bobbie,

I'm ready for ketone testing but Small Kitty is not on the same schedule as me in regards of releasing.
It would be so nice if I could get some urine to test ketone, he doesn't give me an occasion. Everything
is ready, I have ketone sticks and what's needed to gather the urine but there is not. Litter is full of urine when
I arrive so I'm pretty sure he drinks. Food intake is very fine, he's always asking for more, and I give what
he's asking. For weight I have a digital balance that is accurate up to 100 g difference. I prefer to use a food
balance with a food tray on top. This gives very accurate results, when he wants to stop trying to go away.
I don't think he has lost weight, he just have a lot to gain from the previous weeks.

Both of my cats are sleeping all day long and active at night. What about an additional .5 at the proper timing and
keep the +12 as is ? I'll consider looking for smaller scale syringe but I can get a .5 and .25 quite easily with what
I have (.5 for the first line and then 1.0 for the next ones on the syringe)

 

[Photorecon]

With a history of DKA, especially if it's a recent history, you need to be aggressive about dosing. What that means is you need to be increasing the dose every 3 days, possibly sooner, until numbers are in a better range. You also really need to be testing for ketones. If you can't stalk SK to the litter box, then getting a meter that tests for blood ketones is your best option. The Precision Xtra and NovaMax are both meters that test for ketones.

If you are following Tight Regulation, as Bobbie noted, generally doses are raised by 0.25 units. This is the case if you are routinely seeing nadirs under 300. If nadirs are above 300, you can raise the dose by 0.6u. From your spreadsheet, I'm assuming that you work outside of the house. Thus, it's hard to know where SK's nadirs are.

If your cats are used to going outside, I'd really encourage you to get interactive toys and/or play with them a lot when you're home. They will adjust to a new routine but it may take a bit of time. It's lots safer for them to be indoor cats!!

Yeah, I do play with them with laser pointer and grabbing their stomach asking for fight but they become bored quite fast.
They are fighting together a bit, some time licking each other, they have good interaction.

And you're right, I'm only at home from wake-up time at 6 to 7 when leaving and returning at 5h30pm and I have to go
to bed before 9pm. , ideally. I have one day during the week-end where I can nomintor every 3h. or so. It's probably going
to be this Sunday.

 

[Photorecon]

Very worried right now, I've tested with the ''real thing'', the alphatrack II meter calibrated with it's strips and numbers are frightening, 583.

I'm just back from Walmart, they have a Meter that can test for ketone, they will have it Monday. Until then I just hope
SK will urinate so I can gather sample to test.

Evening dose just given, 2.0 still. Is this a bounce still ?

Hope it's gonna be better in 2h, but think it would be a good idea to gear up a little, by how much ? not sure

Sébastien

Ho, forgot to say : Small Kitty has eaten like hell at meal serv. He ingested 2 small Fancy Feast Pâté Turkey and Giblets Feast cans. (those are called Classic in the US).
That's a lot of food for him, 170g. in less then 5 min.

 

[Bobbie And Bubba]

So glad that you are getting a ketone meter, that is what I have as I can not get a sample from the litter box( LB). I do not think this is a bounce as this is the 9th cycle since she you got 241 (13.4) She needs to be increased with the insulin. Can you eye ball the dose by .25 on her next dose? Just do the best you can until you can get the appropriate syringes.

 

[Chris & China (GA)]

I think you could probably go up by .5 since it doesn't look like he's going below 300 at nadir

Is there any way you can get an extra test in during tomorrow's AM cycle since it's Saturday?

 

[Photorecon]

So glad that you are getting a ketone meter, that is what I have as I can not get a sample from the litter box( LB). I do not think this is a bounce as this is the 9th cycle since she you got 241 (13.4) She needs to be increased with the insulin. Can you eye ball the dose by .25 on her next dose? Just do the best you can until you can get the appropriate syringes.

I can eyeball for sure, as a photographer I've come to be good a dosing stuff. A .25 would be a generous 2.0, no visible light line after your flush dose. If you see light below and above, you have a .5, very easy.

Should I expect roof top numbers after that, tomorrow morning, at 2.25 ?

 

[Photorecon]

I think you could probably go up by .5 since it doesn't look like he's going below 300 at nadir

Is there any way you can get an extra test in during tomorrow's AM cycle since it's Saturday?

Hi Chris, happy to see you. Yes for sure I can, what about +3 +6 ? then I can resume with pmps +3 increment.

 

[Chris & China (GA)]

Some cats respond to a dose increase by higher numbers....We call it New Dose Wonkiness and we don't know why it happens, but we don't know what he'll do yet

Hopefully he'll skip the NDW and go straight to some better numbers!

It would be GREAT if you could get a +3 and +6 tomorrow!! It will really help fill in what he's doing!!

 

[Bobbie And Bubba]

So glad Chris weighed in. Go by her recommendations.

 

[Photorecon]

NDW

What's the meaning of NDW ? ''New dose Wipe Out'' ?

One thing I know is that these numbers needs a slammed door in their face.

What should I be looking at after 6.30am tomorrow ? Normal routine ?

 

[Bobbie And Bubba]

NDW is New Dose Wonkiness. It's when you give an increase and instead of the numbers going down right away, they go up. We don't know why it happens, it just does so, don't be surprised if you see her numbers after you give the increase go up some. They will go back down again.

 

[Photorecon]

So let's go for 2.5 tomorrow and see how it goes. Hope it's gonna be fine. I'll post the pspm resutls.

A question : Why do, FDMB members like you, are ready to give their time and hope in perfect strangers ?

That's quite amazing to me. I live in another country, speak a different language and here are people
helping me more then anybody else around me.

Just hope you don't feel this as an obligation, but it's really appreciated.

Thanks

 

[Bobbie And Bubba]

So let's go for 2.5 tomorrow and see how it goes. Hope it's gonna be fine. I'll post the pspm resutls.

A question : Why do, FDMB members like you, are ready to give their time and hope in perfect strangers ?

That's quite amazing to me. I live in another country, speak a different language and here are people
helping me more then anybody else around me.

Just hope you don't feel this as an obligation, but it's really appreciated.

Thanks

You are making me cry. Why, because we have all been in the same position as you, scared and wanting so badly to help our kitties and people here that had been helped before us, paid it forward and that is what we are doing for you. And maybe some day you will do the same if you can.

 

[Chris & China (GA)]

We do it because we want to help!!

All of us came here with the same frightening diagnosis....and most of us came here with the same bad advice from our vets, so it's important for us to "pay it forward" for the kindness that was shown to us!!

In the future, you'll do the same thing!...Even if it's just "I know how you feel....we were there not long ago" are some of the best words a new person can hear!!

 

[Andy & Pimp]

A question : Why do, FDMB members like you, are ready to give their time and hope in perfect strangers ?

Many of our kitties wouldn't be here if it weren't for the "strangers" that helped us, when we were new to feline diabetes.

I haven't been around much simce you've joined, but I've been trying to find a bit more free time lately. I agree with @Sienne and Gabby (GA) about increasing every 3 days and following TR protocol, and also with @Chris & China for raising the dose by 0.5 units.

It is very obvious that Sk needs more insulin.

Good luck with the dosecrease!

 

[Wendy&Neko]

Bonjour Sebastian - some of us are from your country too. Although I'm from the west.

The syringes you want to get are the BD Ultrafine II. I get the ones with the purple and yellow on the box. They have half unit markings. In BC, I've found Safeway is the cheapest, maybe Sobey's is there if you have them. Costo also has good prices for syringes.

For the numbers you are reporting for the blood glucose numbers, you can remove the decimal places. We don't need to be that accurate. The spreadsheet should have the converted numbers on them. I keep a copy of the file I've attached on my computer desktop - it helps me do quick conversions.

Good luck with the increase.

 

[Photorecon]

These things, KDA, CKD... bring you against the wall, this is where you see how fragile
biology is. We have a big credit in keeping this balance straight. Some are putting their energy
in cars, IPhone, computers and material things, we do in our little friends. I think the
reward is way higher, never like a doctor or nurse is doing with their patients but still,
it's a living organism. That's something we must be proud of, I think.

(sorry for crowding the important Lantus forum with crap, I'll stay in the pure medical side
if this is what the way to go is), completly new to this.

Thanks for the spreadsheet Wendy, I'll keep it up close.

 

[Wendy&Neko]

(sorry for crowding the important Lantus forum with crap, I'll stay in the pure medical side
if this is what the way to go is), completly new to this.

An important part of what we do here is support people emotionally, as well as with feline diabetes. Taking care of a diabetic cat is hard. Unfortunately many people choose not too. But you are one of the great caregivers who have taken on that task. Add in other concurrent conditions or complications and it can take a lot out of the caregiver. Vent or talk away. We are family here. I've had pitty parties at my house before.

 

[julie & punkin (ga)]

My concern about increasing the dose is that we don't know yet how low this dose is taking him. I can't say that he's not having nadirs under 200 for certain. I'm sorry to disagree, but I would not increase by 0.5u without that data. In fact, from the data we can see, it's clear that this dose IS getting him at least into the 200's.

Because of the recent DKA, I could be persuaded that the dose needs to be increased, but only by 0.25u. The Tight Reg guidelines say:

INCREASING THE DOSE:

• Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
  • if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing.
  • when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing.

• After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
• After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.

Honestly, I would prefer to see something that showed a little more clearly how low Small Kitty is getting before increasing his dose. I know you said you can't stay up late, and you do have to take care of yourself, but I think I'd wait til Sunday and try to do a curve then and hope it's not a bounce day.

We are all volunteers who learned because someone else taught us how to take care of our diabetic cats using Lantus or Levemir. We're just passionate about passing it on to the next new person who is in that same situation. It's unforgettable what it's like to be in your shoes - loving your cat and needing help from people who understand how to use these insulins in our diabetic cats. There really isn't another resource like this one.

 

[Photorecon]

KETONE NEGATIVE !!!! YEAH !!!!! + AMPS + 4 is now reasonable : 256

So happy, weight is steady, although urine has a little bit of contamination (some very little trace of litter),
the liquid went on top and 3 strips proved it was negative ! THATS SO GREAT !! So glucose has not
yet cross the border, that's great, adjustment would be right on time.

@Julie, you're right about the ''if nadirs are greater than 200, but less than 300'' but :
''if your cat is new to numbers under 200, it is recommended to hold the dose'' is not the case,
Small Kitty has almost been above since diagnosed. So an increase is required, question is by
what level.

If we have to increase by .5, what cycle would be the best (.5 / 2 = .25). There is more yellow during
the AMPS cycle. When does Lantus gears up ? +12 after, or in the next cycle +24 ?

After all it's a slow acting insulin..

Confusing this Small Kitty, seems to act it's own will.

 

[Chris & China (GA)]

Do you think you might be able to get another test in sometime tonight?

That's a big drop for only +2 and it might really help us to know if he's dropping lower later in the cycle.

I realize you need your sleep, but if there's any way you could possibly set an alarm and maybe get a +6, it might tell us a lot about what to do going forward

 

[Photorecon]

+6 = 227 = increase .25 ? ( if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit)

??? .25 increase 2x/day ? or +.5 amps + no change pmps ? Or or the other way ?

?? is 227 ''real nadir'', a solid value or just a start (meaning lower results more valuable) ?

Blood circulation is more active at night for my cats (sleeping during daytime)...

Another point to consider is the black and red values (5 black and 2 red, on the spread sheet) since last increase.

>400 = Above renal threshold if maintained / might lead to ketone in urine ???

I'm confused, need some sleep

 

[Chris & China (GA)]

+6 = 227 = increase .25 ?

I think you mean +4 (or did you put it in the wrong cell?)

Yes, since he got down into yellow tonight, you'd only want to increase by .25 unit .....and both the AM and PM shot should be the same amount, so 2.25 in the AM and 2.25 in the PM

?? is 227 ''real nadir'', a solid value or just a start (meaning lower results more valuable) ?

Our goal for Tight Regulation is to keep the numbers throughout the cycle between 50-120, with most of the numbers under 100. We'd like to see the nadir above 50 to about 80 (the nadir is the lowest point in the cycle)

Another point to consider is the black and red values (5 black and 2 red, on the spread sheet) since last increase.

Remember, lantus dosing is based on how LOW it takes them, not the higher Pre-shot numbers

>400 = Above renal threshold if maintained / might lead to ketone in urine ???

Ketones can be produced at any blood glucose level...it doesn't have to be above 400, but it's more common to have ketones show up when the blood glucose is high

I hope I understood your questions and gave you answers that made sense too, but we will be happy to keep explaining in different ways until you understand!! We WANT you to understand what you are doing!!

 

[Tricia Cinco(GA) & Harvey]

what cycle would be the best (.5 / 2 = .25). There is more yellow during
the AMPS cycle.

Sébastien, you want to give the same dose for both AM and PM cycles - Lantus works best with consistent dosing. As for when to increase, best to do it when you are able to test more - I think you said Sunday? So start the new dose Sunday morning.

When does Lantus gears up ? +12 after, or in the next cycle +24 ?

"Onset" - when the insulin starts to work, is typically around two hours after you give the shot, but ECID (Every Cat is Different).

>400 = Above renal threshold if maintained / might lead to ketone in urine ???

Yes, but usually there are more factors in play, like an infection, not enough food, etc. Still, it's never a bad idea to test for ketones when the BGs are high. HERE is some good info about ketones.

Everyone here has felt what you are feeling. We love our cats and would do anything for them. Most of us were desperate when we came here and found people that understood and helped us. I know my Cinco would not have survived if it were not for the help I found here. Because of the generosity and kindness of the people here, we had five years with him that we would not have had! I feel I have to pay back the help I receive by helping others as much as I can. Plus we all love all cats, so how could we let one suffer when we can help?

 

[julie & punkin (ga)]

+6 = 227 = increase .25 ? ( if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit)

??? .25 increase 2x/day ? or +.5 amps + no change pmps ? Or or the other way ?

?? is 227 ''real nadir'', a solid value or just a start (meaning lower results more valuable) ?

Blood circulation is more active at night for my cats (sleeping during daytime)...

Another point to consider is the black and red values (5 black and 2 red, on the spread sheet) since last increase.

>400 = Above renal threshold if maintained / might lead to ketone in urine ???

I'm confused, need some sleep

If you focus on the low points and work to get the low numbers in the range you want them, the higher numbers will usually come down on their own. So this:

Another point to consider is the black and red values (5 black and 2 red, on the spread sheet) since last increase.
​

isn't a significant factor in determining your dose changes. The yellow 200's tell us that this dose is capable of getting SK to that level at least, so that is the number that's most important.

?? is 227 ''real nadir'', a solid value or just a start (meaning lower results more valuable) ?
​

If he's going lower than 200's, that would be good to know. When we consider dose changes, we're looking at the past 3-4ish days and what might be the lowest numbers during that time. So yes, if there WERE any lower numbers, they would be very valuable for us to know.

Dose is the same am and pm, so a 0.25u increase means the dose would be 2.25u morning and night.

 

[julie & punkin (ga)]

oh - and YAY for a negative ketone test! great job getting it!