I just increased insulin does to 1U at ams. Mao has been on insulin for 45 days. She might have diabetes for over five month. She was treated ketoacidotic crisis at a hospital 45days ago. I have not found the right does for her yet, her BG is always bouncing all over the places. Last night there was trace ketone when I checked her urian, I mixed water in her food to feed her all day. Is there any way to avoid bouncing?
1/17 Mao +13 499 +18 374 +23 471 She looks so sick
- Thread starter miaomi
- Start date
- Status
Re: 1/15 Mao Amps 434 +5 328 +6 389 +8 375 +11 457
Hello Julie, and welcome to Lantus Land (LL). There is a lot of information and experience here and I hope we can help your kitty. Good job on getting your spreadsheet up and running and getting those tests in.
Start out by reading the yellow starred sticky notes at the top of this forum. We all follow the Tight Regulation Protocol here. It looks like you've started to follow that protocol now, although we would have held that .75 the dose a little longer when you see nadirs under 200. For now, just keep at the 1U dose.
Bouncing seems to be a natural part of the process. If MaoMao has been diabetic for a while, her liver has gotten used to higher numbers as the new normal. As the insulin brings her down to lower numbers, the liver panics and you get those bounces. Only by spending more and more time in normal numbers will her liver begin to realize that the lower numbers are good. If you keep following the protocol, eventually the bounces will stop.
You mention that MaoMao has trace ketones. Has she been getting fluids? How is her appetite? The recipe for DKA is infection + not enough insulin + not enough calories. Your spreadsheet says she has not urinary infection. How are her teeth? There can also be infection in the gums.
Links to your previous posts on Health:
http://www.felinediabetes.com/FDMB/viewtopic.php?f=28&t=111551&start=50
http://www.felinediabetes.com/FDMB/viewtopic.php?f=28&t=110173
Hello Julie, and welcome to Lantus Land (LL). There is a lot of information and experience here and I hope we can help your kitty. Good job on getting your spreadsheet up and running and getting those tests in.
Start out by reading the yellow starred sticky notes at the top of this forum. We all follow the Tight Regulation Protocol here. It looks like you've started to follow that protocol now, although we would have held that .75 the dose a little longer when you see nadirs under 200. For now, just keep at the 1U dose.
Bouncing seems to be a natural part of the process. If MaoMao has been diabetic for a while, her liver has gotten used to higher numbers as the new normal. As the insulin brings her down to lower numbers, the liver panics and you get those bounces. Only by spending more and more time in normal numbers will her liver begin to realize that the lower numbers are good. If you keep following the protocol, eventually the bounces will stop.
You mention that MaoMao has trace ketones. Has she been getting fluids? How is her appetite? The recipe for DKA is infection + not enough insulin + not enough calories. Your spreadsheet says she has not urinary infection. How are her teeth? There can also be infection in the gums.
Links to your previous posts on Health:
http://www.felinediabetes.com/FDMB/viewtopic.php?f=28&t=111551&start=50
http://www.felinediabetes.com/FDMB/viewtopic.php?f=28&t=110173
Re: 1/15 Mao Amps 434 +5 328 +6 389 +8 375 +11 457
Welcome to Lantus Land!!
I'm so glad to see you're checking for ketones. Please try to check as often as you can. With a history of DKA and trace ketones showing up, it's important to stay on top of the ketones. If stalking Mao to the litter box makes it difficult to check his urine, there are blood ketone meters available. NovaMax makes a meter. (The strips for the meters are expensive but it makes ketone testing much easier.) I posted this information for someone else yesterday:
I'm also glad to see that you increased your kitty's dose. We may want to encourage you to be aggressive with dosing until Mao's numbers are back down. Just so you know how we look at dosing, if you are following the Tight Regulation Protocol, we don't reduce the dose unless a cat that's within the first year of diagnosis has a BG test that is below 50. It looked like you were seeing some good numbers at 1.5 - 2.0u.
As for the bouncing, bounces are annoying but normal. Kitties are often diabetic for quite a while before they're diagnosed. As a result, their bodies become used to sitting in high numbers. When they start getting insulin, the numbers come back down and their liver and pancreas "panics." As a result, these organs release a stored form of glucose (e.g., glucagon) and counterregulatory hormones. These serve to drive the BG levels back up. It can take up to 72 hours for the bounce to clear. The more time Mao spends in better numbers, the less the bouncing should occur.
Please let us know how we can help. The people here are incredibly generous with their time and their knowledge and we want to do our best to help you get Mao regulated.
Welcome to Lantus Land!!
I'm so glad to see you're checking for ketones. Please try to check as often as you can. With a history of DKA and trace ketones showing up, it's important to stay on top of the ketones. If stalking Mao to the litter box makes it difficult to check his urine, there are blood ketone meters available. NovaMax makes a meter. (The strips for the meters are expensive but it makes ketone testing much easier.) I posted this information for someone else yesterday:
I'm also glad to see that you increased your kitty's dose. We may want to encourage you to be aggressive with dosing until Mao's numbers are back down. Just so you know how we look at dosing, if you are following the Tight Regulation Protocol, we don't reduce the dose unless a cat that's within the first year of diagnosis has a BG test that is below 50. It looked like you were seeing some good numbers at 1.5 - 2.0u.
As for the bouncing, bounces are annoying but normal. Kitties are often diabetic for quite a while before they're diagnosed. As a result, their bodies become used to sitting in high numbers. When they start getting insulin, the numbers come back down and their liver and pancreas "panics." As a result, these organs release a stored form of glucose (e.g., glucagon) and counterregulatory hormones. These serve to drive the BG levels back up. It can take up to 72 hours for the bounce to clear. The more time Mao spends in better numbers, the less the bouncing should occur.
Please let us know how we can help. The people here are incredibly generous with their time and their knowledge and we want to do our best to help you get Mao regulated.
Sandy and Black Kitty
Member Since 2009
Re: 1/16 Mao Amps 435 +3 471 +5.30 512 bouncing high 4th day
Hi Julie and Welcome
Glad you found us.
I do have experience with DKA however I have no personal experience giving fluids. Many here do and can offer their experience and guidance.
Hydration is very important when battling ketones. Adding water to Maos food will help with hydration.
Please continue to monitor for ketones as they can develop very quickly to a critical level. If you get a reading higher than trace, take her to the vet.
A trip to the vet to see if there is an infection somewhere is a good idea.
I'm not convinced she is bouncing. I think she needs more insulin right now. I would hold this dose for 1 more cycle and if the numbers don't move down, increase the Lantus dose tomorrow.
Does your schedule allow you to monitor closely?
Hi Julie and Welcome
Glad you found us.
I do have experience with DKA however I have no personal experience giving fluids. Many here do and can offer their experience and guidance.
Hydration is very important when battling ketones. Adding water to Maos food will help with hydration.
Please continue to monitor for ketones as they can develop very quickly to a critical level. If you get a reading higher than trace, take her to the vet.
A trip to the vet to see if there is an infection somewhere is a good idea.
I'm not convinced she is bouncing. I think she needs more insulin right now. I would hold this dose for 1 more cycle and if the numbers don't move down, increase the Lantus dose tomorrow.
Does your schedule allow you to monitor closely?
Re: 1/16 Mao Amps 435 +3 471 +5.30 512 bouncing high 4th day
Hi Sandy, I can monitor her closely this week. Since I am so worry about the ketones specially if it can develop quickly; I am going to bring her to the vet even I really want to save some money, but I don't know how to giving the fluid & I don't have it available.
Mao is only 6Ib very skinny.
Hi Sandy, I can monitor her closely this week. Since I am so worry about the ketones specially if it can develop quickly; I am going to bring her to the vet even I really want to save some money, but I don't know how to giving the fluid & I don't have it available.
Mao is only 6Ib very skinny.
Re: 1/16 Mao Amps 435 +3 471 +5.30 512 bouncing high 4th day
Marje is one of the people here who have lots of experience with giving subcutaneous fluids. This is something you can easily do at home. You'll need to get a prescription for the fluids and needles, lines, etc. from your vet. This is a link to a video that Marje put together on how to give fluids so you have some idea about what's involved.
Marje is one of the people here who have lots of experience with giving subcutaneous fluids. This is something you can easily do at home. You'll need to get a prescription for the fluids and needles, lines, etc. from your vet. This is a link to a video that Marje put together on how to give fluids so you have some idea about what's involved.
Re: 1/16 Mao Amps 435 +3 471 +5.30 512 bouncing high 4th day
If Mao stays high and flat like this over the night cycle, it's OK to increase to 1.5U in the morning. You can hold doses longer if she starts seeing more yellows and blues.
If Mao stays high and flat like this over the night cycle, it's OK to increase to 1.5U in the morning. You can hold doses longer if she starts seeing more yellows and blues.
Re: 1/16 Mao Amps 435 +3 471 +5.30 512 bouncing high 4th day
Welcome Julie and Mao!
We're glad you are here. I agree with Wendy that you should increase the dose. In fact, you should probably increase the dose 0.5u after every four cycles as long as Mao has nadirs above 300.
I know giving fluids seems complicated but the most important thing is to stay calm. I use 21g needles because the 18g needles the vet uses are like harpoons. I would also have someone with me to help the first few times. You will save a lot of money and stress on Mao if you can give fluids at home.
Please let me know if you have questions.
Welcome Julie and Mao!
We're glad you are here. I agree with Wendy that you should increase the dose. In fact, you should probably increase the dose 0.5u after every four cycles as long as Mao has nadirs above 300.
I know giving fluids seems complicated but the most important thing is to stay calm. I use 21g needles because the 18g needles the vet uses are like harpoons. I would also have someone with me to help the first few times. You will save a lot of money and stress on Mao if you can give fluids at home.
Please let me know if you have questions.
Sandy and Black Kitty
Member Since 2009
Re: 1/16 Mao Amps 435 +3 471 +5.30 512 bouncing high 4th day
Hello again Julie
I see you are on the east coast - we are too.
What time do you shoot?
Hello again Julie
I see you are on the east coast - we are too.
What time do you shoot?
Re: 1/16 Mao Amps 435 +3 471 +5.30 512 bouncing high 4th day
Hi Sandy, yes I am in CT. 11:10 is my shoot time. I am going to give 1.5U. Her +15 499 +18 374 +23 471, I am ready to increase the does. She is lethargy and thirsty, does not have appetite.
Since she is so thirsty, I guess she is dehydrated, I am going to make an appointment to give her some fluid.
marje, your video is great, I am going to discuss with my vet to see if I can give her fluid at home.
Hi Sandy, yes I am in CT. 11:10 is my shoot time. I am going to give 1.5U. Her +15 499 +18 374 +23 471, I am ready to increase the does. She is lethargy and thirsty, does not have appetite.
Since she is so thirsty, I guess she is dehydrated, I am going to make an appointment to give her some fluid.
marje, your video is great, I am going to discuss with my vet to see if I can give her fluid at home.
PeterDevonMocha
Member Since 2009
Hi guys .. No advice from me, but just wanted to stop in and say hi, and that you are in the right place for getting your baby back to feeling puurfect!
Lauren&Tommy (GA)
Member Since 2010
((Miaomi)), good morning and welcome to LL. You couldn't have picked a better place or a more wonderful group of people to help you get Mao into some much better numbers. It's wonderful that you are checking for ketones regularly and it's obvious that you love your baby and want her to be well. I too just wanted to drop by and offer moral support to you. You and Mao can do this :YMHUG:
You will need to learn to give fluids at home but if her ketones go more than just a trace and you can't get them right back down with subq fluids, syringe feeding, etc, you have to take her to the ER. Sometimes you cannot treat ketones at home. And a kitty with trace ketones can go into full blown DKA in 24 hours.
Could we please ask that each day you start a new condo when you first do her AMPS? Thank you!!!
Could we please ask that each day you start a new condo when you first do her AMPS? Thank you!!!
Suzanne & Cobb(GA)
Member Since 2013
Hi Julie and Mao!
You can get the syringe at a drug store. It's like the kind you would use to give a baby liquid medicine. You'd want one of the bigger ones, I'd think. I haven't had to syringe feed or give sub-q fluids but you are in the right place! Just wanted to stop by and say hi as well. The people on this board are great. You'll find a real sense of community that is focused on one thing: getting Mao better!!
Good luck with the fluids!
~Suzanne
You can get the syringe at a drug store. It's like the kind you would use to give a baby liquid medicine. You'd want one of the bigger ones, I'd think. I haven't had to syringe feed or give sub-q fluids but you are in the right place! Just wanted to stop by and say hi as well. The people on this board are great. You'll find a real sense of community that is focused on one thing: getting Mao better!!
Good luck with the fluids!
~Suzanne
The quickest place might be your vets office. I'd ask if they have 10-12 ml needleless syringes or petsmart carries them, too, I believe. You can order them online but it will take a while to get them.
Online sources:
Thriving pets
lambert vet supply
The ones I like the best are ringless.
Pippins Roost.....scroll down to ringless syringes.
This is the best video I've seen to show you how to assist feed a cat
Online sources:
Thriving pets
lambert vet supply
The ones I like the best are ringless.
Pippins Roost.....scroll down to ringless syringes.
This is the best video I've seen to show you how to assist feed a cat
Sandy and Black Kitty
Member Since 2009
Hi Julie,
Is Mao eating at all today?
Did you increase her dose this morning and shoot 1.5u ?
At a time like this, let her eat whatever she likes. Don't be at all concerned about carbs.
Anything goes - break open a can of high carb food and see if she is interested in that.
Another trick is to place a small bit of her food onto your finger tip, gently open her mouth and place the food behind her front teeth, on the roof of her mouth.
Many times getting a kitty to eat just that small amount gets them eating again.
Is Mao eating at all today?
Did you increase her dose this morning and shoot 1.5u ?
At a time like this, let her eat whatever she likes. Don't be at all concerned about carbs.
Anything goes - break open a can of high carb food and see if she is interested in that.
Another trick is to place a small bit of her food onto your finger tip, gently open her mouth and place the food behind her front teeth, on the roof of her mouth.
Many times getting a kitty to eat just that small amount gets them eating again.
Hi Sandy, I just purchased a syringe in case if Mao doesn't want to eat I can do something to help. I gave her 1/4 Pepcid AC this morning, she started eating, she's not starving like before, but ate at least 5oz food so far today, that's not bad right. The increased does this morning made her number down to 360 @ +3.10, I am going to make more tests, hope she is getting some yellows and blues.
There can be several reasons for the bump in numbers. It may be a food spike. It's possible that Mao's nadir was before the +5 and her numbers are on the way back up. (The nadir is a moving target. It's not always at +6. Some cats also have early nadirs and some have routinely late nadirs.)
FWIW, the numbers in your subject line indicate that you didn't give a shot. You keep numbering on a 24 hour "clock" if you skip a shot. Since you couldn't get the AMPS but did give Mao a shot, your +13 is really a +1, etc.
Hopefully, the dose increase will help Mao to feel better.
FWIW, the numbers in your subject line indicate that you didn't give a shot. You keep numbering on a 24 hour "clock" if you skip a shot. Since you couldn't get the AMPS but did give Mao a shot, your +13 is really a +1, etc.
Hopefully, the dose increase will help Mao to feel better.
julie & punkin (ga)
Member Since 2011
hi Julie! i haven't met you yet, but wanted to say welcome. i'm glad you increased her dose today and have some options for feeding her.
I want to reiterate what Sandy said - if she's not eating, it's better to tempt her with anything she's willing to eat, even if it's not low carb. very important for her to eat enough calories.
hope she's doing better this evening! :YMHUG:
I want to reiterate what Sandy said - if she's not eating, it's better to tempt her with anything she's willing to eat, even if it's not low carb. very important for her to eat enough calories.
hope she's doing better this evening! :YMHUG:
julie & punkin (ga)
Member Since 2011
hi!
i read through your other posts on the Main Health board.
Are you giving her the pancreatic enzymes? if so, how are they working?
Is her poop still weird or is it more normal?
I'm not clear on what the situation is with her eating. in one of those earlier posts you said that she was eating a lot - i think you said something like 6 cans or so. so this is quite a bit different now, it seems. do i have that right?
is she eating enough for her weight to be stable now or do you think she is still losing weight?
Sometimes we have to be a little bit of a detective to figure out what's going on, but we can tell she needs more insulin. I'm glad you increased her dose today. Can you take a look at the post A Primer on Pancreatitis and see if it describes what you are seeing in Mao? I think you said she's hasn't been tested for pancreatitis, right?
you can leave food out for her overnight.
i read through your other posts on the Main Health board.
Are you giving her the pancreatic enzymes? if so, how are they working?
Is her poop still weird or is it more normal?
I'm not clear on what the situation is with her eating. in one of those earlier posts you said that she was eating a lot - i think you said something like 6 cans or so. so this is quite a bit different now, it seems. do i have that right?
is she eating enough for her weight to be stable now or do you think she is still losing weight?
Sometimes we have to be a little bit of a detective to figure out what's going on, but we can tell she needs more insulin. I'm glad you increased her dose today. Can you take a look at the post A Primer on Pancreatitis and see if it describes what you are seeing in Mao? I think you said she's hasn't been tested for pancreatitis, right?
you can leave food out for her overnight.
- Status