1/30 Zelda AMPS 42 - Not panicking but...

Peter Moore

Peter Moore

Member Since 2019
Wow ok. If not for you guys I'd be panicking and rushing her to the ER, but -

Last shot was 0.25 12 hours ago. She just ate a nice can of Fancy Feast and I threw in a tsp of high carb dry food (I don't yet have the wet food with gravy).

She had vomitted a little overnight, so I included a 1/4 tab cerenia that they had given me back when she was hospitalized.

No hypo symptoms. Sitting on my lap happily now like nothing's going on. Will continue to test every 20 minutes or so. (What number should I rush her to the vet for? Fortunately they're open momentarily).

I have some slightly diluted maple syrup ready to go if need be. Any other advice appreciated.

(Please be remission... Please be remission...)
 
Hi , I'm too new to help, but add a 911 to your post above title. may I suggest mentioning in the comments above when you switched to the 12 hour cycle from your 18 hour cycle, and perhaps type it out above, sort of like your original post, for the past week or so?
We really recommend the spreadsheet because it's so easy to monitor, but since yours is altered it is more difficult to see any pattern, and itmay help with a speedier response in this case?
You're doing great, remain calm and keep testing at 15-20 minutes :)
With love, Nikki
 
To add the 911, go to the edit title button near the top right of the screen, the pop up will indicate a roll down arrow, change it to the red 911. Gets eyes fast.
 
Looks like she's on her way out of the danger zone! She has earned a reduction, so you can try to measure out a dose somewhere between a drop and the 0.25 she's been getting.

Not sure about whether you should shoot this morning - I'll wait for the more experienced to chime in.

Congratulations - remission may indeed be on the horizon! Just stick with the program and hope you continue to see good results!
 
Yes will keep testing to make sure but it does seem she's bouncing back up. Obviously no shot this morning right?

I was almost thinking of starting drops at this point but you guys think attempting a 0.1 - 0.15 would be better at this point?

The vomit concerns me a little. Could that have been caused by the low numbers?

Thanks!!
 
Peter Moore said:
The vomit concerns me a little. Could that have been caused by the low numbers?
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It is possible.

I'm glad you caught the low number. I'm trying to remember .. did Zelda ever have DKA? If so, then we don't encourage skipping. The next dose to try is 0.1u. I think you already got the image of what 0.1u looks like. Can you keep monitoring?
 
I tagged some more experienced eyes in different time zones. I'm not familiar with the AT meter, but think that below 68??? is not safe. Continue testing and feeding small amounts (1-2tsp) every 20 minutes to keep her rising, posting numbers so people can be up to date. Please add the 911 to your title. As long as she continues to rise, don't panic, but do keep testing even after shes passed the "safe" mark as she may be artificially inflated by food which wears off, and her BG may well drop again.
Don't feed any large amount, because we dont want to fill her up so she's inappetent when she needs to eat.
There's a sticky on hypos, also on shooting low numbers.
With love, Nikki
 
Please test again and don't forget the treat for letting you test. During low numbers like these (lime greens), you need to feed each time you see a lime green and then test 20-30 minutes later to see if the number is coming up. Once the number is above 68 on the AT meter, you need to monitor for 2 hours with no food to make sure she remains safe.
 
@nslade001 thanks, and just to reemphasize her last shot was now over 12 hours ago. I will test periodically this morning, not to worry. And yes, she ate a good but not excessive amount of food. Am going to encourage eating throughout the morning as well.

@Mandy & Rex she had ketones in her urine only at the very beginning of this ordeal, back in July. It was not identified as full blown DKA though. Also that was corticosteroid induced, and followed (we think) a month of >300, maybe >400 BG consistently. Since starting insulin we've never had ketones. Even if we've skipped a shot, for whatever reason, we've seen glucose in the urine but never ketones.

Thanks for reminding me about the treat! I wish there was a no carb treat she was interested in ... I can do a piece of Orijen kibble though. She also goes nuts over raw beef (USDA prime only!!) maybe that?

If you look at what happened between 1/27 and 1/29, we skipped a shot the night of 1/28 and resumed the morning of 1/29, effectively a 24-hour injection cycle. By 1/29 evening she was fairly low compared to when we were doing 16 hour injections. I wish I'd gotten the AMPS yesterday...

Anyway, given her sensitive tummy right now there's no way in hell I'm injecting this morning, but I will test PMPS and post and we'll make a call then! Yes I do have the image of 0.1, and I have calipers. I already calculated my syringes to be 1.36mm / unit, so I can attempt a 0.1 that way. At that point the markings are useless, of course.

Thanks!!
 
All right. You can give a piece of meat - no issue there! :D Beef, chicken, etc. Please keep testing until she's above 68. She's not safe yet.

I just looked at the SS for the past few days and realized you had a lime green on 0.25u on 1/22. We would have recommended you reduce to 0.1u then.

As for PMPS, please post and see what kind of advice you may get.
 
Would you be at home to test this cycle and next cycle? If you want to do a drop, then just stay with the drop and see if it's enough insulin. The depot needs at least 6 cycles to stabilize so why not just do it with the drop? You can always increase later.
 
Mandy & Rex said:
Would you be at home to test this cycle and next cycle? If you want to do a drop, then just stay with the drop and see if it's enough insulin. The depot needs at least 6 cycles to stabilize so why not just do it with the drop? You can always increase later.
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I like that plan. Yes, I am home all day and can test, though I'd rather spread them out a bit more at this point (3-4 hours?) if that's not useless. I don't know about testing over night though.

One question - when we start talking drops, and assuming nothing else is at play, is there still a plausible risk of hypoglycemia at that point?
 
Well I'm gonna go practice drops for a few minutes and also see if she'll eat a little more before doing it.
 
Still get a +1 and +2 to see how the cycle might play out. Since the diabetes were steroid induced, with diet change and some insulin support, she could very well be trying to get off the juice. ;)
 
Peter Moore said:
One question - when we start talking drops, and assuming nothing else is at play, is there still a plausible risk of hypoglycemia at that point?
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Short answer - yes. But that depends on what you think a hypoglycemia means. If you mean a number below 68, that is called a low number. A hypoglycemia means you are seeing symptoms, such as unsteadiness on feet, seizures, blank expressions, etc.

A drop means you hold the plunger in all the way before inserting into the vial/pen, releasing the plunger (no pulling back), and withdrawing from the vial/pen. Then when you do inject, you insert, push in the plunger, count to 5, and withdraw while still holding the plunger in. I forgot to hold the plunger in when I withdrew on Rex's one and only drop dose and he still dropped low so I do not know if he even got any insulin.
 
I mean dangerous levels and symptoms. So you're saying there's not a significant risk of that with a drop of lantus or there still is?

I got the drop technique down pat. I was a techie in college and the mechanics of it make perfect sense.

I just want to make sure Im not doing something incredibly unwise at this point.
 
Peter Moore said:
just want to make sure Im not doing something incredibly unwise at this point.
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Just get a +1 and +2 and let your meter be your guide as to how much more testing you need to do.

Post if you need help.

When I do the drop, I hold the plunger in as I remove the needle from the skin so the drop doesn't get sucked back in.
 
Here is what a 0.1 dose looks like in the event she bounces up sky high and you decide to do more than a drop.

upload_2019-1-30_10-8-35.png


As Mandy said, in hypo event she would be unsteady on her feet, looked and act confused and possibly seizure. With an AT2 meter, the "take action" number is 68 which is where you would pull out the HC gravy and steer her upwards.
 
Peter Moore said:
I mean dangerous levels and symptoms. So you're saying there's not a significant risk of that with a drop of lantus or there still is?
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Hi,
not to scare you but to remind to stay cautious: a while back a well regulated cat on 0.1U (if I am not mistaken ) passed away in the ER after battling Hypo. The caregiver left for friends for only for a little while and that was it. I cannot recall the names or I'd tag. Please be careful.
@Peter Moore
 
Good Lord. Was that Lantus??

Well a drop it is. I've been squirting onto a napkin and noticing a drop seems to be about 25% of what I was calling 0.25 before.

I will test I promise. I just like to know the risk profile.
 
One more thing- I noticed on your SS last night that you didn't post any tests after her shot. One way that we can predict the cycle is getting a +2. If it is the same or lower than preshot, you can expect an active cycle, and can leave food out accordingly.

Also, one sign of a dose being too large can be extended cycles. You may find 12 hour dosing easier on the smaller dose.
 
I didn't inject this morning at all and she was sleeping until just recently so I was giving her a break. Complicating matters, our furnace gave out last night so we're dealing with repairing that and trying not to freeze to death!

She just woke up and asked for more food though so I'll test in a little bit. But I'm very confident she's not skyrocketing.
 
Peter Moore said:
I didn't inject this morning at all and she was sleeping until just recently so I was giving her a break. Complicating matters, our furnace gave out last night so we're dealing with repairing that and trying not to freeze to death!

She just woke up and asked for more food though so I'll test in a little bit. But I'm very confident she's not skyrocketing.
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Hope your furnace gets fixed quick. They always die on the coldest days!
 
Ah ok. Even despite skipping this morning?

I was figuring if she was up in the 200s or something... But I'm more than happy to go lower if that's the consensus.

I'm close to the lake, so it's "only" -10 or so. In the burbs they have it way worse! Repair man is coming though, and we have a fireplace, so Zelda is not a catsicle. :)
 
Mandy & Rex said:
Lantus is not dosed based on preshot numbers. It's dosed on the nadir.
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Ah yes, of course. That much Dr. HatesHomeTesting made clear. I just thought (maybe incorrectly) that when it came to skipped shots or other exceptional events, there might be scenarios where you would dose based on a preshot number for the purpose of stabilizing back to a good level and then begin the lower doses thereafter. For example, when she was at the emergency vet on Jan. 11 for the 45 (which was 4 hrs post-shot, thus very different from this morning) they even said to check the pre-shot number and inject the standard dose (0.5 at the time) if BG was over 300. Once she was back to a good level is when we started 0.25.

Don't mean to argue just like to understand all these nuances. :)

In any event, I wholeheartedly agree that one drop is our next dose! Though is there any plausible scenario where we'd skip tonight entirely? My guess would be not, just because of the necessity to ween off as slow as possible?
 
I am glad you did not shoot this morning. You fed some high carb kibble first thing this morning, and kibble lasts longer in the system. Meaning that her current numbers could still be inflated be kibble. When it wears off she may go back down. We don’t want to shoot high carb influenced numbers. And you only want to shoot if over 68 anyway.

Old style insulins were dosed based on preshots, many vets haven’t wrapped their head around dosing by nadir yet. Having said that, maybe get a +11 and post here for us to debate the 0.1 vs a drop dose.
 
Oh by the way, I didn't see anyone weigh in on the modest vomiting this morning. Could that have been because she was very low overnight (presumably lower than 42)? I don't usually see vomiting as one of the commonly cited hypo symptoms though. On the other hand, once she got back into good territory her appetite and demeanor returned to normal.

If the vomiting was caused by something else, and it in turn led to the 42, that might be worrisome. That would be a similar pattern to what happened the night of 1/11.
 
No there was definitely some food.

I wasn't paying close attention. What happened was at 3 AM I realized the furnace was off, and she was also asking for food, so I gave her half a can of FF. I didn't notice the vomit at that point, so it could have been after that feeding. In fact I'm pretty sure it was because there was some of the Orijen kibble and I did give her a tiny bit of that at 3 AM but not last night.

So yes, most likely it was sometime between 3 and 7 AM this morning (remember 42 @ 7 AM), and there was some food.

No diarrhea. Stool's been normal this whole time.

She also ate a lot last night, and quickly. I've seen her more than once be gluttonous the night before and then puke a bit early the next morning.
 
Hmm I'm not sure I have any insight there.

Rhubarb would puke if she gobbled dry food. My 2 civvies puke bile in the morning cause they don't eat overnight. There would sometimes be puke in litterbox room if one was constipated.

Doesn't sound like yours is any of those situations.
 
Yeah, I mean I'm not gonna lose sleep over it; I think the most likely explanation is gluttony the night before (2 full cans of FF chicken) and then the 3 AM feeding upsetting her stomach sufficiently to make her hurl.

I was mainly curious if folks have seen vomiting as a result of low numbers or if it's usually the other way around.

Edit: Actually she may well have been constipated. I've long suspected she has been, because she has ginormous poops only 1-2 times a day, and she used to have much more fiber in her diet obviously. And the vomit was right by the litter box, so that's real interesting. I never made that connection before.
 
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It's possible she was lower and gobbled down some food to try to compensate, then it would be a scarf and barf.

You could try adding a little pumpkin or babyfood squash to her food for some fiber. And add a little bit of water to her meals to make sure she stays hydrated and her system keeps moving.
 
Well interesting that you mention pumpkin and the idea of added fiber. I know you guys aren't keen on dry food but the ingredient list of the Orijen is one I find really impressive. The carbs are lentils, beans, pumpkin, berries and other really good slow digestable carbs. I mean, it looks like a fantastic diet for a diabetic HUMAN at least. I get that cats are different, but if we'd consider adding pumpkin why wouldn't we consider small quantities of a kibble that has things like that? (Not to mention the dental benefits )
 
Cats are carnivores. They do not eat fruits and vegetables in the wild. Many ingredients are high in carbohydrates as well.

We suggest pumpkin as a natural assistive aid for cats' digestive system. It can help both diarrhea and constipation. I give it to all my cats now.
 
Peter Moore said:
Well interesting that you mention pumpkin and the idea of added fiber. I know you guys aren't keen on dry food but the ingredient list of the Orijen is one I find really impressive. The carbs are lentils, beans, pumpkin, berries and other really good slow digestable carbs. I mean, it looks like a fantastic diet for a diabetic HUMAN at least. I get that cats are different, but if we'd consider adding pumpkin why wouldn't we consider small quantities of a kibble that has things like that? (Not to mention the dental benefits )
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There are actually not many dental benefits to dry food. A good food for dental is chunks of raw meat. I give Rhubarb a chicken gizzard weekly, and when she was on insulin, small pieces of raw steak as test treats. The small pieces were too tiny to help with dental any though.
 
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