? 10/26 Ming in hospital. What dose should his PM be?

Crista & Ming

Crista & Ming

Member Since 2018
Previous: http://www.felinediabetes.com/FDMB/threads/10-25-ming-in-hospital-what-does-should-i-give-once-hes-home.205419/

I’ve updated my SS so please take a look!

I’m quite concerned about him getting 10 units today at the vet today. And I know a few of you have expressed concern about it as well. The few reasons why I’m not saying no to it is I wonder if it will work and also I’m hoping to bring him right home after and do damage control and TAKE control.

Last night, on 7 units, he was... okay. He did drop at the 3 hour mark which to me feels like it’s not a good thing and I fed him small handful of dry food because I don’t want him to be hypo (duh) but I’m not always there to give him food or test him so closely.

(I also need to look up what high calorie canned food is as someone mentioned before.).

IM specialist texted me and said she is quite happy with the 7 units. Which idk if she meant it’s good or she thinks 7 units PM is the way to go.

What should I do tonight? He should be getting 10 units RIGHT NOW in hospital
 
No advice on tonight's dose.

I am not sure...to me it looks like he cleared a bounce and came down to hit those low greens and bounce right back up again.

I am sure Wendy or Chris will be by later with some advice.

In the meantime...:bighug::bighug::bighug::bighug:. I hope once he gets home things settle down again for him.
 
I will be back later. What time is your shot time tonight? So I can have an answer by then. I'm in the middle of helping organize a huge regatta for high school kids tomorrow. :eek: But want to make sure I have time to get back to you.

You want high carb food, not necessarily high calorie. As much as I hate the quality, some of the Fancy Feast Gravy Lovers are high carb. Or Weruva Grandma's Chicken Soup is better quality and doesn't contain wheat.

With those greens last night, no way he should be getting 10 units today, more like 7 or 8. Oh well, stock up your hypo kit.
 
His shot is at 8.

I’m also curious: with PZI, I usually will feed him and wait 15-30 minutes before I give a dose. What’s the proctocol with lantus?

I also have to remind myself that he’s getting 2.5 mgs of pred with his 10 units in the AM.

But I also understand lantus carries over to the next cycle and I can definitely see that with his PM curves. He’s low by the time I’m shooting him. Is there an explanation for that? Is that typical with an overdose or bounce on lantus?

I’m just trying to make sense of everything. I feel really stupid and out of control.

Is he not reacting to the AM shots because his PM dose is too high?
 
Hi. Glad he is home. With lantus we test, feed, shoot all in 5-10 minutes. Onset is usually at +2-3. A bounce generally occurs if a cat drops to lower numbers than used to and you would see a much higher preshot number. It definitely looks like he bounced from the greens. Many cats are lower at night. Max was often.

I’d suggest you read the yellow stickies at the top of this forum which explains all this much better than I can.

Do you ever sleep?o_O
 
Kris & Teasel said:
I think the better dose for Ming is around 7 u for now. My opinion only ...
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7 for both night and day? I like that too.

Since he’s getting 10 during am, I’m going to assume he’s gonna be riding that insulin train right into the PM so in my head, I was thinking doing 5 u and then try 7 u in the morning. Then continuing from there.

Those are my thoughts. Could be wrong or right
 
Depots from larger doses can take 4-6 cycles to deplete, meaning that 10 unit dose could influence what happens tonight, and possibly tomorrow. We determine how to dose the cat based on how low a dose takes them. But in order to figure out what a dose is doing, you need to have a stable depot from shooting consistently the same dose for several cycles. Skipping or giving a lowered dose will reduce the depot and not give you a true picture of what that dose can do. The depot also takes about 5-7 cycles to get established when you first start Lantus. He's just on day 4 today.

Perhaps a stupid question, but are you using U-100 syringes to give the dose? Are you using Lantus from a cartridge or a vial or pen?
 
Wendy&Neko said:
Depots from larger doses can take 4-6 cycles to deplete, meaning that 10 unit dose could influence what happens tonight, and possibly tomorrow. We determine how to dose the cat based on how low a dose takes them. But in order to figure out what a dose is doing, you need to have a stable depot from shooting consistently the same dose for several cycles. Skipping or giving a lowered dose will reduce the depot and not give you a true picture of what that dose can do. The depot also takes about 5-7 cycles to get established when you first start Lantus. He's just on day 4 today.

Perhaps a stupid question, but are you using U-100 syringes to give the dose? Are you using Lantus from a cartridge or a vial or pen?
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Ah I see. I just don’t want him to get low tonight if I give him a 7 u dose. What do you think I should do then?

In hospital we’re getting the insulin... from a vial... I don’t know what a cartridge is actually. But it’s definitley not the pen and we’re using u-100

Edit: I’m out right now but there’s definitely some questions I haven’t answers and will! Thanks :)
 
Crista & Ming said:
Ah I see. I just don’t want him to get low tonight if I give him a 7 u dose. What do you think I should do then?
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Can you take a test at +11 and post then? I presume that is 7:00 PST? My answer might differ based on where Ming's numbers are going to be at preshot. A +11 will give us a heads up.
 
His +11 on my OneTouch Ultra 2 is 6.2 mmols/L or 112.

Sooooo that’s low ... and I think onetouch reads a bit higher than the pet ones we’ve been using all week.
 
And I forgot to take a photo of his chart this morning but when I went to pick him up, he was around 20 or 370s most of the day.
 
Typically, though not always, the pet meters are a little higher than the human meters. My vet used the OneTouch and found it was pretty close to what she got from the labs.

Interesting that he is coming down towards the end of the cycle. Do you know any of his numbers from the day? COuld you put the 10 units in the AM dose.
 
Sorry I can’t remember. But they were doing BGs every two hours. I only remember that his AMPS shot was 300 and his numbers throughout the day were 360-430
 
I didn’t do any tests when I came home because I passed out. Only had one hour of sleep after my night shift before I had to go out and run errands and then go back and pick Ming up.
 
He’s actually always been lower right before his PM shot. I told this to my vets. No comment from the specialist and vet said it’s okay.

Siiiiiiiiiiiiiiiiigh.

I’m itching to just NOT shoot. But awaiting your previous advice, @Wendy&Neko
 
If he hadn't recently had ketones, a no shot would be a consideration. However, ketones factors in the decision. Has he been tested for ketones lately? Do you have ketostix at home or a blood ketone meter?

One thing I have to say up front. I will not be able to stay up with you tonight. I am exhausted and tomorrow is going to be an extremely physically demanding day so I need by sleep. On this forum, we say that if someone encourages you to shoot lower numbers, they stay up with you. I can't do that tonight, but I will see if someone else will be around.
 
The last time he peed at the vet, he was negative for ketones and has been negative for most of the week. The last he had them was on the 19th.

I have ketone stix at home. I’m going to do a test soon since it’s time to feed him and give his pred.
 
Have you fed him yet? Is it possible to stall, ie. don't do anything, including not feeding and test again in 1/2 hour.

I wouldn't shoot yet either. The 10 unit dose is what you are seeing.
 
Yes I’ve fed him now and his pred. He didn’t eat everything as usual. He usually comes back down to eat and can take up to an hour or two to finish his meal.

My vet said to test in an hour.

What a headache. I’m always happy but sad when you guys are right. Happy because it just proves we know a lot more and sad because the stuff I don’t want to happen is happening. The only good thing about this is it proves 10 units is too much. Stress in the AM at the vet probably kept his numbers up too.
 
@Wendy&Neko
Just throwing out an idea...
If it comes down to skipping the shot tonight, would an 18/18 be a viable option rather than skipping tonight? At least he'd be getting insulin sooner than later.
 
Feeding can cause the blood sugar to go up. It's good to see what his numbers would be, without influence of food. It's possible his numbers would now go up because of dinner, or it could be because the insulin is wearing off and he's going up anyway.

Jill has a good suggestion, as usual. One option is to do two 18 hour cycles, which gets you back on schedule and does get some insulin in him before waiting the full 24 hours. The downside is you'd be dosing at 2:00 AM this morning. And possibly have to monitor after that. Are you working tomorrow?
 
No I'm not working all weekend.

I was speaking to the night nurse and she herself would give 5 units and monitor. She's here all night and can help me. She understands what you guys do a lot more than the vets.

Could you explain the 18/18 schedule? So I would give him 7 units (or whatever units) at 2 am and another 7 units back at 8 pm? (if my finger counting is correct haha)

Edit: and I have the numbers for this morning
 
Yes, you have it right on the 18 hour schedule. I'd like to see where he is on his next test before deciding what you'd dose. It'd be good to know if he's stopped dropping or still going down.
 
I'm sorry if I'm keeping you up, Wendy! I'm really thankful you're helping me out right now though :)

He's sleeping. I also fed him some temptations as instructed by night nurse (NN). NN doesn't want him to rebound/bounce so she does want me to give him some insulin at one point tonight.

But yeah, next time this happened, I will try stalling instead and see what's happening before I meddle in everything.
 
Temptations are high carb food. I would toss them and invest in some low carb treats. The next test may be higher numbers due to the treats.

I have put out a query for help and Sandy may be stopping in. She has experience with DKA and higher doses. I won't last much longer.
 
I have some low carb treats. I was giving the high carb to up his BG. But I understand.

His number was 4.9 or 88. Not much or any change.

Sorry, Wendy!!
 
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Hi there :cool:

Shift change...Wendy tugged on my sleeve for assistance so Ive come to hang out with you tonight.

Looks like you and Ming have landed in Lantus and Levimir Land (L&LL) squarely on the initiation by fire path.
No worries. We will help you safely sort it all out. This is the best place to be.

So, how did you discover Ming was diabetic?
 
Hi Sandy! And good night, Wendy!

He had pancreatitis (again) and he was diagnosed through that. He started pred last Saturday because he's had ~6 pancreatitis flare ups since his diagnosis in March 2018. I felt it was time to do something different.
 
Same, Wendy.

I'm just staring at my vet's plan. Her plan outlined that if Ming is > 5.6 mmols or 101, give regular dose. Or if we have to delay 3 hours, give his regular dose until he's over 101 and just reduce the AM dose by 0.5 units.

Uh NO! His 7 units at night was already TOO much. And 10 units in the AM is def overload. I told her twice. Ugh. What a headache. I have to somehow convince her whatever we decided here is the best course of action so we're all on the same page. Worst case scenario is I say I did what she planned but that would just prove to be annoying if an emergency comes up and I have to "tell the truth" lol
 
Right now, Ming is sleeping. He's eaten about 70% of his fancy feast can. I don't want to change his diet just yet until we get this poopshow under control. One thing at at time. He was only into eating FF at the hospital so that's what he's gonna get.
 
He's a cutie-pie!
Crista & Ming said:
I'm just staring at my vet's plan. Her plan outlined that if Ming is > 5.6 mmols or 101, give regular dose. Or if we have to delay 3 hours, give his regular dose until he's over 101 and just reduce the AM dose by 0.5 units.

Uh NO! His 7 units at night was already TOO much. And 10 units in the AM is def overload. I told her twice. Ugh. What a headache. I have to somehow convince her whatever we decided here is the best course of action so we're all on the same page. Worst case scenario is I say I did what she planned but that would just prove to be annoying if an emergency comes up and I have to "tell the truth" lol
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We call that the "smile and nod" method of dealing with certain vets. I've used it many times. Most of us have.

The way I see it -
First the most difficult part of switching from a non depot insulin to a depot insulin is changing your thinking.
Consistency needs to be established -the sooner the better. You need to find a dose that you can shoot consistently, AM and PM, and try and string 4-6 cycles of that same dose together. Dosing decisions with Lantus are based on evaluating how low a particular dose takes your kitty. With Lantus you are not shooting the PS number, but rather the number your kitty will be at onset, typically 2-3 hours down the road. The PS values help you know if BG is heading up or down

I see he has been flirting with ketones in the recent past. Its super important that you test at least once a day right now. Ketones can quickly develop to life threatening levels. My Black Kitty once went from negative to large in exactly 24 hours.
So you know, the recipe for ketone development is -
not enough calories + not enough insulin+ infection or some other systemic inflammation.
The period of transitioning from a non depot insulin to a depot insulin can be tricky to navigate in the face of an inflammatory condition. It can be a vulnerable time.
How is his appetite? Has he lost weight recently?
 
I'll change his litter set up tomorrow and just put a splash of litter so its easier for me to test his ketones or I'll go out and get some of those paper ones.

Definitely, I saw him go from negative ketones to high/4 mmols of ketones in a night and then down to trace ketones.

I just looked through his charts and the numbers total fluctuate between 7.6 kg to 7.4 kg. Might because he moved or the scale wasn't calibrated correctly. But it seems "stable" enough.

His appetite is good. He asks for food and he eats his snacks (freeze dried raw).

He's at 7.4 or 133 now.
 
Crista & Ming said:
I just looked through his charts and the numbers total fluctuate between 7.6 kg to 7.4 kg. Might because he moved or the scale wasn't calibrated correctly. But it seems "stable" enough.

His appetite is good. He asks for food and he eats his snacks (freeze dried raw).

He's at 7.4 or 133 now.
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All good! :cool:

So, the 133, would that be +14 (14 hours since his last shot?
 
Would it be +15? I'm counting with my fingers hahaah. He got his shot at 8 am (I assume, I didn't give it. Someone in the hospital did) and now it's 10 pm.
 
Are we trying out the 18/18? I like that plan so far. I'm reading up on Lantus. It definitely is hard to wrap my head around it.
 
Would you say Ming the low 3 hours ago was his "nadir" for his AM cycle?

Also, what are the rules for posting multiple times? I'm really scattered brain and I think of things after I hit "post reply"
 
Sorry!! I don’t mean to rush! Thank you! I’m just insane and antsy. I spoke to the night nurse to feel better. She thinks the 18/18 is interesting. She only worries he’ll be high all day.
 
Crista & Ming said:
Would it be +15?
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8am to 10pm is 14 hours (according to my fingers:p)
Crista & Ming said:
Are we trying out the 18/18?
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Yes. After the two 18 hour cycles you will be back on track to resume shooting every 12 hours at what I assume are your desired shot times of 8a/8p.
Crista & Ming said:
I'm reading up on Lantus. It definitely is hard to wrap my head around it.
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once you get PZI out of your head it will become easier. You will be in the Lantus groove before you know it.
Crista & Ming said:
Would you say Ming the low 3 hours ago was his "nadir" for his AM cycle?
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it was the lowest for the 12 hours following his previous shot but I see it in the context of the last 4 cycles all had a different dose. With Lantus the effects of a dose change you make one cycle will most likely affect the following cycle. Think of an ocean liner...you don't get a fast reaction when attempting a sharp a turn.
Crista & Ming said:
Also, what are the rules for posting multiple times? I'm really scattered brain and I think of things after I hit "post reply"
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No worries. Your condo is the place to get those thoughts and questions out .
Crista & Ming said:
9.7 or 175 at +3. What to do? @Sandy and Black Kitty
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you mean +15? We start thinking about what to shoot at +18.
Crista & Ming said:
Sorry!! I don’t mean to rush! Thank you! I’m just insane and antsy. I spoke to the night nurse to feel better. She thinks the 18/18 is interesting. She only worries he’ll be high all day.
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No problem. I didn't want you to think I disappeared on you.
Regarding the NN worrying Ming will be high all day, one of the many time honored maxims here inn L&LL is "Better a day too high than an hour too low"
 
Ok! Thank you Sandy for answering and acknowledging all my questions and concerns :) :) :) :bighug:

Should I continue testing hourly or just see where we’re at at +18?

And what dose are we thinking?
 
Crista & Ming said:
Should I continue testing hourly or just see where we’re at at +18?
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You can wait until +17. Please place all your recent tests on the ss - keeping the ss up to the minute is important.
Crista & Ming said:
And what dose are we thinking?
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You dont want him dropping like a rock. Keep in mind that the next 18 hour cycle will likely end higher because there is not a Lantus dose that will provide 18 hours of duration. Have you ever used humulin R as a bolus?
 
We used humulin in hospital for Ming and injected it IM when his BG was too high. Is that humulin r? Is that what it means to be in bolus?

I don’t have any at home of course or know how to get it.
 
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