11/20/11 Mikey AMBG 134

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miso00

miso00

Member Since 2011
I had some trouble testing him throughout the day. He was getting agitated too easily. There is so much for him to adjust to-new home, 15 other cats and getting tested. He is finally coming out of his "safe"room and found a spot he likes in the bedroom. He is still hiss/growling at my cats and I have one cat that is not too happy he is here, but none of them are in danger. I think we are finally able to get his BG's more often throughout the day starting today. He has stopped eating so much (doesn't seem as hungry as the first 2 days he was here) He went to the vet friday and got a clean bill of health except for the expected blood/urine results that showed he was diabetic.

I'm not sure why his numbers were at 243 last night after eating and 134 this morning. Does it seem like a drastic drop from his AMPS yesterday which was 359? I know in the SS i have looked at sometimes the #'s can fluctuate a lot but since I am new to this I'm not sure what that means, what to look for in him etc.
 
Re: 11/20/11 Mikey AMPS 134

Hi I don't have an answer for you. That is a nice AMPS. I hope you can get some more tests in this morning to be sure he isn't dropping too fast.
 
Re: 11/20/11 Mikey AMPS 134

At 9:05AM 125 BG (AMPS was at 7:09AM) No insulin administered.
 
Re: 11/20/11 Mikey AMPS 134

Jennifer, thanks for posting the new number.

Since Mikey's BG an hour later is 125, and we don't have any data on these low numbers to support shooting insulin and you have to leave the house for a bit I've asked you to skip this morning's shot and get another number when your back home in a few hours. I'm posting here to let everyone know that I recommended that due to the minimal data we have.

Can you post here when you have a number later? The Lantus folks have much more experience and can better help you than I can, my background is with different insulins although I do use Lantus for Kiki.

Thank you all for helping with this very handsome DCIN foster kitty. If any of you would like to read about him, you can view his blog page here: http://fdmb-cin.blogspot.com/2011/10/mikey-in-ny-needs-home-immediately.html
 
Re: 11/20/11 Mikey AMPS 134

A couple of thoughts...

If Mikey seems agitated when you're trying to test, you may want to give a couple of treats. Either the usual freeze dried chicken or even some cooked chicken if he likes people food. (I use Wellness jerky-style treats.) The more Mikey associates testing and treats, the easier testing will become. I give Gabby multiple small meals early in the cycle (she tends to have early drops in her numbers) and she gets fed with each test. So treats and food are associated with a test. She actually comes when I call her because she's very food motivated.

It's hard to answer your question about Mikey's numbers last evening. If you had a PMPS, you would know whether this was actually a drop in his numbers at PM +2. There's just no way to guess accurately.

I know you're going to hear many of us really push you to get tests. Testing before you shoot is the only way to know if it's safe to give insulin. Getting spot checks (at least one each cycle) will help you to make good decisions about dose -- and will help us to help you with those decisions.

You are going a great job helping Mikey to get acclimated. Some of the change in his numbers may be the result of his getting more comfortable. BG levels rise with stress. As you're seeing better numbers, it may reflect how well he's settling in.
 
Re: 11/20/11 Mikey AMPS 134

HI Jennifer!

One thing I'll add to SIennes great advice is that you also want to be as consistent as possible with your shot times.
Every 12 hours. Shooting an hour early (only 11 hours after the previous shot) as you did 11/19/AM can act like giving a higher dose, and sneak up on you, due to overlap.
If you get into a situation where, due to scheduling conflicts, you know in advance you have to shoot early , you can safely do that in increments.
You can shoot 15 min. early each cycle or 30 min early every other cycle (once each 24 hours) until you reach your desired time.

Keep up the good work and collect your data. It will slowly start making more sense. :-D
 
Re: 11/20/11 Mikey AMPS 134

miso00 said:
I'm not sure why his numbers were at 243 last night after eating and 134 this morning. Does it seem like a drastic drop from his AMPS yesterday which was 359? I know in the SS i have looked at sometimes the #'s can fluctuate a lot but since I am new to this I'm not sure what that means, what to look for in him etc.
Click to expand...

Morning! I looked at Mikey's SS and altho I am no expert here I would guess that the dry food Mikey ate on the 18th spiked his #s for the next 24 hrs or so. Once it cleared his system he got back down into the blue you saw this morning. Could be the same thing happened on the 17th. Dry food is much higher in carbs, usually about 18%, than the wet LC we feed around here.

Skipping his shot this morning will affect his #s, too. See if you can get a BG test every couple of hours or so today, since you haven't been at this very long the more data you can get the better.

If it were my cat under these circumstances (being new to this and having not a lot of data yet), I probably would have skipped his shot this morning too!

Keep up the good work!
 
Re: 11/20/11 Mikey AMPS 134

One quick housekeeping item -
since you did not shoot this morning, please change your condo header to read "AMBG 134" instead of AMPS.
Also, since you did not shoot this morning any further tests before PMPS will be measured in hours since the last dose. So when you get t o PMPS time it will be +24.
If you need to change your shooting schedule to an earlier time, this would be an opportunity to do so.
 
I appreciate the housekeeping tips. Do I have to change the SS to say +24 since the AM shot was skipped or do I just make a note of it? If I need to change it how do I do that?
 
The +hours are how we enter tests in the header....so for example, the tests you got today would be a +12 (or AMBG) 134, +14 125, etc. You always count the hours from the last shot.

Speaking of shots, I see that you gave 0.5u @+19 today. Your next shot needs to be given 12 hours from that shot....so roughly 2:30AM. Please do NOT shoot at your normal shot time tonight!
 
Hi everyone,

I'm don't normally give dosing advice but Mikey is my DCIN case, Jennifer and Marc are wonderful for fostering him. I had suggested the token dose in the afternoon if he was over 300 because I didn't want to lose the momentum, he finally had a low number. My thought was a token dose, 1/3 of his normal dose, just 0.5 U, then at normal shot time tonight he could get 1U or even 1.5 depending on what his 7pm and 10 PM preshot looks like.

I'm not a lantus expert and I very much appreciate all of you helping, but I do think she could give at least a partial dose of 1 unit at the regular shot time and not at 2:30 in the morning.

This cat has not been given insulin BID on any set schedule for a very long time. He was getting 3U at each shot but when he got those shots is unknown. He was being fed dry with his previous owner. There are many variables here, the new home, getting home tested, getting shots twice per day consistently (not sure owner was doing BID each time) plus he's in an environment that is a lot less stress than the previous one.

He's got a great shot of going OTJ and that is why I suggested the token dose mid-way in the hopes of not emptying out the shed. I do think he can get a shot tonight depending on what the 7PM and 9PM numbers are. I spoke to Jennifer a short time ago and he is in the 400s right now.

Does he really need to wait 12 hours for a shot? This is not a typical just starting out on insulin kitty.
 
My concern would be that you could easily have Lantus onset from the shot at the regular time coinciding with the nadir from the shot given at +19. If Jennifer can stay up to get tests to make sure that Mikey's numbers don't tank, then if numbers are really high, it might work. IMHO, it might have been a better option to shoot early (e.g., by an hour or two) than to have given a token dose at +19.
 
PLEASE.....if you are advising someone, put it on the board! Advising off board is against FDMB's policy, and it makes it hard to help someone when they are getting advice elsewhere and coming here for advice too......
 
Laurie and Mr Tinkles said:
PLEASE.....if you are advising someone, put it on the board! Advising off board is against FDMB's policy, and it makes it hard to help someone when they are getting advice elsewhere and coming here for advice too......
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I don't advise off the board if I can help it, this is why I wrote it all here so you would know what's going on. Today Jennifer had to leave and she did post here first but after waiting a while she came to me since I'm the case manager. I would never ask any of my DCIN foster friends to not call me if they need me. I always encourage advice to be taken here but if I need to, I will give advice. But as you see I posted it here. As a rule I try to not giving dosing advice, even on the board you might see that on most of my posts since 2006 I don't usually give dosing advice.

Sienne, the shot given at +19 was 1/3 of his normal dose, instead of 1.5 is 0.5, and as mentioned his dose just a week ago was 3 units at each shot. Could she give 0.5 at his normal shot time tonight? That would be a total of just one unit for the entire day.
 
I'll let Sienne answer your specific questions BUT lantus does best with consistency......that is shooting the same dose every 12 hours unless the number is too low for the caregiver to shoot. Regardless of what his shooting schedule has been in the past, I really urge you all to get him on a 12/12 schedule with a consistent dose.
 
Jennifer, if you had encouraged the bean (Jennifer also) to post here for advice, or posted your suggestion here yourself, it would have enabled others to see it and have input BEFORE the token shot was given and make other suggestions that might have been a better, safer option. You keep saying you don't know Lantus, please let those who do help Jennifer.

I have the utmost respect for the work that you and DCIN do, and I understand your desire to help Jennifer. All I ask is you have the same respect for us.
 
Sienne, the shot given at +19 was 1/3 of his normal dose, instead of 1.5 is 0.5, and as mentioned his dose just a week ago was 3 units at each shot. Could she give 0.5 at his normal shot time tonight? That would be a total of just one unit for the entire day.
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Jennifer --
I'll be completely honest -- I don't know the answer. I know what the danger might be. I don't know Mikey well enough and there isn't a great deal of data yet to help guide a decision. In principle, it might be OK. I'm going to see if there's someone with more experience than I have who can lend a hand.
 
Ok, let's figure this out.

First, I have questions:

Does Mikey have any history of ketones?

And do you have any more numbers tonight?

I'll be back with a longer post in a minute.
 
Ok, more questions. Can you help me sort out today's times? Your spreadsheet says the 125 was at 7:20, which would be about +10 after last night's shot. Your post says the 125 was at 9:05, which is about +12. Then the 0.5u was given at 2:24, which was about +17 after last night's shot. Does that sound right?

Here's what I think we're working with:

PMPS last night: no reading, shot 1.5u (9:15pm)
+2 ~ 243
+10 ~ 134
+12 ~ 125 (no shot)

+17 ~ 315 (0.5u given)
+3 ~ 416

My opinion about shooting again tonight: I wouldn't. We just don't have enough data. Mikey has been getting 1.5u BID, but we don't know if that is a good dose for him or not. We don't know his onset/nadir/duration to be able to give an educated guess about what time might be safe to shoot. We might get away with it if he happens to be in a bounce tonight, but we don't know if this is a bounce either. Jennifer is also having some trouble testing (understandable). I wouldn't take the chance. If Mikey is ketone prone then I might change my answer. ;-)

For future reference, if you are ever faced with a lower than usual preshot and nobody is here to help, our usual guidelines can be found in this sticky: Shooting and Handling Low Numbers. Normally when we stall a shot, we shoot full dose whenever the cat gets to a number the caregiver is comfortable shooting. That becomes the new shot time. If it gets so late that dealing with that new shot time would become a problem, then usually it's best just to skip that shot.

Mikey might have been shootable if you had been able to test again at +12.5 or +13, but since you had to leave then you did the best you could. That's all any of us can do. I've skipped plenty of shots, especially with Jazzy, when she was low at +12. It happens and they always get back on track eventually.

Keep in mind that we give advice here based on our experience combined with a published protocol. I wouldn't give a shot at +7 for my own cat and so can't recommend it for anyone else. I might give a shot at +10 under some circumstances, maaaaaaaybe +9 in extreme circumstances and if I could test all night, but not any earlier than that. We also have an unwritten "rule" around here that if someone recommends something outside the box, that person needs to be prepared to stay with the caregiver until we know the cat is out of danger. I'm not able to do that tonight, so that factor does play into my recommendation. I'm more used to helping bail people out of low numbers when they have shot early by mistake and wouldn't want to recommend that approach to a new caregiver. Ultimately the decision is in Jennifer's hands but that is my 2 cents.
 
I don't know if he has a history of ketones. I did have him to my vet friday who reviewed the previous vet records and he didn't say. My vet just did urinalysis and blood work and everything was fine minus the fact sugar was in his blood and urine therefore he's diabetic (which we already knew). I just did his BG was 370 at 9:35. I'm not sure how to post it since his last real shot was last night ( a shot of just .5u was given at 2:20pm today, the dose i've been giving him since 11-14-11 is 1.5u BID)

I tried to give him some food but he didn't even seem interested in it. When I first got him he could eat the whole can in one sitting! Is that a good/bad/neither good/bad sign?

I was hoping to change his "regular dose" to 11pm tonight. Attempting to get him on a better dosing schedule for me. His previous owner didn't have a set schedule and since I have had him it's been a little "off" with me being a "new bean" and having some human errors last week.
 
I hope you saw Libby's post about skipping the shot tonight. If you skip a shot, you are able to change the shot time without a problem. So, if you need to move Mikey's shot to 11:00 AM tomorrow, you can do so without worrying.

When a diabetic cat is unregulated, they are often hungry -- even ravenous. This is because the food they are metabolizing isn't getting into the cells. As a result, they eat but lose weight. As you get them on a better dose of insulin and you see their BG numbers coming down, insulin is helping the glucose (the result of metabolism) get into the cells. What often happens is that their appetite is decreased. Hopefully, this is what you're seeing with Mikey. It's also possible that he's feeling a bit punk. His BG levels have been swinging up and down. Sometimes, this can make a cat feel a bit under the weather.
 
the earliest I would give another shot tonight would be +10 (which would be 12:20), and that is only if he is still in the high 300s or higher. If he is lower than that, then I can't recommend shooting early. If you shoot at 12:20 tonight, then you can gradually back the time up to 11. Usually you can move shot times by about 30 minutes a day, but of course it depends on the numbers.
 
Jennifer,

I think Libby and Sienne answered your questions already.

Are you testing for ketones? If not, please get ketostix and start testing regularly. An ounce of prevention is worth a pound of cure!
 
Libby,
Your summary of the BG #'s and times is correct. I was a little confused on how to post them in the SS since the numbers go from +1 and stop at +11 and I needed to go higher. I can test him at 12:20 tonight and post it and then have someone advise me from there, is that possible?
 
Jennifer is two hours ahead of me so 12:20 her time is 10:20 mine. I can be up and check on her and Mikey.

So, if I'm clear, IF he is above 300, she can shoot 1.5u at 12:20 which would be his PMPS. She'll have to get a +1 and +2 and see where he's going.

THEN, tomorrow, she can shoot 15 minutes early (12:05 pm) to start getting back to a shot time of 11. I actually think it would be ok, if numbers allow shooting tonight and in the morning, if she just shoots tomorrow at noon. That puts her on a better number for her tests and moving her time back slowly.

Is this all correct?

One thing, Jennifer, normally if we help you, we stay up with you. I'll be up until midnight my time, 2 am your time, with Gracie's last feeding but because I've been sick, it would be tough for me to be up after that. It would at least get you through a +1 test. Would you be comfortable with that?
 
Ok, Marjorie, I think your summary is easier for me. It was a little confusing going from post to post and being a "new bean" it's like reading another language. I am comfortable with what ever time you can be here until.
 
I can't stay up to help Jennifer....I'm sorry, but I have to be up and out early in the morning.

Marje, here's Libby's post....
Libby and Lucy said:
the earliest I would give another shot tonight would be +10 (which would be 12:20), and that is only if he is still in the high 300s or higher. If he is lower than that, then I can't recommend shooting early. If you shoot at 12:20 tonight, then you can gradually back the time up to 11. Usually you can move shot times by about 30 minutes a day, but of course it depends on the numbers.
Click to expand...

She suggested only shooting at 12:20 if Mikey was still in the high 300s or higher. Jennifer would be shooting 2 hours early, so there needs to be a good margin for safety.

Marje, I would not offer to help Jennifer shoot if you can't stay up at least until after onset. Onset is generally at +2 or +3. Jennifer has no experience with handling drops, lower numbers, etc. JMHO
 
Thanks, Laurie. I did go back and read Libby's post again and caught the "high 300s or higher" but I'm also glad you bolded that.

I want to help her get Mikey back on track so I can sleep and wake up to check in on her after onset. My phone has LL on it and I can post from it.

Thank you Laurie!!
 
I do think the big question will be if Jennifer (Mikey's bean) can stay up to test. There may be some other folks on the West Coast/Pacific time who will be around. I know I won't be able to hold out until onset and/or nadir.
 
I'm confused again. Am I supposed to shoot at 12:20 if he is in the 300's? I can shoot at 2:20am (which is 12 hours and seems "safer") and then 2:20pm tomorrow and then start to do the 30minute increments to get him back down to 11am/11pm (where I want to be)
 
Hi Jennifer,
IF I have read this whole thread correctly....
The restriction on only shooting if he was in the high 300s at 12:20 was because that would be "early" by two hours since the dose you gave him this afternoon.

If you can wait until 2:20am to shoot him, then that "high 300s" would not be the "line in the sand" that Mikey would need to be at in order to shoot. You could give him his normal dose at 2:20am, then again tomorrow at 2:20pm, and then start backing off by 30 minutes per day (or 15 minutes per 12 hour cylcle) in order to eventually get to an 11am and 11pm schedule that works best for you.

Carl
 
Jennifer:

That is entirely up to you. If numbers are really high, one can shoot early to get the insulin in them. I think that is what Libby was thinking...and that 12:20 a.m. your time is the earliest you could shoot to get some insulin into him.

But, if you want to wait 12 hours and shoot at 2:20 am, that is up to you. I think if his numbers are high (Libby thinks high 300s), then you could shoot any time AFTER 12:20 so if you wanted to pick a time like 1 am or 2 am that's easier to work with, you could retest and if he's still high, shoot then. Does that make sense? You'd still be shooting early as long as he is high but it would be closer to 12 hours from his last shot time. Then you could gradually work him back to 11.

Just tell me what you'd like to do so I can help you.

ETA: Carl is right....if you want to shoot at 2:20 am, then he wouldn't have to be in the high 300s. You could shoot him 12 hours from his last shot even if he is in the mid 200s. Also, if you shoot at, say 2:20 am then you can shoot at 2 pm tomorrow afternoon. Then Tues, you could start doing 30 min increments once a day (pm) or 15 at each cycle.
 
I have about 15 minutes to test him. I will test him and then post the number and then we can determine the next step. Is that ok?
 
Yes, Jennifer. Test and post, and then wait for feedback.
Carl
 
Marjorie,
All yours, I'm just watching. Just wanted to make sure someone was here to answer time sensitive questions...

Carl
 
That's a no brainer then. No shot now.

So....two choices:
1. skip and start over again tomorrow morning at whatever time you want to get him on consistently

2. check him again in one hour and/or two hours and see where he is in case you can shoot.

Let me know...standing by.
 
also, should i be changing the subject line or just keep it? (I'm not as up to date on the housekeeping tips)

I'd like to put his BG #'s in the SS but I'm not sure how to chart them since there is one +12 and one +17 and the SS chart only goes up to +11?
 
Jennifer,
You can put the +17 in the +5 column after the PMPS, and the +12 in the PMPS column. Make a note that he got no shot at PMPS time.

I think that works ok.

Carl
 
Jennifer:

Well....you didn't shoot this morning so that is correct the way you have it. But then you shot a reduced dose at +17 and no shot at PMPS. I wouldn't worry about this condo subject line. The people who need to know what is going on, do.

For his SS, you need to show in the column where you shot that you did so. You should be able to reduce the font and put the BG and then "shot 0.5u @ 2:20pm". If you shot at 2:20, that would normally have been about +5 right? But there is no number there.

Under "PMPS" put "no shot". Then go out to +3 after PMPS and put 248. We may need to do some more adjusting to that but that will work for now.

So....please let me know whether you are skipping tonight or are going to try and shoot again at 2:20? Thanks.
 
I think the SS is correct now.

I fear if I don't and fall asleep and he drops too low I won't know? I would love to skip it and just shoot tomorrow at 11am because it's an easier/quicker way for me to get to the schedule "I" prefer, but "I" am not important right now. If it's better to see where he is at in 2 hours then I will stay up. I am leaning towards testing him again at 2:20 but since I don't have the experience you all have am I just being over paranoid?
 
Jennifer:

SS is fine but I'd just show that you shot .5u at the 315 earlier today (+5 on the SS).

I know you would like to get some insulin in Mikey but he has come down a lot since the 370. And I know you have to be tired. We all want to put our cats first BUT I think safety has to be first and that means a rested bean. If you are exhausted and trying to deal with it, you are doing him no good.

IMHO, I think you should skip, get some rest, start over again at 11 am. But it is your decision and we'll help however we can.
 
Jennifer
I agree with Marjorie. His numbers have dropped since that shot, and I'm not really sure they are going to go up much in the next couple of hours.
If you skip, that solves your schedule problem as well. You can start fresh at 11am, and I'm sure there will be people on line at that time of day.

You're doing a great job!
Carl
 
I trust what you say, especially since you were very helpful the other night. As long as you feel I can skip the shot I will. I would love to get some rest. I did A LOT of volunteering this weekend which I love but it was 2 very long days. I will be up at around 6am as I normally do so I can test him then and then will start posting a new condo.

How does that sound?
 
Sounds like a good plan.....now get some sleep!

Carl
 
Jennifer:

His numbers may come up in the morning but you can get his shed refilled and start over at a time that can be more consistent for you both. Just think of it as if you'd given a fur shot....something that happens to everyone.
He's at remarkably good numbers right now for having only gotten .5u insulin today.

Get some rest. Post in the morning and if he's still running low and you don't know whether to shoot..don't feed him and post. Remember...we dont' want to feed in the two hour time period before we shoot because
you don't want a food spike PS number. There will be people around.

Great job tonight....you're learning. Ni Ni!!
 
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