Tanya and Ducia
Member Since 2017
Posted empty by error, my computer throws issues. Please see the post below
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? 3/16 Ducia PMPS +10 322, +11 360, AMPS 361, +1 379 need help interpreting BGs thru the day
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Tanya and Ducia
Member Since 2017
Hello,
I think that I accidently undershot Ducia’s 1U dose @PS.
I checked the insulin syringe afterwards under the neurosurgical gaggles and a small drop appeared on the top needle. The gaggles increase the view significantly. I do not know for how much I under dosed her. The drop didn’t run down just stayed at the tip of the needle.
Also Ducia is prone to fast drops in the AM cycle and I ask that you check her hourly updated SS to help me understand the readings. I can test at any time. Various carbs value food is ready for steering. The hypo tool box is also nearby.
She was flat Yellow last PM: +8 251, +9 258, +10 246, +11 245.
The AMPS is also Yellow 234. Next test is @+1 and then @+2.
She is post DKA, post Hypo, Anemic, the infection is present. She is fit with Etube. She takes Clavamox x 2 a day and Famotidine x 3 a day.
She is prone to low numbers between +2 and +5 in the AM cycles and can drop quickly during this period. Yesterday her +2 was 179 and her +4 was 85.
Yesterday her AMPS+6 nadir of BG 118 was higher than her AMPS+ 4 of 85. It adds a lot to my already chronic confusion. I also like to panic and to mess things up
.
Sincerely grateful,
The Confused One
I think that I accidently undershot Ducia’s 1U dose @PS.
I checked the insulin syringe afterwards under the neurosurgical gaggles and a small drop appeared on the top needle. The gaggles increase the view significantly. I do not know for how much I under dosed her. The drop didn’t run down just stayed at the tip of the needle.
Also Ducia is prone to fast drops in the AM cycle and I ask that you check her hourly updated SS to help me understand the readings. I can test at any time. Various carbs value food is ready for steering. The hypo tool box is also nearby.
She was flat Yellow last PM: +8 251, +9 258, +10 246, +11 245.
The AMPS is also Yellow 234. Next test is @+1 and then @+2.
She is post DKA, post Hypo, Anemic, the infection is present. She is fit with Etube. She takes Clavamox x 2 a day and Famotidine x 3 a day.
She is prone to low numbers between +2 and +5 in the AM cycles and can drop quickly during this period. Yesterday her +2 was 179 and her +4 was 85.
Yesterday her AMPS+6 nadir of BG 118 was higher than her AMPS+ 4 of 85. It adds a lot to my already chronic confusion. I also like to panic and to mess things up
.Sincerely grateful,
The Confused One
Nan & Amber (GA)
Member Since 2016
Morning, Tanya!
You're doing fine, don't worry. We'll just see how today plays out, don't worry too much about the extra drop of insulin left over.
The patterns are always confusing-- there are so many things going on, from bounces to the depot to (I suspect in Ducia's case) some overlap between shots (I think the drops you have been seeing in the AM are likely influenced by the PM shot). Luckily, there are lots of folks who are very experienced in sorting these things out around here, so they can help with any real puzzles. For right now, though, the important thing is that you've been keeping Ducia safe, and everything you're doing now is going to keep her safe.
One important thing: I haven't seen a recent note on your spreadsheet about ketones. When was the last test?
You're doing fine, don't worry. We'll just see how today plays out, don't worry too much about the extra drop of insulin left over.
The patterns are always confusing-- there are so many things going on, from bounces to the depot to (I suspect in Ducia's case) some overlap between shots (I think the drops you have been seeing in the AM are likely influenced by the PM shot). Luckily, there are lots of folks who are very experienced in sorting these things out around here, so they can help with any real puzzles. For right now, though, the important thing is that you've been keeping Ducia safe, and everything you're doing now is going to keep her safe.
One important thing: I haven't seen a recent note on your spreadsheet about ketones. When was the last test?
Tanya and Ducia
Member Since 2017
Last recorded is on 3/13 @AMPS 11.5 Neg/Trace.
Yesterday she sneaked behind my back.
This morning she plainly refused to pee when she saw me with a spoon.
I actually am thinking that maybe we should resume SQ fluids. The Dr at the ER where we went for infection advised against it because there were no ketones, Negative ketones, when she tested it.
Ducia also became very difficult when giving her water via tube, she resists actively.
Yesterday she sneaked behind my back.
This morning she plainly refused to pee when she saw me with a spoon.
I actually am thinking that maybe we should resume SQ fluids. The Dr at the ER where we went for infection advised against it because there were no ketones, Negative ketones, when she tested it.
Ducia also became very difficult when giving her water via tube, she resists actively.
Tanya and Ducia
Member Since 2017
Overlap is when the PM insulin still works but the new AM dose is given anyway?
Then how to explain her usually higher +10 and +11?
Tanya and Ducia
Member Since 2017
I wish I could measure it better. The gaggles I used to inspect enlarge a lot.
I guess her numbers thru the day will tell me.
Gill & George
Member Since 2015
Looks like Ducia is bouncing of the greens yesterday, if the +2 is lower than the amps(below 210 or so) then I would be thinking she's attempting to clear the bounce and you may find that she has an active cycle.
Just seen the +2 she seems to be staying flat and yellow, doesn't look like she is clearing the bounce just now, if she is still the same at +3 then it would seem likely that she is continuing the bounce for the time being.
Don't worry about the little drop, I found there were 3 full drops in 0.25 of a unit with my syringes, so with the partial drop you are describing you are probably looking at less than 0.07 u, at this point that's negligible.
The following is taken from the new to the group sticky it explains overlap, carryover, depot and bouncing, the bits in blue are links which offer more in depth explanation.
A full understanding of the following concepts will go a long way in helping you regulate your kitty's blood glucose when using Lantus or Levemir:
Just seen the +2 she seems to be staying flat and yellow, doesn't look like she is clearing the bounce just now, if she is still the same at +3 then it would seem likely that she is continuing the bounce for the time being.
Don't worry about the little drop, I found there were 3 full drops in 0.25 of a unit with my syringes, so with the partial drop you are describing you are probably looking at less than 0.07 u, at this point that's negligible.
The following is taken from the new to the group sticky it explains overlap, carryover, depot and bouncing, the bits in blue are links which offer more in depth explanation.
A full understanding of the following concepts will go a long way in helping you regulate your kitty's blood glucose when using Lantus or Levemir:
- Carryover - insulin effects lasting past the insulin's official duration
- Overlap - the period of time when the effect of one insulin shot is diminishing and the next insulin shot is taking effect
- Insulin Depot - a "spare tank" of insulin, which has yet to be used by the body
- LANTUS & LEVEMIR: WHAT IS THE INSULIN DEPOT?
- Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).
Tanya and Ducia
Member Since 2017
Thank you.
I am going to read it right now. Again.
I cannot explain why it doesn't settle in my head. When I read it all makes sence. When I try to understand in these terms what is going on with Ducia it all falls apart as card house.
I am usually not that dumb.
Maybe I am tired, maybe it 's because English is the third language for me, maybe it's because I avoided medical aspect of life very successfully. It is not only that I never heard of FD I actually never met a human with D.
I am going to read it right now. Again.
I cannot explain why it doesn't settle in my head. When I read it all makes sence. When I try to understand in these terms what is going on with Ducia it all falls apart as card house.
I am usually not that dumb.
Maybe I am tired, maybe it 's because English is the third language for me, maybe it's because I avoided medical aspect of life very successfully. It is not only that I never heard of FD I actually never met a human with D.
Nan & Amber (GA)
Member Since 2016
There are a lot of things that are going on at the same time. I'm not necessarily the best person to explain it all-- I have not looked at as many spreadsheets and patterns as the real experts around here, so I am somewhat guessing on all of this. What really makes it hard to see the pattern of the insulin action is the reaction of the cat's body-- what we call bouncing, an increase in BG in response to drops into blues and greens. The bounces can last multiple cycles, and I think you can see in Ducia's chart that she has a tendency to get into greens during the day and then bounce and stay high the next night. When she drops low very early in the day (+1 or +2), that is (I think) too early to really be attributed to the shot that was just given-- it's either a bounce ending, carryover of the previous shot, or both. The fact that some of her earlier cycles she went low late in the day (including on that first cycle with the hypo) makes me think that she is a cat that has a long duration of lantus, so I think that carryover might be part of the story. But bouncing is also definitely a big part of it, and probably explains why you do often see higher numbers late, at +10 or +11, in some cycles, too.
It is all very complicated!!!! And honestly, I don't think it's worth worrying too much about figuring out exactly what is going on-- I mean, we'll never know for sure, anyway! But knowing what the possibilities are can help in making the important decisions about shots and when/how much to feed. For now, just let the experts on here guide you, and know that you are not alone-- there are a lot of us that find all of this confusing, and pretty much all of us did at first!
Tanya and Ducia
Member Since 2017
Or maybe the drop I left in the syringe was larger than I thought?
On the full dose 1U by +2 179 yesterday she active, walking about and now she sleeps.
Have you ever read the Sticky Note on the Insulin Depot? My favourite quote from there is:
"Have you ever wondered why, when you are giving the same amount of insulin every time, the response is different in each cycle?....So sometimes, the answer is “just because.”"
Insulin is a hormone not a drug, so less predictable. I know it's hard in the beginning. I too wanted to understand everything so I could attempt to control it. But it really helped me when I realized that it really is up to the cat and her body. There is only so much that I could do. That's when I learned to relax a bit.
Speaking of which, Ducia is pretty flat right now. You can relax and probably go a few hours hours until the next test. When kitty is high and flat, you need to put down the test kit and take advantage of the opportunity to focus on other things. Feline diabetes is hard on the caregiver too, especially emotionally. Take the breaks when you can.
"Have you ever wondered why, when you are giving the same amount of insulin every time, the response is different in each cycle?....So sometimes, the answer is “just because.”"
Insulin is a hormone not a drug, so less predictable. I know it's hard in the beginning. I too wanted to understand everything so I could attempt to control it. But it really helped me when I realized that it really is up to the cat and her body. There is only so much that I could do. That's when I learned to relax a bit.
Speaking of which, Ducia is pretty flat right now. You can relax and probably go a few hours hours until the next test. When kitty is high and flat, you need to put down the test kit and take advantage of the opportunity to focus on other things.
Feline diabetes is hard on the caregiver too, especially emotionally. Take the breaks when you can.
Gill & George
Member Since 2015
This looks like she is still bouncing she's staying flat. It will pass.
Skinnying the dose by shaving a drip, all be it accidentally like you did, is unlikely to have to much of an effect. Especially as you now have been shooting the 1u for a few cycles and the depot will also be driving the numbers.
Tanya and Ducia
Member Since 2017
Hi,Have you ever read the Sticky Note on the Insulin Depot? My favourite quote from there is:
"Have you ever wondered why, when you are giving the same amount of insulin every time, the response is different in each cycle?....So sometimes, the answer is “just because.”"
Insulin is a hormone not a drug, so less predictable. I know it's hard in the beginning. I too wanted to understand everything so I could attempt to control it. But it really helped me when I realized that it really is up to the cat and her body. There is only so much that I could do. That's when I learned to relax a bit.
Speaking of which, Ducia is pretty flat right now. You can relax and probably go a few hours hours until the next test. When kitty is high and flat, you need to put down the test kit and take advantage of the opportunity to focus on other things.
I read this sticky. I fact I was reading on the overlaps from another posts when your post came in.
I will test and feed Ducia at +4, that'e reg time and she already asks for food. I gave ger a teaspoon. Than , if she is still flat I'll take a break.
I do feel exhausted and it won't be helpful if any surprise come along.
Tanya and Ducia
Member Since 2017
That's it. I do think of insulin as a drug. When one takes it the effect is expected in certain period of time with relatively same result on anyone who took it. Wrong perception on my part probably because I would never put anything unpredictable in myself.
Tanya and Ducia
Member Since 2017
See if you can get a nap this afternoon. Sometimes flat yellow cycles precede active ones, which might be tonight. It's not true for all cats, but we have yet to see if Ducia likes to do that.
Tanya and Ducia
Member Since 2017
OK, I will take a rest if +4 reading is yellow.
Ducia seems to like to test me to the extremes.
Ducia seems to like to test me to the extremes.
Kris & Teasel
Member Since 2016
Humans who are diabetics have to test their blood glucose frequently and alter their insulin dose accordingly. Your body is doing this with the insulin it produces but you're not aware of it.
Tanya and Ducia
Member Since 2017
Gill & George
Member Since 2015
Hope you catch some well earned ZZzzzz's Tanya.
Tanya and Ducia
Member Since 2017
Thank you
Tanya and Ducia
Member Since 2017
Good morning everyone,
Ducia continues today on 1U dose.
Last PM cycle she was in Yellow, then there was some Blue in the middle of the day and her PMPS +10 was 322 and PMPS +11 was 360.
I will post her AMPS in the title line as soon as I have it at 8 am pacific.
Can you please continue helping me to understand her numbers thru the day?
I worry that after yellow flat AM cycle and the relatively calm PM cycle with a bit of Blue some dramatic drops may come. It was also my fear for yesterday's AM cycle which turned out to be false alarm. I hope it will be false for today too.
But due to my lack of experience I ask you please to check her SS and share your thoughts.
Ducia continues today on 1U dose.
Last PM cycle she was in Yellow, then there was some Blue in the middle of the day and her PMPS +10 was 322 and PMPS +11 was 360.
I will post her AMPS in the title line as soon as I have it at 8 am pacific.
Can you please continue helping me to understand her numbers thru the day?
I worry that after yellow flat AM cycle and the relatively calm PM cycle with a bit of Blue some dramatic drops may come. It was also my fear for yesterday's AM cycle which turned out to be false alarm. I hope it will be false for today too.
But due to my lack of experience I ask you please to check her SS and share your thoughts.
Nan & Amber (GA)
Member Since 2016
Hi Tanya--
I was going to wait until you started a new thread for today, but I was wondering: what did you decide to do about sub-Q fluids? I know you were thinking of re-starting them, not sure you got any advice on that yesterday, though.
Hope Ducia gets into some lower numbers for you today (safely, of course!).
I was going to wait until you started a new thread for today, but I was wondering: what did you decide to do about sub-Q fluids? I know you were thinking of re-starting them, not sure you got any advice on that yesterday, though.
Hope Ducia gets into some lower numbers for you today (safely, of course!).
Tanya and Ducia
Member Since 2017
A few minutes after given her AMPS food which she ate herself and 10ml water via Etube Ducia vomited mostly water but some food too.
It is not the AB that caused the vomit because she had the AB 7 hours ago.
I am aware that if food or water given too fast thru the Etube nausea or vomit can happen. I gave the water very slowly. The amount of water was 10 ml. It is the same amount she used to get with her AMPS food when she was receiving her medication and we never had such problems. The 10 ml portion of water is by far smaller that the vet in ER recommended but what she used to. Now I have to think it is too much to be given at once.
Do you have any other thoughts about it?
She does not seem dehydrated at all. Her poop is moist as well as her gums. If I tent her fur up and let go it flattens right away. I was only concerned of her water intake because the vet wanted her to have 35 ml x 4 times a day. I truly believe it is too much. I moist her food every time she eats.
I will test at +1 and +2. If her BG is too low how should I plan her in between the meals snacks given now that she has lost some food to vomit? Should it be higher carb % food? Or the same 6% she ate at AMPS? I have higher and lower carb value food ready to be used.
Please let me know if what I plan at the moment does makes sense to you.
It is not the AB that caused the vomit because she had the AB 7 hours ago.
I am aware that if food or water given too fast thru the Etube nausea or vomit can happen. I gave the water very slowly. The amount of water was 10 ml. It is the same amount she used to get with her AMPS food when she was receiving her medication and we never had such problems. The 10 ml portion of water is by far smaller that the vet in ER recommended but what she used to. Now I have to think it is too much to be given at once.
Do you have any other thoughts about it?
She does not seem dehydrated at all. Her poop is moist as well as her gums. If I tent her fur up and let go it flattens right away. I was only concerned of her water intake because the vet wanted her to have 35 ml x 4 times a day. I truly believe it is too much. I moist her food every time she eats.
I will test at +1 and +2. If her BG is too low how should I plan her in between the meals snacks given now that she has lost some food to vomit? Should it be higher carb % food? Or the same 6% she ate at AMPS? I have higher and lower carb value food ready to be used.
Please let me know if what I plan at the moment does makes sense to you.
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Tanya and Ducia
Member Since 2017
Good morning Nan,
I haven't decided on SQf yet.
I would give at least 50 ml/24 h.
The human medic at home thinks Ducia does not need it because she does not have dehydration symptoms. Her food is watered, gums and poop moist, the litterbox visits are regular. I keep SS updated with water intake in the Remarks session.
I will open the new thread a little later on.
Nan & Amber (GA)
Member Since 2016
Has she eaten since she vomited? You'll want her to have enough food "on board" by the time the AM shot starts working.
I'd get another ketone test in as soon as possible. If she's started to get fussy about having a spoon under her to catch the urine, you can try putting some crumpled plastic wrap in the box in her favorite spots-- all you need is a drop or so.
I agree that the amount of sub-Q fluid originally recommended seems a bit high, but the fluids can help "flush out" any developing ketones. Please bring this up in the new thread today-- I'd like to have some of the folks who are experts in DKA recovery give their opinion on this. Ducia's been doing great for a while now, I don't know how long the really intensive nursing needs to be maintained after the DKA. I'm a little worried with the elevated numbers and the vomiting today-- just a little worried, it sounds like she's doing fine overall, but I would like to hear from the experts.
I'd get another ketone test in as soon as possible. If she's started to get fussy about having a spoon under her to catch the urine, you can try putting some crumpled plastic wrap in the box in her favorite spots-- all you need is a drop or so.
I agree that the amount of sub-Q fluid originally recommended seems a bit high, but the fluids can help "flush out" any developing ketones. Please bring this up in the new thread today-- I'd like to have some of the folks who are experts in DKA recovery give their opinion on this. Ducia's been doing great for a while now, I don't know how long the really intensive nursing needs to be maintained after the DKA. I'm a little worried with the elevated numbers and the vomiting today-- just a little worried, it sounds like she's doing fine overall, but I would like to hear from the experts.
Tanya and Ducia
Member Since 2017
Thank you Nan!
Good idea about plastic liner in her litterbox corner. I will watch her closely.
The SQf water is good question to post in anew thread and I will do it.
When I mentioned that the vet recommended 35 ml x 4 a day I meant orally, via tube with 35 ml syringe.
The same advised to cancel the SQ fluids completely on 3/10 after the ER visit. And so we did.
Good idea about plastic liner in her litterbox corner. I will watch her closely.
The SQf water is good question to post in anew thread and I will do it.
When I mentioned that the vet recommended 35 ml x 4 a day I meant orally, via tube with 35 ml syringe.
The same advised to cancel the SQ fluids completely on 3/10 after the ER visit. And so we did.
Tanya and Ducia
Member Since 2017
No, she didn't eat after and sleeps now.
I will test at +2.
Should I offer &5 snack in anticipation of the AM insulin dose kick? Or higher carb %, like 7%?
Nan & Amber (GA)
Member Since 2016
Let's stick with her regular food for now and see what the +2 brings.
Tanya and Ducia
Member Since 2017
Right, let's wait for +2 test.
I have 7% and 9% ready to be given.
I also have some 14% and 15% ready for later if needed but would rather stay below 10% if possible.
I have 7% and 9% ready to be given.
I also have some 14% and 15% ready for later if needed but would rather stay below 10% if possible.
Tanya and Ducia
Member Since 2017
Did you get my reply to this post of yours?
I don't hit the reply link in the lower right corner of your post.
I typed in the empty window that read "Type your reply".
I am doing the replying correctly?
Tanya and Ducia
Member Since 2017
New thread was opened at:
http://www.felinediabetes.com/FDMB/...n-water-vomiting-and-sq-fluid-therapy.174892/
http://www.felinediabetes.com/FDMB/...n-water-vomiting-and-sq-fluid-therapy.174892/
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