? 3/21 Millie Lantus AMPS 418, PMPS 396 When is an increase necessary?

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Sylvia & Millie

Sylvia & Millie

Member Since 2017
http://www.felinediabetes.com/FDMB/threads/3-20-millie-amps-79-at-dosing-suggestions.175082/

Millie is post DKA and has a tendency to drop in the low range. I wanted to hold her current dose of 1 u of Lantus for a few days. We have not stayed with a particular dose for more that two days but I don't want to maintain the dose it if an increase is necessary. Suggestions? It's actually too late now because it's shot time but this way I know in the future.
 
With SLGS you do a curve after a week and then increase if you aren't seeing lower nadir or if you ever get a number under 90. Even with TR you wouldn't increase before 6 cycles at a dose. Lantus is a depot drug and needs to build up over time to see what a dose will do. It requires patience. You can't rush the process.
 
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Sylvia I agree with Elise. Have you taken a look at the sticky for SLGS? It is very helpful:).

Lantus likes consistency. Millies numbers will be all over the place if you are changing the dose too much without kitty earning reductions or increases.
Your doing a great job!
 
Hello and welcome.

Since Millie was hospitalized for DKA less than one month ago you need to be very careful. A post DKA kitty requires close monitoring- it's something of an intensive care situation.

Daily monitoring for the presence of ketones, is a must. Are you monitoring for ketones?

A post DKA kitty needs to consume approximately 1.5 times the calories normally required for ideal body weight. Converting those calories to energy and delivering that energy to the body cells requires insulin. calories and insulin must be managed so that low numbers can be avoided. Decreases and skipped shots are best avoided right now - reducing insulin can open the door to the formation of ketones.

Was there an infection present when Millie was hospitalized ? If so has it been addressed ? How is her weight? How is her appetite? Behavior?
 
Yes, we monitor for ketones; so far she has been negative.

She lost lots of weight due to the two back-to-back episodes of DKA. Her appetite has been good for the most part (she tends towards being very finicky about food and can go days without eating). I have been feeding a variety of low carb, trying to keep her interested in meals. Her behavior is fine, she is happy and affectionate.

Our problem with maintaining insulin doses has been low numbers (a bg of 62 even after feeding and giving Nutracal). So the struggle has been to avoid ketones and hypo.

During the DKA, they suspected pancreatitis and she received antibiotics for two weeks.
 
Was the morning of 3/18 a skip? It helps if you enter skip or 0 or NS (no shot) in the unit column, so we know you didn't just forget to enter the dose.

It's really hard to figure out what dose you should be giving when you are jumping around in dose. It would also help us get a better idea of how a dose is doing if it was possible to get the odd test at night, perhaps just before you go to bed. Many cats go lower at night. We figure out how a dose is working by seeing how low it takes Millie. Giving us the night time picture helps us figure out whether a dose is working. As is dosing consistency.
 
We didn't give a shot on 3/18, I just entered the information.

We will test her tonight before bed.

Sandy - Should I increase Millie's daily calories? I'm not sure how to meet the 1.5 times caloric intake unless I give her a higher calorie food, but I know this affects her bg. Millie has always beens trim and she's a grazer.
 
Will keep that in mind.

Just realized it's been less than two hour since her shot, we are heading to bed, not sure if it's worth testing so soon?
 
Sylvia & Millie said:
Yes, we monitor for ketones; so far she has been negative.
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That is information we look for and should be placed on the ss as well, either in the remarks column or in the cell corresponding to the time of the test. If you look at my Black Kittys ss, for the dates 6/22/2008 and 6/23/2008 you can see one method of documenting timing and results of ketones testing. You can also see on those dates that in a matter of 24 hours his ketone level went from *trace* to *large*. Three days later he was hospitalized with his second episode of DKA; the first episode was 34 days prior. He was down to 7.5 lbs.
Sylvia & Millie said:
Her appetite has been good for the most part (she tends towards being very finicky about food and can go days without eating).
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Going days without eating is dangerous for the healthiest of cats. In Millie's case it opens the door and invites ketone development.

Sylvia & Millie said:
I have been feeding a variety of low carb, trying to keep her interested in meals
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it may be a better strategy to feed her higher carb food for the time being, which would allow you to get more insulin into her and the extra calories would help her regain the weight lost from the back to back DKA episodes. Something to consider.
 
So I should give higher carb for now? In an earlier post I was told to do high calorie and not high carb (Wellness brand was cited, I plan to get some today).

I try to entice her with food as much as possible. She became anorexic during her DKA episodes. Party Mix treats was how the animal clinic got her eating again. Obviously I won't feed that to her but I've wondered how to help her gain weight. Her appetite has been good lately which is great!
 
With ketone prone/post-DKA kitties, the rules do not necessarily apply. In part, because you are wanting to do everything you possibly can to prevent the development of ketones, you need to be exceptionally careful when it comes to skipping a shot.

The reason that ketones develop in due to an infection or inflammation + not enough calories + not enough insulin. Because insulin is a part of this equation, skipping a shot can be one factor that increases the likelihood of ketones cropping up. (I have been known to tell people to give their cat the equivalent of an ice cream sundae if that's what the cat will eat in order to get food/calories on board.) I would rather see you load your cat up on food -- even high carb food -- to keep numbers propped up rather than skip a shot.

Another factor is that Lantus dosing is based on the nadir. It's especially important with a post-DKA kitty to get some spot checks in throughout both the AM and PM cycles. Ketones do not necessarily develop because numbers are high. What the high numbers are likely reflecting are a bounce off of some of the lower numbers you've been seeing. In response to lower numbers, the liver and pancreas release a stored form of glucose along with counterregulatory hormones which both cause numbers to spike upward.

 
How much weight did she lose? What is her optimal body weight ?

Do you think she is strong enough to survive another episode of DKA?

If it was my kitty, at this point in time I would focus on restoration before regulation.

Both skipped meals and skipped shots should be avoided. Mixing as much water as she will tolerate into the wet food will assist in keeping her hydrated, which is also important.

Higher BG from extra carbs can be managed/offset with insulin. Keeping the insulin flowing will help get the energy from the carbs into the cells.

You see the way DKA works is that when there is not enough energy from food making it into the cells, the body will breakdown fat and protein to try and fulfill the need for more metabolic energy. The excessive breakdown of these stored reserves creates a toxic by-product - ketones. As ketones build up in the blood stream, the resulting pH and electrolyte imbalances can very quickly develop to life threatening levels , a state of DKA.
 
Great explanation. It took me a minute to understand both of Millie's dangers (DKA & low numbers). It does seems best to steer her away from the DKA now that she is prone. I look at the food list and found some foods I'll pick up as well as low carb treats.
 
I'm not sure how much weight Millie lost (7 lbs?) because she wasn't weighed. She id become quite skinny, very boney. She could probably stand to put on another 3 lbs. I'm not sure she could deal with another bout of DKA, especially since she is not at optimal weight. She was in very bad shape during the second episode.

Focusing on restoration makes sense especially since everything I've read said that it could take several weeks to recover from DKA.

I definitely hear what everyone is saying and this puts into a different perspective. Thank you all very much.

BTW, I picked the CORE Wellness and she ate it right away; normally food has to be introduced slowly.
 
Sylvia & Millie said:
I'm not sure how much weight Millie lost (7 lbs?) because she wasn't weighed. She id become quite skinny, very boney. She could probably stand to put on another 3 lbs. I'm not sure she could deal with another bout of DKA, especially since she is not at optimal weight. She was in very bad shape during the second episode.
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My Black Kitty barely made it through his second round with DKA, a third one would likely have done him in.
Below is BK after his first DKA (left) and about 5 months later (center). The photo on the right is BK fully restored (about 6 months after his 2nd round with DKA ) - and just home from his first major dental surgery, (something like 8 extractions) which he needed desperately but would not have been possible had he not regained what he had lost.
Recovery can take time. Persistence and perseverance along with a huge leap of faith that those 'strangers on the internet' are steering you in the right direction are required. That and a good bit of coffee.:coffee::coffee::cool:
BK 5-2008 vs 10-2008 (400x332).jpgJust home from dental - cropped (348x400).jpg
 
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