? 3/25 Millie AMPS 449 (AT) Dosing advice needed for post DKA kitty on Lantus.

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Sylvia & Millie

Sylvia & Millie

Member Since 2017
Millie had two bouts of DKA. Numbers were running low, now they are high. Would like to know when is it time to increase Lantus dose? We are due for a shot in 35 minutes.

Since she is recovering and lost lots of weight, she was put on a higher calorie diet to help her gain back weight. Appetite is good and ketones have been negative. We were changing her dose trying to regulate. We've kept it at 1 unit for several days, just wondering when would be the best time to increase the dose?

http://www.felinediabetes.com/FDMB/...is-an-increase-necessary.175163/#post-1923964
 
This is from the Lantus SLGS protocol:

After 1 week at a given dose perform a 12 hour curve, testing every 2 hours OR perform an 18 hour curve, testing every 3 hours:
Note: Random spot checks are often helpful to "fill in the blanks" on kitty's spreadsheet.
  • If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit
  • If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose
  • If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit
As your cat's blood glucose begins to fall mostly in the desired range [lowest point of the curve approaching 100 mg/dl (5.5 mmol/L) and pre-shot value around or below 300 mg/dl (16.6 mmol/L)], do lengthen the waiting time between dose increases.

If you decide to change another factor (e.g., diet or other medications), don't increase the insulin dose until the other change is complete (but do decrease the dose if your cat's glucose numbers consistently fall below 90 mg/dl (5.0 mmol/L) as a result of the change).

Don't be tempted to rush the process along by increasing the dose more quickly or in larger increments-- no matter how high your cat's blood glucose is! Rushing towards regulation will cost you time in the long run, because you may shoot past the right dose.
 
Hi there. I've been looking for you.

@Kris & Teasel Millie is currently trying to avoid a 3rd episode of DKA so is outside standard protocols.

Since with Lantus we base the dose on how low the current dose is taking kitty, not having any overnight information makes it extremely difficult.

Did you skip the PM shot on 5/22? (Rather 3/22)
 
Sandy and Black Kitty said:
Hi there. I've been looking for you.

@Kris & Teasel Millie is currently trying to avoid a 3rd episode of DKA so is outside standard protocols.

Since with Lantus we base the dose on how low the current dose is taking kitty, not having any overnight information makes it extremely difficult.

Did you skip the PM shot on 5/22?
Click to expand...
Thanks for this! It's hard to remember everyone's details when a lone post pops up. Over to you Sandy ... :)
 
If you are going to be around to test this weekend, and the evening cycles too, and have supplies, I would increase to the 1.25. It's hard for us to help you decide on the increase because there are no night time tests on her spreadsheet. Have you tested for ketones in the past couple of days?

ETA: I'm only saying this because of the very recent DKA. Is there any way you can get more mid-cycle tests? That would help to tell the whole story of how the insulin is doing.
 
I agree with Sandy with respect to the PM tests. Is it possible for you to get at the very least a before bed test every night?

It really looks like Millie's numbers are bouncing around. Without the PM tests and some spot checks when you see lower pre-shot test numbers, it's very difficult to help you figure out dosing. With a post-DKA kitty, getting the maximum amount of insulin on-board is important.

 
We will be doing a couple of mid-cycle tests today. Millie is very difficult to test, we have to wrap her in a towel and she gets very upset, even refusing her favorite treats. She has started to become leery of either one of us approaching her, even for her insulin shot. Because of this we have avoided a full curve but are trying to get occasional random tests in. I know this is important so today we will two, hopefully showing the nadirs.

Yes, I've been testing for ketones, except I couldn't get any yesterday (she is pooping more because of the food and covers her urine).

We give her an evening shot at 9pm. We will get a night time bg test (11 or 12pm) this weekend.

No, no shots were skipped on 3/22.
 
I agree with Dyana. I think there's room for an increase however since most kitties run lower on the overnights missing that half of the picture makes it very difficult to say if it would likely be safe. Getting that information will help us to best help you to safely navigate the tricky waters of post multiple DKA.
 
She loves the Friskie Party Mix. I bought several other brands and have tried them, all of which she has refused (including the Orijen). I will be cooking her some shrimp and chicken today to see if that works.

So, this is my thoughts in proceeding. Take two mid-cycle tests today. Continue checking ketones (always). Increase pm shot to 1.25. Take a pm test (11:30/12:00); if possible try a later time.
 
My understanding was an increase may be I'm order but this has now confused me (from the Lantus protocol):

'Don't be tempted to rush the process along by increasing the dose more quickly or in larger increments-- no matter how high your cat's blood glucose is! Rushing towards regulation will cost you time in the long run, because you may shoot past the right dose.'

Maybe keep her at the 1u until I have more information (evening readings)?
 
Many cats object to being restrained which could be why Millie is fighting you. You might want to look at this article about a clip that helps to calm cats. The author of the published article they refer to is one of the major researchers on feline stress. The Clipnosis clip is available on Amazon.

Friskies Party Mix is without question very high in carbohydrates. It would be iike giving your diabetic child cookies and ice cream as a treat. If cooked shrimp or chicken don't work, have you tried freeze dried chicken or other freeze dried proteins? Most pet stores carry these products or you can find them online.

When you note that you're feeding Fancy Feast "all flavors", what does that mean exactly? Are you feeding only pate style (i.e., Classics) or are you feeding other styles, as well?

Millie may, in fact, need a dose increase. However, for those of us who have seen lots of kitties and lots of spreadsheets (SS), to our eyes, you are missing half of your data. The last thing in the world we want to od is recommend something that could harm your cat. As a result, we are cautious. It is a delicate balance between having a cat that is post-DKA where maximizing insulin keeps ketones at bay an not having enough information to help you make an informed and safe decision.

 
Yes, I know about the treats. I take two pieces and break them into crumbs. I've bought several of the treats on the list. I have some new ones I will be trying on her today.

I was feeding her the FF classic- beef/chicken/beef & chicken; she liked it. Now we are giving her the Wellness CORE beef, venison & lamb flavor which she loves.

I will keep the 1u dose in the pm and test her at night, hopefully this will help. I understand her case being a bit difficult and us needing to add more info. We unfortunately have a number of circumstances complicating things but we'll get this done!
 
Freeze dried chicken works like a charm for most. These treats very quickly earned the well deserved nick name if "kitty crack". I could not have survived without them.

Regarding your quote from the protocol, please note it is a general guideline. It does not take into consideration the needs of a kitty fresh from 2 back to back DKA episodes.
 
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