4/12 Wrigley - AMPS +12=77 | +12.5=93 | +2=65 | 3.5=57 | 4.25=51 | PMPS=298 | +2.5=214

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ewalker405

ewalker405

Member Since 2015
We just tested Wrigley and he is at 77 somehow. Bouncing from high numbers yesterday? I don't understand this completely. We are feeding him now. His normal shot time is 7:30 CST, which is right now. Should we still give him the 1 unit or wait a half hour and see what his numbers do?

Thanks
 
Hi,
The reason for stalling is to see if the numbers will rise to a safe spot before shooting. When stalling you do not feed. If you have already fed (as you have) the food will inflate the numbers. Since you are very new to the board, there is not much data on Wrigley's spreadsheet to help predict what he will do. I think that you should simply skip this shot, but wait for advice from one of our very experienced dosing members. It looks to me that Wrigley's dose may still be too high.

Welcome to L&L!

Ella & Rusty
 
As you are new and don't have much data yet, you should not shoot under 200. I am not experienced enough to give you dosing advice and you should wait until someone experienced comes along which hopefully shouldn't betoo long. But do not give the insulin with a low number of 77
 
Thanks. I didn't know we were suppose to skip feeding too. I will remember that for next time.

More information that might matter: About a week ago he had ketones in his urine and we took him to the vet. They held him for 48 hours to give him fluids and insulin. I was told that skipping a shot is not great since he had ketones before.
 
Keytones changes the whole ballgame (pun intended). It is very important that he have his insulin. What would you think about giving what we call a BCS (Big Chicken Shot) this morning: maybe .5 of a unit (half your dose)? And make sure that he eats and gets enough fluids (you can add water to his food to make it more "soup-like". Since you will be shooting late, your evening shot will be 12 hours from your A.M. shot. You can get back on your shot schedule by moving the shot time 30 minutes a 24-hour day (either all at once, or in two 15-minute sections).

The 93 represents the food. Keep a close eye on him today. Will you be around? Do you have enough strips?

We have some very knowledgeable people on the board who have had experience with keytones, low numbers, etc., and I know that you will be getting some good information soon.

Ella
 
That would be the food bringing up the numbers. I will tag a couple of people to see if I can find someone for you. You might be able to give a later shot but you need to wait for an experienced person. I can see you are concerned about the ketones but keep feeding and giving extra fluids
@Vyktors Mum @Sienne and Gabby could you have a look and see if you are able to help Wrigley please

Could you tell us your name please:)
Edit to add: I see Ella has been able to assist you.....great
 
Just gave him .5 units and some more food. He didn't want to eat at first until we put a piece of tuna in it and now he has eaten almost a whole can of FF in 2 trips to his food.

My name is Eric btw. Thanks for the help
 
It would be good if you make mention of ketones in your signature, as Ella said knowing that ketones have been an issue changes things. Also which protocol you're following. With TR there only no shot number is one below 50 HOWEVER we do suggest you post for advice before shooting 150 or under until you know what you're doing. Suggest you get a +1 test.

ETA - here's yesterday's link http://www.felinediabetes.com/FDMB/threads/4-11-wrigley-amps-408-3-214-pmps-259-3-186.136045/ we link each condo to the previous one so we can go back easily to check the kitties history.

And here's 4/10 http://www.felinediabetes.com/FDMB/...19-pmps-4-64-please-help.135982/#post-1402327
 
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Since coming home from the vet last week, he is on a couple other medicines. Do these matter for insulin or numbers?

-Clavamox antibiotic tablets: twice a day for 7 days.
-Denamarin 90mg tablets for liver: once a day at night
-Renal K Gel: 1/2 teaspoon twice day for potassium
 
Hi Eric,
Go easy on the amount of food so that he doesn't "scarf 'n barf". Also, after the effect of the food you have given him wears off, his blood glucose may drop again. In that event you don't want him to be too full, because you may need to use some higher carb food/gravy/karo syrup to bring his numbers back up again. Keep monitoring him!

Ella

Here is the relevant section from the "Sticky" on shooting low numbers at the top of the Lantus/Levemir forum. It may help you to put things in perspective: HOW TO DEAL WITH LOW PRESHOT NUMBERS **** The following guidelines apply to the Tight Regulation Protocol for Lantus or Levemir **** You just tested your cat’s preshot number, and there is a much lower than usual number staring back at you. What do you do? There is no one-size-fits all answer, but there are some general guidelines. As with everything else, each cat is different (ECID) and each caregiver is different too. The short answer is that most kitties can be shot at +12, almost regardless of the number, once you are data ready to do so. The exception is that shooting 30s or 40s is not recommended for most cats, so if the cat is less than 50 then usually the best option is to wait until they are above 50 to shoot. While you’re waiting, the shed is draining, so you want to get the insulin in as soon as it makes sense to shoot. If it is your first time shooting green, then we will likely suggest that you stall the first time, even if the number is 80-100. That will let you collect data on what your cat will do when you stall. One thing you can do if you are having a low cycle is to get a +10 and +11. Those will give you a good idea of how quickly the cat’s numbers are rising (or not) when preshot time arrives. Beyond the general guidelines, there are other factors we consider when we are helping someone with a low preshot. If the low preshot is not part of that cat’s normal pattern or there is reason to think something might be wrong, we will be more conservative. If the cat is not a food spiker or tends to have an early onset/early nadir then they may not want to shoot as low. If the cat has a late nadir, then they will HAVE to learn to shoot low. We will also be more conservative in some cases because of the person – if you are not able to monitor then you want to be more careful, or if you are not sure that you can get back to the board to keep us updated throughout the cycle. Trust me, if you shoot low, we will be watching for your updates and we will worry if we don’t see them. We have to be a lot more careful with the cats who eat only dry food, because they don’t have access to the tools the rest of us use to keep our cats safe. Also, when it comes to very low preshots, there is an unwritten rule that whoever helps that person shoot low should expect to sit with them through any low parts of the cycle. There have been times when I knew a cat’s number was likely shootable, but I also knew that I could not be around to help if the shot resulted in low numbers later in the cycle. For safety’s sake, if I could not find someone else who would be available to support for the next several hours, I would most likely suggest that the shot be reduced or skipped. I will not encourage someone to shoot low and then abandon them. There are a lot of other scenarios, and you always want to keep your cat in mind. Some general rules when stalling (ECID): ** 50s or higher – don’t feed. The number will bump up on its own soon due to the insulin wearing off. ** 40s or lower – you have a couple of choices. When 40’s occur at the end of the cycle, it can be beneficial to withhold food and test in 15-20 minutes to determine if kitty is on the rise or hasn’t reached nadir yet. If they are hanging in the 40s for a while, or if they are still dropping, it is ok to feed a tsp or two of LC and retest. This is very tricky. You want to avoid feeding too much while you’re waiting for them to go over 50, because you don’t want to artificially inflate the number with food. --- Example: if kitty is 43 and you feed a whole meal, or feed some HC, and the number bumps up to 52, is that the cat’s natural end-of-cycle rise, or is it food spike? What if it is food spike? Then if you shoot the 52, when the food wears off he might drop back to the 40’s (and when insulin kicks in a couple of hours later, you might have a problem). If the 52 is the cat’s natural rise, then he will probably keep rising for the next few hours until insulin kicks in. If you can’t tell whether the number is food spike or natural rise, it’s safest to wait. Your data will help you here. Study the spreadsheet. How much food spike does the cat usually get? How many hours after the shot does the insulin’s onset usually occur in this cat? At what number is the cat likely to be when onset occurs? If the cat does drop, how easy/hard is it to regain control of the numbers? How carb sensitive is he? ** Test often (every 15-20 minutes, or at most every 30 minutes). You want to catch the rise the minute it starts. With most of our cats, once they start to rise they will really zoom. You want to get the insulin in as soon as possible, because it will be another 2-3 hours before the insulin kicks in and you don’t want to let the cycle get too far ahead of you. Perhaps the most important guideline in shooting low is that any time you shoot your lowest ever number, you should get a +1 and +2 to give you an idea of how the cycle will go. If the +1 is not higher than PS, or if +2 is much lower than PS, that means “pay attention” over the next few hours. Those tests will also help you become even more data ready for the next time you are presented with a low preshot reading. Using the overlap by shooting low is a great way to take advantage of Lantus/Levemir’s long, flat cycles, once you have learned to do so safely. ~ written by Libby and Lucy
 
Most people make note of the meds they're giving and whatever the health issue is in the comments section of their SS. If it's more than a temporary issue, eg kidney disease then I would put that in your signature too. What is going on with him?

Doesn't seem like any of those meds have sugar in them given his numbers.
 
Hi, Eric.

I'm a transplant to Columbus from Chicago. I've been in Ohio for a year now and I miss everything except my job in Chicago!!

How long ago was Wrigley having issues with ketones? (And which vet are you using in Chicago? I was using Cat Hospital and really do recommend them. They saved Gabby's life.)

A few words about ketones...
Ketones develop usually due to an infection or an inflammation being present along with not enough insulin and not enough calories being consumed. Because a cat isn't eating or not eating well, there isn't enough of the usual food to be metabolized so stored fat is being broken down and that's what produces ketones and throws electrolytes out of balance. Looking at Wrigley's SS, if ketones are still present or it's recent enough that it's a concern, Wrigley would be better off with your not reducing the insulin dose unless the numbers indicate you need to and instead, feeding a higher carb food.

Clavamox is an antibiotic so it looks like there was an infection. I'm assuming this is in pill form. (Sometimes the liquid form of medications is in a sugar syrup base -- not a good thing for a diabetic cat!) Obviously, Wrigley's potassium levels were off, as well. This can happen with DKA -- potassium and phosphorus levels are affected. If Wrigley wasn't eating prior to the ketones developing, there may have been some issues with hepatic lipidosis (aka "fatty liver") and the denamarin is good for liver support.

Do you have Ketostix? You can get them at pretty much any pharmacy. You can Wrigley's urine for ketones or an alternative, is to get a meter, either a NovoMax or Precision Xtra, both test blood ketones. The ketone test strips are expensive and unless ketones are repeatedly a problem, testing urinary ketones is what most of us do.
 
All the medicines were given to him with the diabetes diagnosis. The antibiotic was just in case and only 7 days since he was in the vet. Also when they tested him there, his potassium was lower and his liver numbers were higher than they liked so that is the reason for the other drugs. They said the liver is most likely secondary to the diabetes and once we get his BG under control his liver numbers should be better. We are going to the vet sometime this coming week to get him tested again to see if he still needs this stuff.
 
Hi Sienne,

Wrigley's ketones were last week. I did get some ketone test strips yesterday but haven't used one yet. I need to figure out how to get some urine. Our normal vet is McKillip Animal hospital and the 24 hour vet we used for his stay was Premier Veterinary Group. I really like both of them except for how expensive it is.

Everything you described with the ketones sounds exactly like what happened to him. I am sure his BG was high because he hadn't been diagnosed yet. He also wasn't eating much at all which contributed to the ketones as well as the liver issue.
 
I have a hard time catching Furball in the litter box to get a ketone test. The idea is to stick the test strip in the urine while they're using the litter box.

Don't forget to keep updating your subject line with each test today so others can see how you're doing and if you need help.
 
Hi Eric and Wrigley

Just popping by to check in and see how it's going. I'd be sure and get a +1 and +2 test to start since you shot a lower number that was food influenced. But with the ketones in his history, Ella was correct that you must get insulin into him. And food/water.

If he's had ketones, there is typically an infection somewhere so I'd have the vets check his mouth closely as we often see dental issues causing infections. Is he urinating normally...no signs of a urinary tract infection?

it actually is not typical for a diabetic cat to have high liver values. Cats, diabetic or not, can have bacteria come up through the intestines and cause infection in the liver and bile duct which can raise liver values. They can also have inflammation which affects pancreas, liver, intestines called triaditis but they are usually pretty sick with that.

I'd also be sure the vets closely monitor his potassium levels because high potassium levels are as bad as low. It is not abnormal for a diabetic cat to have lower blood potassium levels because insulin causes potassium to move from the blood into the cells. However, even with diabetic cats, there is a point where they would need potassium supplementation. I'd just be sure they keep an eye on his levels and fdiscuss stopping the potwssium when you get up to a normal range (which may vary depending on the lab your vet uses).
 
I would feed him two good tsps of Low carb food....if you have a 4-6% carb food, that would be great. I'd test him 30 minutes after you feed. If he's still dropping but above 50, repeat the food. You want him to flatten out above 50 as the goal. If he drops below 50, I'd give him two tsp of high carb gravy and recheck 30 mins later.

If he gets below 50, put up the 911 so someone can pop on and help you. I can check in but I've got company coming this morning for a few hours so I can't stay on the board.
 
I'll watch for you, Eric. Anytime you're getting close to 50 you want to check every 30 minutes until you are confident that he's holding flat and surfing.

Be back in 15 minutes to see your +2.5
 
A lower number at +2 generally means that it is going to be an "active" cycle and you will have to keep a close eye on him until his numbers begin to rise during the second half of the cycle. The morning food has apparently worn off, so one thing that you can do is give him small amounts of a low carb food and see what happens when you test again.
Oh, I just see that Marje has given you detailed instructions. Follow them!

What is your normal feeding pattern? Most diabetics do best on several small meals spread out over the day. That way their carb intake level is relatively constant and consistent. If you are at work all day, it would be a good idea to invest in an automatic feeder. What kind of food are you feeding?

I'll be around for another hour or so and can check on you, but I'll be out for a few hours after that. As Marje says, if things get rocky, put the 911 prefix on your condo.

Oh, good, I see that Julie is here to keep an eye on you. Be sure to do everything she advises!

I'll check on you before I have to leave, too.

Ella & Rusty
 
great! Do you want to test in 30 min or 45? I wouldn't go longer when he's in the 50's and hasn't passed his nadir yet.

I caught punkin at 32 once with no symptoms. Fortunately Lantus and Lev are so slower acting compared to other insulins that it's very rare that we see a symptomatic hypo. Usually that's only in cats where the people aren't hometesting.
 
I will test again in 30 or 45 and post here again. I have karo and FF with gravy if I need it. I am getting better at the ear pokes too. I have gotten blood on the first or second poke by freehanding the lancet and going at a 45 degree angle. He still flinches each time so I hate doing it.
 
Yay on getting the hang of testing! that's a huge hurdle to overcome.

Are you using neosporin ointment with pain relief on his ears? If you think it's hurting him, you can put that on about 1/2 hr before poking and then wipe off any excess before you poke. It numbs the site. I tried it on myself where the cats had scratched my foot and it's pretty amazing. I put in on punkin's ear every night when we were done, then wiped off the excess in the morning and he seemed to tolerate the poking without it hurting.
 
ewalker405 said:
They said the liver is most likely secondary to the diabetes and once we get his BG under control his liver numbers should be better. We are going to the vet sometime this coming week to get him tested again to see if he still needs this stuff.
Click to expand...
FWIW, Noodle had FHL (hepatic lipidosis/liver disease) at DX because she'd stopped eating with the DKA, it wasn't because of the diabetes. Her liver values returned to normal quite quickly once she started eating normally again, but she also took Denamarin to supplement for several weeks.

You're doing great, Eric! You'll get the hang of all of this sooner rather than later. It's really trying coming back from a crisis like DKA, but being proactive and making sure Wrigley safely gets insulin is so important. Great work.
 
Hi guys,
Checking in before I have to leave. Eric, you are doing very well. We use Neosporin with Pain Relief Ointment, too, and it really helps. Wrigley's ears will begin to bleed better after you've been at it for a while and they have developed more capillaries. Blood flows from the tip of the ear down, so it helps to put some pressure just below where you intend to do the ear prick. This creates a "dam" and gets the blood to bead up better. Vaseline or Neosporin lightly applied to the ear before poking will help the blood bead up.

I'll check back later, after we check on our friends' house, which has water issues because of the snow melt.

You are in Julie's good hands!

Ella & Rusty
 
Since he's just above 50, I would go with Marje's advice and give him 2 teaspoons of low carb food and test in 20 to 30 minutes. Some cats will surf along in the 50s and stay safe.
 
Right. Low carb above 50, high carb when he goes below 50.

one reason is that if he's going to go below 50 on this dose you want to know it so you can reduce the dose with the next shot.

Do you have another test yet.? If you are ok handling numbers under 50 on your own, then you don't need to keep checking in. But if you'd like help then keep checking in every 20 to 30 minutes or so.
 
Thank you. Wrigley is going up. He is up to 90 now.

I have some 30 gauge lancets coming from Amazon, but in the mean time I pick up some 26 gauge from CVS. His ears are bleeding a ton in 1 poke with these. So weird how the other day we couldn't get blood to now we are getting too much.
 
If he is up again for his PM shot time, which it seems like he will be, I am going back to the default of 1 unit. If anyone disagrees, please let me know though.

Thanks
 
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I just want to echo what Marje mentioned -- elevated liver values are not typical with a diagnoses of diabetes. Usually, there is something else going on that causes elevated liver values.

I'm not familiar with Mckillip or with the emergency vet you use. I have used the emergency vets that are on Clybourn at around Western. The internal medicine vet cared for Gabby when they were only in the suburbs. FWIW, I don't think there is a cheap vet in Chicago. I do recommend Cat Hospital since it's a cat only practice and the owner is very involved with the American Animal Hospital Assn and their practice is accredited. However, having a vet you like is important.

I would stick with the 1.0u. It's fine if you're not sure what to do to post and ask for help before you shoot. Just remember to not feed in case you need to stall.

 
PMPS is 298. He is starving too. He has been begging for food the last hour or so. He is munching away on some FF classics right now. Giving him 1 unit as soon as he finishes. If numbers are good and I only get 1 reading after his meals at night, when is best? Around +3?

Thanks all!
 
It is always suggested that you get a bedtime test (your bedtime!). With the current big bounce, I think that a bedtime test will be sufficient this evening. If he had been low at PMPS, a +2 test would be advisable. If +2 is about the same as PMPS or lower than PMPS, that is an indication that it will be an active cycle and you may need to set some alarms during the night to test him. But it looks like you are safe tonight! Get some rest! Good job today, Eric.

Ella & Rusty
 
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