4/22 Kasha AMPS 451 - PMPS 462, +6 456 - help?

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kryskat

kryskat

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Another day starting with high numbers. What's going on?

She threw up clear fluid/bile/whatever this morning early. But I got her to eat most of her Wellness (with layer upon layer of chicken dust for encouragement - but yesterday she was immune to the chicken dust, so this is an improvement) and she ate a bowl of chicken (real chicken) as well (a little less than 2 Tbsp). So, appetite may be improving. I just wish her numbers were lower and I won't be able to check during the day cuz I'll be at work for the first time this week (since I was sick).

Suggestions? Should I start thinking dose increase? I'm out of town next week, leaving Sunday, so if there are any changes made, it would have to be soon...

Yesterday's Condo
 
Re: 4/22 Kasha AMPS 451 - dose?

Have you taken Kasha to the vet? She was doing well and then her numbers started to rise when you noted that her appetite was down. With the vomiting there could be something going on with her. Infections and other issues can cause BG's to rise. I would recommend a visit to the vet to make sure there is nothing else going on with her. Also, are you testing for ketones in the urine? You can purchase the strips over the counter at any drugstore. As far as the dose....I will see what others say about her PM dose. But I am afraid there may be something else going on. I would have her checked out by the vet.

ETA - I see now that she was diagnosed with UTI. Are you giving oral antibiotics?
 
Re: 4/22 Kasha AMPS 451 - dose?

I agree with Paige...it might be good to have here checked by your vet, especially if you are going to be away...
 
Re: 4/22 Kasha AMPS 451 - dose?

You wouldnt want Kasha not feeling well while you were away--I'd just grab a quick visit to vet just in case--
Who will be caring for Kasha while you are away??
Yes, you should be checking for ketones-absolutely--get ketodiastix at any drug store & check his urine- hold under the urine stream when he is in LB-If stick turns a color, check chart on bottle to see if ketones are present--OK? They can make a cat very sick...
 
Re: 4/22 Kasha AMPS 451 - dose?

She was just at the vet. She had an antibiotic shot. She's eating again. Could it possibly be that something happened with the insulin? I'm confused, cuz she's not really showing much of anything with the insulin. I don't know if I should increase it to .5 units and see if she shows anything or what? I have almost no time at at to go back to the vet before I leave, so this is really stressful...
 
Re: 4/22 Kasha AMPS 451 - dose?

I know how worried you must be :YMHUG: How old is your Lantus?
 
Re: 4/22 Kasha AMPS 451 - dose?

Please remember to link your condo from the previous day. Yesterday's condo: viewtopic.php?f=9&t=12554

Umm....Kasha was at the vet on 4/20. See that day's condo for more info. I'd also suggest Ketostix vs. Ketodiastix. The former tests for ketones only and the latter for ketones and urinary glucose. Testing for UG isn't particularly helpful.

It think you said that Kasha has had this AB in the past? Do you recall if it upsets her tummy? Did the vet suggest that something like Pepsid may help? And if not, it might be worth checking to see if giving Pepsid would help to settle Kasha's stomach and get her eating back to normal. It's been about 36 hours since Kasha had the AB shot. If you don't see her numbers coming down by this evening, you might want to see about getting her into the vet on Friday -- or at least talk to the vet. Even a shot isn't going to work immediately and the UTI is probably driving the numbers up.

It may also be that there was too big of a drop in amounts when you change syringe types. I think if numbers haven't improved by +11 (can you get a +11 today?), you should post for input. I think raising the dose may be prudent because we don't know if there is an issue with how much you were shooting before vs. now and because of the infection. The combination of not enough insulin and an infection can be a risk for DKA.

Krys - I don't recall if you said who was taking care of Kasha and your other kitties while you were gone. The day before you leave, if you post, asking for DPS (dear petsitter) input, we can help you come up with a safe dose while you're traveling.
 
Re: 4/22 Kasha AMPS 451 - dose?

I have no faith that I'll be able to get her to pee on a strip or even catch any of her urine. They tested her urine the other day (not a sterile sample, but she peed all over the exam table) and found blood cells in it, indicating a UTI. I don't know if they tested for ketones and my vet isn't in today. I left a message for another vet, who has treated her in the past and is treating another cat of mine now, but he won't be in till this afternoon. I'm just wondering if it's her or the insulin - my refrigerator can be temperamental and I'm hoping it didn't do something like freeze the insulin briefly or anything.
 
Re: 4/22 Kasha AMPS 451 - dose?

The AB did not upset her stomach in the past. She ate 3 bowls of chicken and turkey last night (really, quite a bit of food for her), so she's eating. This morning she got down most of her Wellness (as I mentioned) and ate a whole bowl of shredded chicken (approx 2 packed Tbsp) and part of another bowl I left for her.

My insulin was purchased 3/14/10, I believe. I forgot and left it out a couple of times (literally, 2 times) but never for very long.

I don't know if I'll get a +11 today. I got into work late today and I haven't been in all week.

Stress...
 
Re: 4/22 Kasha AMPS 451 - dose?

In the absence of any other answers for tonight - if her numbers are still high when I test for PMPS (or earlier if I get home earlier) should I just try to go .5 units tonight and see if it makes a dent?
 
Re: 4/22 Kasha AMPS 451 - dose?

You make a good point re. the insulin. Not everyone can get more than 28 days out of a cartridge. I really have to change every 28 days or Gabby's numbers get wonky. And, if your refrigerator is temperamental, you might want to try a new cartridge first and see if that helps. Otherwise, unless Kasha's numbers drop this cycle, you can increase. If it were me, I would probably change the cartridge first.
 
Re: 4/22 Kasha AMPS 451 - dose?

I agree with Sienne.....if it were me I would try a new cartridge.
 
Re: 4/22 Kasha AMPS 451 - dose?

The cartridges are smaller, aren't they? The place I got it only had the vials - almost $100 a shot...
 
Re: 4/22 Kasha AMPS 451 - dose?

Just want too offer support and with Do Lou's last refill we switched the pens which are 5 to a box. Hope she feels better soon :YMHUG:
 
Re: 4/22 Kasha AMPS 451 - dose?

Ok - I've got a call into the vet and I ordered a refill on the insulin so I can pick that up and try that for tonight's shot. Just ordered another vial this time - they said I'd need a new prescription for the pens (cartridges) so maybe next time.

I'm really hoping it's just the insulin and that this hasn't done too much damage... She ate like a little piggy last night and this morning was into her 2nd bowl of chicken when I left.
 
Re: 4/22 Kasha AMPS 451 - dose?

OH I hope that it is the Lantus!!! angry(2)_cat Hope you can get it for tonights PM shot------good luck! :mrgreen:
 
Re: 4/22 Kasha AMPS 451 - dose?

My dad was just at my house, doing some work on it (he's awesome that way) and I got a hold of him and asked him to try to test Kasha's BG. He's seen me do it, but never tried himself and I was hoping he'd test while I was away next week, since he'll be at my house some or all of the days I'm away near her morning nadir. And I walked him through inserting the test strip, he put the phone down and came back and told me the number. I'm so proud of him! He's not a big animal person so this is quite a feat for him. Unfortunately, the number was 413... I'm really anxious to try a new vial of insulin tonight. She's not really fluctuating at all now.
 
Re: 4/22 Kasha AMPS 451 - QUESTION...

I have a question for anyone: I was reading the instructions on the Lantus site and it recommends drawing air into your syringe up to the amount you plan to withdraw and then injecting that air into the vial of Lantus before drawing in the insulin. Do people do this?

Also - do you roll the insulin in your hands to mix it before inserting the syringe to draw your dose? I didn't see that listed on the site - my vet nurse told me to roll it gently in my hands first but I don't see that listed anywhere and on this site I saw something about never roll or shake the vial/pen...
 
Re: 4/22 Kasha AMPS 451 - dose?

Here is some info from one of the stickies at the top:

PROPER HANDLING OF LANTUS and LEVEMIR
Lantus and Levemir should be inspected visually prior to administration and should be used only if it appears clear and colorless.
--Never shake or roll your vial, cartridge, or pen.
--Inuse and unopened Lantus and Levemir should be stored in the refrigerator between 36 to 46 degrees F (2 to 8 degrees C).
--Be careful your refrigerator is not so cold that the insulin freezes. Do NOT use Lantus or Levemir if it has been frozen.
--Never reuse syringes. You'll run the risk of contaminating the whole vial/cartridge/pen.
--Do not inject air into vial and especially not cartridges or pens. Cartridges and pens are designed to work on a negative pressure principle.
--If you draw up too much insulin in the syringe... squirt excess either into the air dramatically like they do on TV or into a paper towel... anywhere but back into vial/cartridge/pen. There is a silicon coating inside the syringe. It can contaminate the insulin vial with silicon (this is probably what makes "floaties", it forms a white precipitate).

Better to waste a drop than ruin whole vial, cartridge, or pen.Pre-filling Syringes with Lantus (see page 3) is NOT recommended.

Lantus and Levemir should not be diluted or mixed with any other insulins or liquids.
 
Re: 4/22 Kasha AMPS 451 - dose?

Yes - I'd read the sticky - I just want to verify what people actually do. So you just take the Lantus out of the fridge and draw into the syringe? No rolling or mixing in any way?

And does anyone inject air into the syringe like it suggests on the Lantus site?
 
Re: 4/22 Kasha AMPS 451 - dose?

My Vet told me to do both of those things, so I'd be interested in some feedback as well. I actually found that injecting air led to more bubbles, so I stopped doing that.

Jason


kryskat said:
Yes - I'd read the sticky - I just want to verify what people actually do. So you just take the Lantus out of the fridge and draw into the syringe? No rolling or mixing in any way?

And does anyone inject air into the syringe like it suggests on the Lantus site?
Click to expand...
 
Re: 4/22 Kasha AMPS 451 - dose?

I'm going to go a little different direction than everyone else, and suggest that the numbers look like a combination of the dose reduction not holding, and the UTI. Could be a little rebound in there too, from the fast drop on 4/19, but she doesn't usually bounce that much so I would lean toward the other two. I would increase the dose to 0.5, then monitor because as the infection clears, the numbers could drop rapidly.
 
Re: 4/22 Kasha AMPS 451 - dose?

Oops, I misunderstood. Sorry bout that. What I did was take the insulin out of the fridge and place it on the counter. No rolling or mixing. Get my syringe and push the plunger all the way in to get any air out before I insert the needle into the insulin (my syringes were always cocked out about a 1/2 unit right out the box). Then I would insert the needle and pull out what dose I needed plus one extra unit. Remove the needle and tap the syringe a little to get the bubbles to the top. Then I slowly turn the plunger to remove the bubbles. I found that turning it was easier and prevented me from accidently squirting out the whole dose. By getting that extra unit you are able push out the bubbles and still get the correct dose. Then you put the insulin back inthe fridge. I sure hope this makes sense, I'm typing on my phone and the words are teenie tiny.
 
Re: 4/22 Kasha AMPS 451 - dose?

Jason - I suspected the same thing, that injecting air led to more bubbles so I also stopped, but just read it again on the Lantus site.

My vet said that you have to roll it to mix it, but that's the opposite of what the sticky says and I didn't see anything on the Lantus site about it either. On some human sites, they said they roll it in their hands gently to warm it - I don't know if it has to be mixed. Anyone else roll it?

Ok - I'm getting a new vial tonight. At the very least, I'll have some backup insulin. I think I'll try the new insulin tonight and maybe take her back up to .5 or a skinny .5 unit dose and monitor her tonight. I just really want to see if she responds to the insulin because right now her numbers are just pretty flat (and high). Once I know she's responding, i could possible try the old insulin again and see if she goes flat again. Of course, if this works, why I would want to try that I don't know.

Any thoughts? s.5 units tonight?
 
Re: 4/22 Kasha AMPS 451 - dose?

Libby and Lucy said:
I would increase the dose to 0.5, then monitor because as the infection clears, the numbers could drop rapidly.
Click to expand...

Libby suggested going back to 0.5 and monitor closely. I would take Libby's advice :mrgreen: :mrgreen: :mrgreen:
 
Re: 4/22 Kasha AMPS 451 - dose?

Yeah - I can monitor until sunday morning and then I'm gone for a week, so I hope this stabilizes...
 
Re: 4/22 Kasha AMPS 451 - dose? - 457 @ +11

Ok - I've got the new vial of Lantus and I'm going to try .5 units tonight. Going to feed the little girl in a bit and make sure she gets some food down, then shoot... Will keep you all posted... Wish me luck.
 
Re: 4/22 Kasha AMPS 451 - dose? - 457 @ +11

Good luck, I hope it is the Lantus :thumbup
 
Re: 4/22 Kasha AMPS 451 - PMPS 462~ .5 units

Ok - she ate dinner fairly well and has finished off a lot of cooked chicken today (2 + bowls while I was out and 1/2 another bowl after eating 1 1/2 Tbsp Wellness and chicken dust. A bowl of chicken for her is about 2 packed Tbsp, torn up in little pieces. Just hopefully gave her .5 units - praying it's not a fur shot, cuz that would just figure. Today at work thinking about all this, I actually thought "What if I've just been giving fur shots all week?" Like could I really be stressed enough to forget how to give her the shot? Who knows?

I'll check back in with numbers in a bit.
 
Re: 4/22 Kasha AMPS 451 - PMPS 462~ .5 units

krys - another little pearl I've learned from here: You don't necessarily have to catch Kasha in action (peeing). Take a small amount of clean litter (small like a tsp or tbl) - mix in a small amount of water to make it paste like or slightly thinner. You then check this with a ketostix. This is to check to make sure your litter doesn't turn ketostix's positive on its own. If your litter gives you a negative test then you can find a "pee ball" from Kasha and do the same thing - mix a little of the dirty urine with small amount of water and test for ketones. If the stix does turn positive you know the ketones are from Kasha. Fresher pee balls are easier to work with.

Another little hint - if you are going to stalk the litterbox when she is going - make sure you have something handy to stick in the urine stream. (assuming you aren't going to just stick a ketostix in the active stream :-D ) I have heard of some keeping a spoon of sorts - long handle/smallish spoon that you can swoop in while they are peeing. I'd just keep it right next to the litter box in case you ever did catch her in action.

Good luck with the new Lantus. I also keep mine in fridge. I do NOT shake/roll. I do NOT inject air into the insulin. I do use the pens - if the vial goes bad - there is alot of insulin that you could potentially waste. If a pen goes bad - it is usually much less to waste - saves money that way over time. The pens come 5 to a pack - and most of the time have a long self life if not opened and kept in fridge.

Good going to your Dad - it is great that he was able to test.
 
Re: 4/22 Kasha AMPS 451 - PMPS 462~ .5 units

good luck with the new juice and the new dose, I hope that gets Kasha back on track quickly.
 
Re: 4/22 Kasha AMPS 451 - PMPS 462~ .5 units

There are some insulins that are a suspension -- like Humulin N. These insulins require that you roll or otherwise "mix" them. Lantus is not a suspension and as such, there's nothing to mix. It is, however, fairly fragile. You don't want to shake rattle or roll it and you don't want Kasha to play soccer with it.

Libby's suggestion makes good sense. New Lantus and an increased dose! And hooray for your dad!! I'm sure it would ease your mind if he were able to take care of Kasha while you were away.
 
Re: 4/22 Kasha AMPS 451 - PMPS 462~ .5 units

Well, I doubt my dad will "take care of Kasha" for me (he's not an animal person and I can imagine the look of discomfort he would have if he read that - LOL) but he'll at least check her BG and hopefully show my mom that it's easy to test the BG so she can do it too.

The more people to check on my little girl, the better...
 
Re: 4/22 Kasha AMPS 451 - PMPS 462, +3 417

Oh, come on... It's +3 and I got a reading of 417. I even tested myself to make sure my meter and strips are working. So far nothing is changing.
 
Ok - nothing is changing. I don't know what to do. Assuming I didn't give a fur shot - what is going on? Should I just try to get her into the vet today (Friday)? Looks like I'm going to have to cancel my trip... This is really, really upsetting :(
 
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