5/31 Chianti pmps 67 ack!

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itzj

itzj

Member Since 2014
So 67. Um. Retesting in 10 to see what is going on.

If he is still low is this a skip situation or a half shot?

And should I feed differently tonight?
 
Thanks. He has been fussy the past two days. Also we are in the process of slowly removing the chow in the house (11 total cats, crystal cat is pushing us more wet) We thought he wasn't getting any but now wonder if he was at night. He wasn't in the day.
 
You shot 3.0u into a 78 day before yesterday. This isn't much lower, but it is the lowest you would've shot, so I wouldn't do it without monitoring.

Will you be able to get another test in tonight? I think if you can't test again tonight, I might just skip the shot. What do you want to do?



Per SLGS (below) you would reduce the dose by 0.25u the next time you do shoot, because you have a nadir below 90.

From SLGS:
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.
Lather, Rinse, and Repeat!


How to handle a lower than normal preshot number

In the beginning we suggest following the guidelines in the FDMB's FAQ Q4.4:

Q4.4. My cat's pre-shot level was way below the usual value. Should I give the injection?

A4.4. There's no hard and fast rule, but if you don't have data on how your cat responds to insulin, here are some general guidelines.
  • Below 150 mg/dl (8.3 mmol/L), don't give insulin.
  • Between 150 and 200 (8.3-11.1 mmol/L), you have three options: a.) give nothing; b.) give a token dose (10-25% of the usual dose); c.) feed as usual, test in a couple of hours, and make a decision based on that value.
  • Above 200 (11.1 mmol/L) but below the cat's normal pre-shot value, a reduced dose might be wise.
  • In all cases, if you are reducing or eliminating insulin, it's wise to check for ketones in the urine.
  • Above the normal pre-shot value, give the usual dose, but if the pre-shot value is consistently elevated, it's a good idea to schedule a full glucose curve to see whether a change in dose or insulin is appropriate. In most cases, the target "peak" value should not be below 100 mg/dl (5.6 mmol/L), and for some cats it might be higher.
Keep in mind that these are general guidelines, and they should be personalized to your own cat's reactions to insulin. If your experience is that your cat does not became hypoglycemic with a dose which is close to her usual, then your experience should be your guide.

With experience, you may find that lowering these thresholds may work well for your cat. When you have reached that stage, the following guidelines are suggested for Lantus and Levemir users following the Start Low Go Slow approach:

If the preshot number is far below usual preshot numbers:
  • Do you need to stay on schedule? Then skip the shot.
  • Do you have some flexibility with your schedule? Then stalling to wait for the number to rise might be a good option. Don't feed, retest after 30-60 minutes, and decide if the number is shootable.
  • Repeat until the cat either reaches a number at which you are comfortable shooting, or enough time has passed that skipping the shot is necessary.
If the number is near usual preshot numbers:
  • Look at your data to see what numbers you have shot in the past and decide what would be a safe, shootable number for your cat. Don't feed. Stall until kitty reaches the preshot number you've decided on and then shoot.
We usually don't suggest or recommend shooting a preshot number less than 90 mg/dL when following the SLGS Method. Remember that with SLGS, your goal is to achieve flat numbers that are greater than 90, so there is no need to push a cat into numbers lower than that.

When in doubt, please use the guidelines from the FAQs Q4.4 posted above.

Sometimes there are circumstances such as ketones present, an unusually low preshot number, a caregiver leaving the cat with a sitter, relatively high flat curves, loss of appetite, infection, a schedule change, ability to monitor, etc. which may call for adjustments to these guidelines and suggestions. Please ask for guidance if any of these or other circumstances present themselves or are of concern.​
 
If you give gravy from high carb, make it about a teaspoon.

Here are the directions on handling things:
http://www.felinediabetes.com/FDMB/threads/how-to-treat-hypos-they-can-kill-print-this-out.15887/
TREATMENT

During treatment for hypoglycemia, try to test every 15 - 20 minutes until you see the bgs begin to rise. Then continue to test until you are satisfied that the cat is out of danger.

LOW NUMBERS – WITHOUT SYMPTOMS
Retest glucose using a large blood sample to make certain you have enough blood, and if you still get a low number (40 – 60mg/dL or 2.2 – 3.3mmol/L) give food or treats until the blood glucose numbers rise to an acceptable level. If the cat refuses to eat even his/her favorite foods, you can syringe feed or administer a small amount of syrup.

Remember that syrup or any other sugared syrup/preparation will spike the blood glucose ONLY for a short period of time, so food is really important with mild and moderate symptoms. Dry food (high carbohydrates) will keep the blood glucose numbers elevated longer.

After a hypoglycemic episode cats may be more sensitive to insulin, so a reduction in dosage is generally required, especially considering too much insulin – whether due to dosage, inadequate food intake, or the cat’s changing insulin requirements – caused the hypoglycemic event in the first place. With moderate to severe episodes, your Vet may have you skip the next injection altogether.
IT IS VERY IMPORTANT THAT YOU DISCUSS YOUR CAT’S HYPOGLYCEMIC EVENT WITH YOUR VET, SO TOGETHER YOU CAN DECIDE UPON THE NEXT COURSE OF ACTION.

Always keep in mind that with low blood glucose and no symptoms, the BG you get is not as important as where it is headed. In other words, if you get a BG of 100 mg/dL or 5.6 mmol/L or less and there are still several hours or more before the insulin peaks, your need to watch your cat (and the numbers) carefully and take appropriate steps. With very low numbers and NO SYMPTOMS, a cat can be fine one moment and seizing the next.

BE PREPARED! KNOW THE SYMPTOMS AND KNOW THE TREATMENT!

​
 
Just tried to give him gravy and he won't touch it. He only wants purebites at the moment.

ETA he is acting totally normal other than not wanting food. No hypo symptoms at all.
 
that's good, but you still want him to get some kind of carbs. Are the purebites high carb?

Because Lantus is slower-acting, a hypo can last a long time and often symptoms don't appear until things are in a crisis. I think I'd try squirting some honey or karo in his cheek pocket along his gums if you can get some in.
 
Squirted some honey in. Followed it with a purebite and he was happy before he could register being pissed off.
 
He is now play with a magnet under the fridge. I think he enjoys watching me squirm. And I think he sensed me stressing too much over our crystal cat and he decided to up the anty.
 
Dry food can increase the amount of insulin needed by a huge amount. We had one kitty here, Scooter, who had 13 cats in the household. Everyone was sure that he wasn't getting any dry food, but lo and behold, when the dry food left the house, Scooter went from 5.5u to OTJ in an extremely long, long day and a half of constant low numbers and carbing him.

Can you recheck Chianti again? It must've been 20 minutes by now.
 
Ok now he's at 90.

Do we shoot anything? I don't want hypo, but don't want a huge setback because of his neuropathy.
 
I think the game has changed because of your dry food going away. I think if i were you, I would skip tonight and restart tomorrow at maybe 2.5u. But even with that, I would still test more tomorrow. It's hard to say what he might need as far as dose, now that he's not eating dry food.

He might bounce from getting in the 40's too, but even if he does bounce, I still would be more conservative on the dose because of the food situation.
 
Well there is still a tiny bit of dry out since we are struggling to get the crystal cat off it, but it is not much and when the bowl is empty it's empty.

Will skipping the dose make him instantly go really high? It's hard to see him take so many steps backward with his legs. Seems like anytime now that he gets in the upper 200s he starts really struggling with his legs again. Would a super low dose help buffer that jump or is it just too dangerous?
 
Unless you can delay your shot schedule quite a bit tomorrow, I think a skip is the way to go tonight. If you chose to delay and shoot, you can get back on schedule 15 minutes a shot, or 1/2 hour once a day. However, SLGS says no shot below 90 and even though he's there now, it's influenced by the honey. I'd test him again an hour after your last test. The effects of honey can wear off.

For reference, here is your last post: http://www.felinediabetes.com/FDMB/threads/5-29-chianti-amps-78-need-some-eyes-on-his-chart.138654/
 
Thank you for coming to take a look. We ended up skipping since it was so far off shot time. I'm just praying he doesn't go too high. What is your opinion on the am dose? Does 2.5 sound good? We also make the syringe switch in 2 days.

I am debating sucking it up and getting the zero carb mature health formula chow to have minimally out. I am having a very hard time getting our crystal cat to go wet and the others are not too happy either. I think it is going to take very gentle coaxing to make the switch.
 
I agree with Julie on the 2.5U, especially if you are still doing solo duty with Chianti while DH is away.

What brand is the zero carb chow? I have never heard of a real zero carb dry food. With crystal cats (I have one too) getting them to switch to wet is much better for their health.
 
The chow is the young again and they have a mature health version with lower minerals. I don't know that we would keep it long term but this transitioning is harder than we thought. The crystal cat is a very nervous cat and he prefers eating with his mother. She however will push him right out of his bowl of wet but won't do the same with the dry. When he eats the wet, if I manage to find a flavor he will take, he is constantly nervously looking up for other cats. But if you try to get him in a room alone, he has like ptsd and thinks he's going to the vet again. Since our vet said sometimes the blockages can result also from not eating and stress we're trying so hard to get him there without creating another problem. He is at least eating more wet than he was with the goal of getting him on as much wet as we can. I was already stressed out of my mind before trying to implement this change. It is proving very hard so I'm just trying to compromise the best I can for all the little bodies - human, feline, caprine, etc - in the house. :/
 
None of the Young Again are zero carb foods, but may be better than other dry food. I keep a Feliway diffuser going in the house to help the stress of my crystal kitty. The other thing that can help is glucosamine chondroitin supplements. My nervous guy is getting Cosequin. It is supposed to help the bladder wall.

Looks like Chianti handled the skip well.
 
I ordered the cosequin but have only successfully gotten it into him once so far. I wanted Chianti to take it too but he has rejected everything I've put it in. I have really weird cats none of them really eat anything that other cats eat. Or at least any of the cats I had as a child.
 
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