6/21 Goose AMPS 106, NS, +1.75 411, + 3 411. Dosing help?

[Anshu and Goose]

For continuity:

• Link to yesterday's post
• Link to intro/ health history on the main forum

Goose had another low-ish reading this morning.

• Last night PMPS 424 around 8 PM, then fed 69g fancy feast wet food, then given 0.1U at 8:50 PM.
• This morning, AMPS 106 around 8 AM, then fed 69g fancy feast wet food, no shot given. BG around 10:15 AM -> 411

I guess the main questions for now are:

• Is today's uptick still a bounce? Should we do something differently to help his BG stabilize?
• Are we correctly skipping doses (when we see below 150 pre-shot)?
  If he is bouncing upwards, giving insulin seems like it may (eventually) push him too low again and force another bounce. On the other hand, if he goes too high for too long do we have ketones to worry about?
• Is the current dose (0.1 U) appropriate ?

Thanks so much for the reply last night @Wendy&Neko . We've posted Goose's health summary on the health forum now. And thanks for the numbers for reductions with AT. Answering the other questions from yesterday's post in a reply below:

Q: Which syringes are you using? Some syringes have a reputation for inconsistent marking, leading to uneven dosing and odd numbers. Good to see you are using calipers now.

• A: We have been using BD Veo syringes (3/10 mL, 6 mm length, 31G) with 1 U markings. When we got to 0.1 U we switched to using calipers for dosing. We've ordered the UltiCare U-100 syringes with 0.5 U markings to try later this week (still with calipers).

Q: What food are you feeding, and how often? The reason I'm asking is that Goose's numbers don't look like they should for a cat on just a tiny bit of insulin. It may be that if you change how you feed him, you can prevent those sudden drops and get him to stay in safe numbers with a higher dose of insulin. He could also be really bouncy, which is almost universal for all newly diagnosed cats. And yes, you need to wait that out. However long it takes his body to become used to normal blood glucose numbers again, is what it'll take before the bouncing decreases. The only thing you can do is get him to a dose, with the appropriate feeding schedule, that maximizes how much normal BG numbers he sees.

• A: For the past 10+ days, he has been eating Fancy Feast Classic Pate Chicken - 207 gms based on calorie calculations for his age. We had to split it to 3 meals a day and puree it (with a sprinkle of FortiFlora if low appetite, or mirtazapine as appetite stimulant). Timings - 8 AM, 2-3 PM, 8 PM.

Q: On the morning of the 18th, the spreadsheet shows a 65 (which earns a reduction) and a 111. What's the story behind the two numbers?

• A: We measured his BG at 8:02AM -> 65, then fed him 69g FF, and remeasured at 8:35 AM -> 111. The BG 65 really worries us, we weren't sure if he would go further down, so we remeasured 30 mins after eating.

Q: Are you able to get any tests at night after the PMPS shot? Even a +2 or +3 at night will help us get an idea what the night time cycle looks like.

• A: We may not be able to do it consistently, but we will try from tonight to get those as often as we can.

 

[Wendy&Neko]

With Lantus, we typically test, then feed, then shoot insulin, all within about 10-15 minutes or so. since Lantus doesn't onset for a couple hours after the shot, so we can shoot when the head is in the food bowl or shortly after if we know he'll eat in the first couple hours. The timing above looks like you are feeding before testing. In general, you want to try to get a non food influenced test, so you test first - to make sure it's safe to shoot, then feed, then shoot.

For the 18th, I'm glad you delayed the shot before shooting. The 111 would have been a food influenced, but probably it was high enough that it was partly him coming up on his own. You might want to try getting some +1 tests on a normal day, just to get a better idea how much of a numbers bump he does get from food. I say normal day, because yesterday and today were abnormal. I'm actually wondering about today's test value. Typically cats don't go up over 300 points in 1.75 hours. If you get an unexpected low test, you could test again to make sure it's a valid number. With some meters, too little blood will give you a lower number than it should be.

Feeding - you want to try to feed the same timing or close to it in the AM and PM cycles. Some people use an autofeeder for late night feeds, or feeds during the day if they are away. He's been dropping over night, resulting in those low AM numbers. Possibly because he doesn't have any food past his PM meal. Smaller more frequent meals are better for a healing pancreas. If you can feed him in the evening a few hours after shot time, that might help slow those drops into the AM that are too low for you to shoot. I would also change the second AM feed to be a little earlier. Ideally you want to feed the majority of food before nadir. After that, the insulin effect is waning and additional carbs after then will cause the insulin to wear off even faster, shortening duration and making the following preshot higher. As for quantity of food, it's OK to feed a recent DKA kitty more food if he want it and will eat it. Normally diabetics, until regulated, will also want more food because the lack of insulin means they aren't getting the energy they need into their cells.

Keep on putting any ketone test results in the spreadsheet. We will ask for them frequently with recent DKA and having then in the SS means we won't ask all the time. Good to see today was negative. At this point I'd test daily. Ketones can go from trace to large very quickly.

 

[Anshu and Goose]

Thank you so much Wendy! All sounds good and we will get started on these suggestions. We may also just switch to TR fully since we are able to test more now.

Re: the test/feed/shoot. Thankfully i think all but 2 or 3 of our spreadsheet datapoints have testing first, then feeding, then insulin (it was just poor wording above). We have been budgeting a lot more time between test and injection (30 min to 1h) since the testing and feeding were both going slowly. I think now we could probably be doing it all in 15 minutes. He seems to be getting back to vacuuming up his meals.