7/9 Noodle AM...+12 43 +12.5 56 +13.25 75 +14 73 +14.5/PMPS 76 - BCS .5u - +1 82 +2 125 +3 151

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Patricia & Noodle

Patricia & Noodle

Member Since 2015
http://www.felinediabetes.com/FDMB/...3-pmps-176-2-25-120-3-25-102-4-25-114.140311/

Ahhhh Noodle... back to your old tricks! Quick update: I've kept her at this F1.5U dose for longer than I should with her dental coming up and we saw some promising greens yesterday. We had some hairball issues this morning and she didn't eat as much as she should have (~50-60% of her normal calories). Life intervened and I absolutely had to leave after the +4.5, so I left food out and hoped she'd eat a little more.

Fast foward to PMPS and she's at 43, I already fed her regular PMPS LC + 1/2 tsp 19% HC to try to bring her up. I want to give her a shot tonight because we will have to skip in the morning for her dental and I don't want to go 24 hours without insulin. Because of the skip tomorrow AM, her shot time tonight doesn't matter as much. I don't think I want to go too late because of the procedure in the morning, correct? How do I proceed tonight? Since I gave food, do I wait until 2 hours post food for insulin? If she starts to skyrocket can I get away with giving it a bit earlier (I've done a BCS that way before, 5/1)? Dang it, Noodle!

I'm also scared she will be low tomorrow AM before the procedure, but that's secondary, I don't think that's realistic given the past times she's thrown a low number at +12.
 
I have no basis in saying this and it's just my gut talking but I would skip tonight. Chances are you will be able to give at least a reduced dose tomorrow night. See what those with more experience say. With Max I skipped the morning of his dental and he ate in the afternoon but not a lot so that night I gave a BCS shot. Sending dental vines your way.
 
tiffmaxee said:
I have no basis in saying this and it's just my gut talking but I would skip tonight. Chances are you will be able to give at least a reduced dose tomorrow night. See what those with more experience say. With Max I skipped the morning of his dental and he ate in the afternoon but not a lot so that night I gave a BCS shot. Sending dental vines your way.
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Thanks, Elise. That's definitely an option I've considered. I guess with her history of DKA I just worry about skipping shots, especially knowing it will be two in a row and maybe a BCS tomorrow night. I've got at least 90 minutes until I can consider giving a shot, so there's time for other opinions, too!
 
carfurby said:
Is she eating okay? How late can you feed her tonight?
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I JUST thought of that aspect... I can feed her until midnight. She's eating alright, was super hungry at that 43, but wasn't as voracious for her second round of LC.

So +14 is 8:30PM, I could feed until PM+3.5 if I shoot then... something to think about. Thanks for thinking of before I did, Carla!
 
If it was me, I think I would skip the shot because she zoomed down today and you can't feed all night. I know you're worried about ketones, but you can mention it to the vet tomorrow before her dental. She could bounce back up tonight, but I wouldn't want to take that chance. If she's high in the morning, you can give some insulin. My vet always said to give half the dose the morning of the dental.
 
carfurby said:
If it was me, I think I would skip the shot because she zoomed down today and you can't feed all night. I know you're worried about ketones, but you can mention it to the vet tomorrow before her dental. She could bounce back up tonight, but I wouldn't want to take that chance. If she's high in the morning, you can give some insulin. My vet always said to give half the dose the morning of the dental.
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Yeah, she told me to fully skip, but that was on the assumption that I would be giving insulin tonight. She may respond to an email now, but won't be at the office in the morning when I drop her off.
 
If you don't get a response to the e-mail, can you ask them to have the vet call you before she starts the dental when you drop her off tomorrow?
 
carfurby said:
If you don't get a response to the e-mail, can you ask them to have the vet call you before she starts the dental when you drop her off tomorrow?
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I guess I could.. but that wouldn't really help since I'd be emailing about giving a half dose in the morning. Plus, I'll be in a meeting from 9-1!
 
Vets give different directions about giving insulin the day of the dental. I would not give any tomorrow unless your vet says to
 
So she's up a bit from the 43 at this point, I still have at least 45 minutes before I'd consider her safe and outside of food influence... maybe a 1U BCS if she's over 100-125 at +14? Thoughts?

Getting closer to the time I'd have to shoot... @julie & punkin (ga) I noticed you're online, any chance you can take a look?
 
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With her surfing green at +14, no food since +12.5, I think I'm leaning towards skipping. It pains me more than it usually would. I think I worry about her getting to the vet and being sky high tomorrow morning and feeling like they'll think I'm a complete failure as a cat parent.Maybe I'll check her at +14.5 and if she still isn't over 100, I'll go with a skip. It would only leave 3 hours to get food in her before her midnight cutoff. :(
 
Did you take a look at the Shooting & Handling Low Numbers sticky? Here is the part on what to do when you're faced with a low preshot.

I'm still looking. be right back.

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 a cat is lower then usually the best option is to wait until they are at a shootable number to shoot. What constitutes a shootable number will vary by cat, but we don't suggest or recommend shooting a preshot number less than 50. While you’re waiting, the depot 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 40s 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
 
julie & punkin (ga) said:
  • When 40s 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?
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:facepalm: I haven't read that sticky in so long I completely forgot this section... d'oh. I just had a "feed the 40s" recollection in my head and wanted to get her up because 43 *feels* low enough after not hitting those numbers in a while. Like Elise said, the issue is with her dental tomorrow, I can't feed after +3 if I shoot at +14.5 in 10 mins. (It's 8:50 EST now, can't feed after midnight, dental will probably be earlier in the AM since my vet would like the vet doing the procedure to do it while she is in office and she leaves around noon).
 
Next time, I'd just feed low carb with the 40's and wait for her to rise on her own. HC confuses the issue.

I think she's clearing a bounce tonight. My guess is she's going to bounce from hitting the 40's since she hasn't been there for a while.

One option is to wait the 2 hours after the HC, then give a reduced dose, say 0.5 or so. I did get the issue about the dental, and understand why you don't want to have to feed late. I'm thinking 0.5u just to get something in there without it being enough that she would be likely to go back into green numbers tonight.

It must be late for you though, so if you want to skip that's a valid option. Anesthesia can drop the blood sugar though, so it's better to have her starting higher than too low.

So maybe skipping is the best choice. It's up to you - I'm guessing you have a gut feeling about what you want to do . . .
 
julie & punkin (ga) said:
Next time, I'd just feed low carb with the 40's and wait for her to rise on her own. HC confuses the issue.

I think she's clearing a bounce tonight. My guess is she's going to bounce from hitting the 40's since she hasn't been there for a while.

One option is to wait the 2 hours after the HC, then give a reduced dose, say 0.5 or so. I did get the issue about the dental, and understand why you don't want to have to feed late. I'm thinking 0.5u just to get something in there without it being enough that she would be likely to go back into green numbers tonight.

It must be late for you though, so if you want to skip that's a valid option. Anesthesia can drop the blood sugar though, so it's better to have her starting higher than too low.

So maybe skipping is the best choice. It's up to you - I'm guessing you have a gut feeling about what you want to do . . .
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My gut is all over the place! It's 9pm for me now, staying up isn't a problem, but I can only feed her for 3 more hours. I definitely think she's going to bounce, which makes me worry that she will be in the 400's tomorrow morning without anything on board. Anesthesia may drop her... but by tomorrow night I could still have to give a BCS after not giving any for 24 hours. Coming up is 2 hours after the 1/2 tsp of HC (less than she normally gets and 19% when I've typically used 21-22%). I'll grab a test and post in a minute.
 
I gave .5u, enough to have some on board, half the BCS I had in mind, and hopefully enough to keep her off the red floor in the morning which is my main fear. I just can't bear the thought of a full day in 400s and not eating much if at all.
 
Hope it will work out - maybe even that little bit will be enough to help her out tomorrow. I hope you don't have to deal with low numbers tonight!
 
julie & punkin (ga) said:
Hope it will work out - maybe even that little bit will be enough to help her out tomorrow. I hope you don't have to deal with low numbers tonight!
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Paws crossed! I feel ok since she's basically just been surfing for an hour and a half. I may put some HC in the rest of her meals for the night just to keep her up. In my gut, I don't think the .5u is enough to pull her back down from that.
 
I don't think you need to give her hc until just before you go to bed, if she needs it then. If you want to give it to her at +3 if she looks like she's dropping, I'd give it then. Often when a cat gets a significantly reduced dose like this i've seen it peter out about +3 and just stay flat. No way to know if Noodle will do that, but i'm just thinking i wouldn't carb her up before she needs it.
 
julie & punkin (ga) said:
I don't think you need to give her hc until just before you go to bed, if she needs it then. If you want to give it to her at +3 if she looks like she's dropping, I'd give it then. Often when a cat gets a significantly reduced dose like this i've seen it peter out about +3 and just stay flat. No way to know if Noodle will do that, but i'm just thinking i wouldn't carb her up before she needs it.
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Thanks for all the advice. Your input on all of this is so, so appreciated. I really was at a loss when I got that 43 at PMPS. She always does that at the worst possible time!
 
Fingers and paws crossed that she stays flat for you. I was wondering if she were to drop if you could give straight Karo even later if needed. I wouldn't think that would cause problems tomorrow since it's not food. I know you won't need it but was wondering if that would be a possibility. I'm so glad Julie was around to help you. :bighug:
 
tiffmaxee said:
Fingers and paws crossed that she stays flat for you. I was wondering if she were to drop if you could give straight Karo even later if needed. I wouldn't think that would cause problems tomorrow since it's not food. I know you won't need it but was wondering if that would be a possibility. I'm so glad Julie was around to help you. :bighug:
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You know, I thought that, too. Luckily her vet's office is a VCA with an ER, so I can call anytime to check in that case (anti jinx!). Worst case scenario, I have to feed her and we reschedule. It wouldn't be the end of the world. Although I could do without her drooling ASAP. She needs this dental badly!
 
It doesn't look like she needed it, but FYI, when Cinco was going in for his eye removal, I asked what to do if he went low after the food cut off, and they said to rub karo on his gums. So I guess that's okay before anesthesia.

Sending mega good dental vines for Noodle and :bighug: for the bean.
 
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