73 PMPS - No shot?

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LovingErlend

LovingErlend

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Erlend is two weeks off DKA. She was on 2u the first week, now 2.5u the past week. Recent results:

3/25 AM +5: 234
3/29 PMPS: 334
3/30 AMPS: 232 // PMPS: 266

Today's PMPS = 73. Skip this shot and retest tomorrow, or administer a token dose like 0.5u so her body gets some insulin?
 
What type of insulin are you using, what is the lowest number you have previously shot and will you be able to monitor?

I am assuming you have enough strips and HC food/syrup in case you need that.

Also when did Erland last eat, you might want to try stalling if your schedule permits
 
Given that you have not previously shot anywhere near this low I think stalling is an option this time - providing that your schedule can take it because you will then need to be giving the next shot 12 hours from whenever you shoot tonight. This means do not feed and test again in 20-30 mins to see if the number is rising.

You need to be more careful about giving no insulin because of the recent ketone issues.

I'm going to get you the link to help you set up a ss for Erland which will be very helpful for people trying to help you and also great for your own use and the use of your vet - brb
 
She ate a little bit before I saw the post saying not to let her eat for a while. Just tested her again (1 hr after normal PMPS) and it's 69.
 
I think for safety's sake you may have to skip this one. It is not ideal given the recent ketones. However, if your schedule permits you can give her next shot earlier than her normal shot time, anytime you like that it is safe to do so, for eg four hours from now but make sure you haven't fed for the two hours prior to getting the BG test (this is because food raises the BG and a number that may appear to be safe but is food influenced will drop after the effects of the food have worn off).

You will then have to move back to her regular shot time by no more than half an hour per day though (you can move one shot per day by 30 mins or both by 15 mins each) so I don't know if that is feasible for you.

I have also cross posted you in the lantus forum so others may be along with other suggestions.

ETA: because of the way the shed works shooting a token dose with lantus will generally not have much effect on the current cycle but will mess with the cycles following
 
The recent DKA complicates things - 73 vs 69 could be a meter difference and she is holding steady. Could be that she sticks with lower numbers for awhile... I would retest again in an hour and see where you're at if your schedule permits it. Hopefully someone more experienced will be along soon to offer advice.
 
Thank you for the responses. What # reading are we looking for before administering her dose? The SLGS says decrease the dose by 0.5u, so we should shoot 2u at that point?
 
I have asked somone that knows more about SLGS to come and take a look but pls set up a ss as soon as you can it is really important for people helping to get the whole picture.

ETA: Marje is just checking on a couple of others in lantus land then she'll be right over to assist you :-D
 
I like the idea to stall but you want to retest every 20 minutes or so (no feeding) so you can catch her on the rise. I would agree that 73 and 69 are pretty much the same number.

Here is the Start Low Go Slow protocol:

Starting Dose
• 1u – 2u twice per day if kitty’s glucose was higher than 400mg/dL at diagnosis OR if cat is not on a low carb diet
• 0.5u – 1u twice per day if kitty’s glucose was less than 400,g/dL at diagnosis OR if the cat has been switched to a low carb diet
Hold the dose for at least a week
• unless your cat won’t eat or you suspect hypoglycemia
• test often for ketones
• be consistent in timing and type of food
• shoot every 12 hours
After 1 – 2 weeks at a given dose perform a curve every 2 hours
• if nadirs are more than 150, increase by 0.25 unit
• if nadirs are between 90 and 149, maintain the same dose
• if nadirs are below 90, decrease the dose by 0.25 unit
Click to expand...

So a reduction of .25u is normally earned when the kitty gets below 90. However, it concerns me to do this when you have a DKA kitty. What are you feeding her?

eta: are you testing her for ketones and if yes, are you using a blood ketone meter or diastix/clinistix which test the urine for ketones?
 
Here's the thing about DKA.....it's better to feed them higher carb food so you can get more insulin into them. How long has she been ketone free? Do they know what caused the infection since DKA is caused by infection + not enough insulin + not enough food/water. Is she still on antibiotics? Is she eating well and are you giving fluids or is she drinking enough on her own?

What were her numbers prior to increasing the dose? Did your vet increase the dose and why? Are you testing before every shot and also getting other mid-cycle tests?
 
Tested just now (+14 after AMPS shot), still 70. Should we feed high-carb gravy wet, wait for #'s to go up to 160+ and shoot 2.25u?
 
Marjorie: We're waiting on a urine test, but as far as I know she's been ketone free for 3 weeks. The causal infection was a UTI. She was on oral antibiotics plus a long-lasting AB injection (forget the name of the drug) until about a week ago. Waiting on the same urine test results to make sure there's no lingering infection. She is eating well, and drinking a good amount of water.

Vet had her on 2u post-DKA. Raised after 2 weeks of high preshot readings and nadir reading mid-200s. We'd like to test more often but it's difficult given it requires burrito'ing every time and she runs away, hides under the bed and becomes stressed/fearful of us as a result.
 
Here's the thing....she's flat and not dropping still. We don't feed HC to be able to shoot....that's not safe and shooting a carb- influenced number can backfire on you. If you prop her number up with carbs to shoot, then you could miss a reduction that she might earn.

I know you haven't shot this low before. This is a very safe number to shoot but you would have to stay up and monitor her and we don't really have the data on her to know how she reacts to carbs, etc.

Are you feeding her only low carb wet food? If so, I'd follow tight regulation guidelines for reducing because of her DKA history. That DkA makes them more prone to developing ketones again and it happens quickly. You don't need to wait
for the test from the vet. You can buy ketostix at the pharmacy and then hold them under her urine stream till wet....wait 15 seconds and then compare to the chart on the bottle.

You can shoot a reduced dose to get some insulin in her but you will still have to monitor her closely tonight ....as Serryn said, because of the cumulative nature of lantus, you'll still see a fairly busy cycle tonight unless the low numbers cause her to bounce up.
 
Thank you - I can monitor her all night. How many units would you recommend as a reduced dose?

EDIT: yes, only been feeding her low-carb wet food
 
Have you tested her again? Let me know and then I'll let you know about a dose.

Also...shooting this late...can you get her back on time 30 min a day?
 
If you are going to follow the TR protocol on reductions as suggested by Marje then you won't take a reduction now, kitties don't earn a reduction until they go under 50 on TR (also this is the level you would break out the HC food for) so you would shoot the same dose that you have been.
 
Marjorie and Gracie said:
Have you tested her again? Let me know and then I'll let you know about a dose.

Also...shooting this late...can you get her back on time 30 min a day?
Click to expand...

Yes gradually setting her back 30 min / day wouldn't be a problem.

Just tested (+15): 64
 
Normally we don't stall and shoot a reduced dose and normally I wouldn't suggest someone shoot this low the first time they get a number under 200.... I'd just have you skip. But the ketones worry me.

Serryn said she can stay with you and walk you through low numbers. Can you stay up and report them to her? If so, I'd shoot 1u and get a +.5. So 30 mins after you shoot, we need a number. And then a +1. I believe you said you have high carb food, syrup or honey, plenty of test strips...and will she let you test possibly every hour or so for four or five hours if need be?
 
Please be sure you watch her closely until she is up in the mid hundreds. Normally, I would never have a new caregiver shoot this low. I'll be up for your first number. And please don't let the 1u give you a sense of security .....she could still go low this cycle.....and will probably bounce way back up.
 
Once you shoot, please be sure you give her a good helping of food around 7% or so....we want her to start coming up.
 
Yes, same ReliOn meter & strips we've always been using. She's doing about as well as I could expect... good appetite, had fun cleaning herself thoroughly and batting at a toy then resting. Not resisting the burrito as much as she usually does. Hopefully that's a good sign that she's getting more used to it, and not a bad sign that she's not feeling well.
 
No, never <100. Could she have an underlying issue like an infection that causes readings to be lower, or can it only be due to the amount of insulin she's getting?

+1: 73

edit: ate more right after +1
 
Infections usually make the BG go up so what you are probably seeing is lower numbers as a result of the infection clearing up combined with the higher dose of insulin. It's not a bad thing though, a bit scary when you're not used to it but I rountinely shoot Vyktor that low and even lower because I know how he reacts to food and monitor him very closely. Those green numbers are great pancreas healing numbers :mrgreen:

See you at +2 - please don't get complacent yet, it's probably the middle of the night where you are but you still need to stay up and monitor.

You're doing a fabulous job btw :-D
 
Thanks for adding the food info, it is important for me to know when she eats as this has a bearing on her numbers.

Can you give me the approximate quantity she ate, I'm assuming it's LC canned.
 
Just realised that you haven't been using the ss so you probably have no idea what I mean by green numbers. On the ss numbers between 40 and 99 are colour coded green.
 
I'd say 0.75oz total immediately before & after PMPS, 0.5oz after +1, and just as I'm typing this she's back at the food bowl chomping :twisted:

yes, low-carb canned
 
So I'm thinking she is free fed then. Vyktor is free fed and it's a great warning sign for me that he's dropped too low because he suddenly cleans the bowl out completely when he is. If she seems to be suddenly ravenous like that then get a test immediately she's finished eating don't wait for whenever the next scheduled test is.

It's okay for her to eat, it should help her to surf and it's really important to get calories into DKA kitties. If she has no appetite and we need to boost her numbers we can do it with syrup instead of HC food.

Do you have any idea when she normally nadirs?
 
Yes she free feeds... thank you for the warning sign, that is good to take note of.

+2: 101

Edit: Her nadir on her formal vet curve was +5
 
Excellent looks like she is coasting along nicely but there is likely some food involved in that number, see you at +3

Any idea on her when her nadir is - I would check for myself but ahem - no ss and no I'm not suggesting you try and do one right now just gently nagging to make sure you do it later :smile:

ETA: I see we cross posted, have you done any at home? Since you're home testing it would be good if you could, it will save you some money and kitties can react a bit differently at home. Have there been any other recent curves and when was that vet curve - while she was in hospital with the DKA?
 
Yes I would very much like to do a home curve when we get a steady dose figured out.

Her formal vet curve nadired at +5 if I remember right.
 
LovingErlend said:
Yes I would very much like to do a home curve when we get a steady dose figured out.
Click to expand...

Taking the curves at home will help you figure out the dose issues much more easily than a vet curve. When a cat gets a curve done at the vets they are usually pretty stressed so the numbers the vet gets are nowhere near as accurate as the numbers you will get by doing it at home.

How long ago was Erlend diagnosed with diabetes was it at that same time as the DKA or before that?
 
Vyktors Mum said:
ETA: I see we cross posted, have you done any at home? Since you're home testing it would be good if you could, it will save you some money and kitties can react a bit differently at home. Have there been any other recent curves and when was that vet curve - while she was in hospital with the DKA?
Click to expand...

The curve was several months ago before her DKA episode (brought on by an infection whose symptoms she kept pretty well hidden, and her BG readings weren't even extremely high leading up to her hospitalization). No more recent curves, though will definitely be doing one once we're back at her normal dosage. I have this week off work, so hopefully will have on by the end of the week. Testing is easier now as we become more adept at the wrap & pokes, and Erlend has become a little less fractious.

How long ago was Erlend diagnosed with diabetes was it at that same time as the DKA or before that?
Click to expand...

She was diagnosed in August. The recent DKA was at the beginning of March.
 
They are so good at hiding anything that's wrong with them the little stinkers!

You probably know this already but just in case - you should give her a LC treat after every test whether successfully completed or not and make sure you approach her regularly for cuddles between tests so she doesn't think you've just turned into the pokie enemy! I'm surprised she hasn't settled down about it yet but maybe that's because you're not testing so frequently (is it just before shots you've been testing?). Vyktor sleeps through tests these days but I am quite obsessed with the testing so he's had lots of getting used to it :lol:
 
+3: 141

Try to give her treats afterward, but the problem is we can't find low-carb treats that she likes! Have tried a few different brands, baked chicken and so on. You feed raw chicken as a treat?
 
Vyktor used to have a few peices of diced raw chicken breast after each test which made him look forward to the tests but he is so cool about the tests now and so over the chicken that I don't have to treat him anymore (I don't know of anyone else that doesn't treat though no matter how long they've been doing it - Vyktor is just Vyktor :smile: ). I do offer if he looks like he wants something though and he always has a little after his shots. A lot of people use some sort of freeze dried chicken product that kitties seem to love - we don't have it in Australia.

I think it would also be worth your while trying to bypass the burrito process sometimes, alot of cats just hate to be pinned down. If I were you I would start by trying to test without the burrito or any restraint (Vyktor rarely requires any restraint but if he's tetchy I just wrap my legs around him) and then do the burrito if she won't cooperate. If it's the restraint she hates she will start getting the hint about how to avoid it. I have just realised that the burritoing means there is probably two of you having a pj party with her tonight for the test fest - very handy for staying awake! Are you holding up ok?

Has Erlend (such a pretty name, where did it come from?) had anything to eat since that bit after +1?
 
She ate a little just after +2, and some right before the +4. She's eaten a little over 2oz since PMPS.

+4: 245

Out of the clear for tonight? Probably looking at high AMPS tomorrow unless this kicks in late?

I think it would also be worth your while trying to bypass the burrito process sometimes, alot of cats just hate to be pinned down. If I were you I would start by trying to test without the burrito or any restraint (Vyktor rarely requires any restraint but if he's tetchy I just wrap my legs around him) and then do the burrito if she won't cooperate. If it's the restraint she hates she will start getting the hint about how to avoid it. I have just realised that the burritoing means there is probably two of you having a pj party with her tonight for the test fest - very handy for staying awake! Are you holding up ok?
Click to expand...

It was two of us until after +1... I've had to wrangle her for the last 3. Trust me, she will not even let us handle her ear no matter how hard we try :(
 
Sleep pass granted :-D Good job tonight.

Marje and I discussed it earlier and we are of the view that you should not reduce the dose for tomorrows shot unless you were facing low numbers (looks like that won't be happening!)- which will be 12 hours after you shot tonight. You can then start moving the dose time slowly back to your regular time as we discussed earlier

Please feel free to post in the lantus TR forum anytime (you don't have to be following the TR protocol although with a DKA kitty and since you are able to monitor closely I would highly recommend that you look into it). Experienced lantus users are floating around in that forum nearly 24/7

Sleep well - you earned it.

ETA: perhaps you can start just trying to rub her ears as often as you think about it not for testing - the rubbing of the ears was actually the bit that was hardest for me to get Vyktor used to, he hated me touching his ears. He's still not that keen on it but he is used to it now.
 
Thank you so much for your help Serryn (and Marje earlier!)... would be very stressed and lost without all the genuinely helpful people on this board. Erlend says thanks too flip_cat

Will work on getting solid SS entries and hopefully a curve this week. Hope Vyktor is doing well... by the look of his SS he is doing great!
 
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