8/23 Checkers AMPS 430, 85/+10 ???

Chris and Checkers

Chris and Checkers

Member Since 2021
Hi,

I am new to lantus. Checkers was initially Dx in May and put on Prozinc. He went OTJ on 26 July. I wasn't home testing during this time just went to vet for testing and advice. The vet gradually reduced his dose until he said it was okay to be OTJ.

Well that didn't last long, on 17 August he stopped eating and didn't look too good. Tried making an appointment at my vet but couldn't get in for a couple of days. I manage to test his urine for ketone, with ketosis and got moderate. Took him to an ER vet and it was DKA.

He came home Friday and was put on Lantus and a Freestyle Libre sensor was put on him so I am checking his BG a lot. I was told to give 1unit Lantus at 8pm Friday evening after he ate. Well he didn't eat. I called back the vet, they said not to shoot and try in the morning. In the morning he ate a little so I gave him the insulin. I also gave him some Mirtazapine to help with his appetite. Since then he is eating okay, mostly a bit through out the day.

Sorry for the long preamble. The problem is, I can't dose him at 8 am/8pm because I have to be at work at 7am and there is no one else to do it.

Here is my spreadsheet, I hope you can see it
Https://docs.google.com/spreadsheet...xhNRqwtcCprkqQHBA2VF9TqbNqg/edit?usp=drivesdk

My questions are:

Is the change from 430 to 85 in 10 hours normal??? Is this how Lantus works, the first two days were nothing like this, the lowest on day one was 326 and day two was 239. What will happen tomorrow??

Do I need to worry about his next dose at 7pm??

Am I doing something wrong?

I have to go back to work on Thursday, I am afraid of leaving him alone I his numbers go so low.

I am trying to feed him as much as I can, he is a skinny guy and rather fussy.

Help, I am overwhelmed.
 
With DKA it’s never a good idea to skip. He needs as much food, water, and insulin as possible. Lantus doesn’t usually start working until about +2 so you have time to get him eating. You weren’t given anything for nausea? You need either cerenia, a veterinary medication or ondansetron, a human drug that most vets don’t carry but you can get an RX and go to a pharmacy.

He had a late nadir. He should start to come up by pmps. You can not shoot 30 minutes early and only if he is high enough to shoot. Lantus is a depot insulin and the initial depot takes about 7 days to build.

What are you feeding him, wet or dry food or both? Is his food low carb? It would help to have a signature giving that information but you can do that later. What time zone are you in? How long ago did you shoot? It’s just Monday so we can get him at a better shot time by then.
 
I am in west coast of Canada, right now feeding Purina DM as it is what he ate at the hospital. I just did his +11, it is 157 (8.5). Next shot in less than an hour. I needed to go down from 8am to 6am in few days, ver at hos7said it was okay.
 
We usually suggest not moving more than 30 minutes every 24 hours. Moving more can act like an increase.

Is the DM dry or canned?
 
Wasn't given any other medication than the insulin when he was discharged. I had a bit of the Mirtazapine from when he was first DX as he had pancreatitis. I just checked, his BG is 165 so it is increasing.

Wow, this is challenging is 15min okay?
 
He’s coming up on his own so that’s good. Is it about 6:30 where you are? Could you shoot at 7:30 tonight and then 7:00 tomorrow night?
 
So 7:30 tonight. 7am Tuesday. Wednesday ?6:45am, Thursday 6:30? On Thursday I will have to run off to work right after I shoot, is that safe?
 
Hi Chris and Checkers and welcome to the forum.
@tiffmaxee has given you some good advice.
I would not shoot more than 30 minutes a day earlier either.
I would definitely ask the vet for some cerenia and or ondansetron in case of nausea as most post DKA kitties have some degree of nausea for a while. Also ask for an appetite stimulant but make sure you give the antinausea medication first before the appetite stimulant.
I would offer snacks of food every couple of hours as it is very important that post DKA kitties eat 1 and a half times as many calories as they normally do. If you need to work, think about getting an automatic timed feeder.
Also did the vet tell you to test daily for ketones?
To do this you need a bottle of Ketostix or DiaKetostix which you can buy from Walmart or a pharmacy. Collect a urine sample and follow the directions on the bottle. This is also very important as it tells us if we are giving enough food and insulin to keep the ketones away.

Also offer extra fluids. Sometimes subQ fluids are needed. Ask the vet about those.
Bron
 
Because food is so important, if Checkers won’t eat the low carb food, offer him other food even if it is higher carb food as eating any food at this stage is more important than eating just low carb food. Getting in to low carb food can be sorted out later if needed.

A cycle is every 12 hours. Each time you give insulin starts a cycle.

Have all the ketone tests been negative? can you put the results into the remarks column Of the SS please? Thanks Bron
 
Every 12 hours is a cycle. It begins with the shot.
Have you had a chance to read the stickies at the top of this forum? There’s a lot to learn and we will help. While you are off from work it’s a good idea to read those stickies. You will have lots of questions and we will do our best to answer them all.
 
He’s probably bouncing from dropping lower than he’s used to and that is to be expected. That means his body releases glucose because it thinks the bg is too low. As he tests used to having bg in the normal range he won’t bounce as much hopefully. Don’t be concerned if he stays high tonight and even fur several cycles. Bounces can clear quickly or take 4-6/cycles to clear.
 
So I am still freaked out about the degree of change in the BG curve. If the nadir goes into the LO bg range will it always go up or is intervention? I am not sure I understand what is happening.

I shot at 7:15pm and added the times I have shot to the spreadsheet.

I have an appointment at my regular vet on Wednesday, I will ask for anti-nausea and some subQ fluids. I am also thinking about going back to Prozinc.
 
You need to get used to how lantus works. It’s a depot insulin and the initial depot takes about a week to build. That’s when you find out if the dose is working or needs adjustment. You need to give it a chance. Please read the yellow stickies.
 
Why do you want to go back to prozinc?
Lantus is a great insulin for cats. You are just not used to have it works yet. If I were you, I would leave it fro a while and see how you go.
 
Chris and Checkers said:
So I am still freaked out about the degree of change in the BG curve. If the nadir goes into the LO bg range will it always go up or is intervention? I am not sure I understand what is happening.
Click to expand...
The normal range of BG numbers on the freestyle libre are 50-120 (2.8-6.6)
The 85 you got earlier today is a very safe number and it is showing that the insulin is working well.
The higher numbers from the previous two days could have been from bouncing or just because the full effect of the dose was not felt yet.
The beauty of Lantus insulin is that once the cat settles down into a lower range, the curve is a lovely flat curve.
Don’t freak out about that drop…..just be aware that you can control drops by feeding food. If needed you can feed higher carb food to get the BG to come back up more quickly. But if you are feeding every couple of hours which you need to be doing for the DKA (except for the 2 hours preshot) the food should slow any drop.
 
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