9/1 Charlie +4 is 435. Should I be concerned

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EllieKozak

EllieKozak

Member Since 2014
Hello! Per the advice of the kind folks here I'm starting a new thread on our friend Charlie. His amps was 395 and his +2 was 414. I had to run out to get more food for him and just got the post about giving him some supplemental humulin. Too late now? I will be close by the computer all day so can tweak dosages etc whatever he needs. Thanks again.
 
Re: Charlie 8/31 it's a new day Thank God! BGs

I would now wait for the R until past his Lantus nadir. He's had some nadirs as early as +5. Since you're going to be home today, that should work.

Just to clarify, because there was a question about it last night, it looks from the spreadsheet like you started using Lantus on 8/25. That means today is day 7 on it. Do I have that right?

I'd get another test at +5 and let's see where he is then. I'm thinking then would work for an R shot. I'd like to try subq at that point, if you're willing.

edited to add your post from yesterday.
 
Re: Charlie 8/31 it's a new day Thank God! BGs

Hello Ellie, nice to see those numbers for Charlie and happy to know that things to seem to be better for both of you! Sending more lower BG vines and weight gaining vines for Charlie.
 
Re: Charlie 8/31 it's a new day Thank God! BGs

Regarding his Lantus dose - we'll hold that for a total of 4 shots or cycles, then if he's still running high, increase it.

How is Charlie feeling today? With possible ketones in the picture, we encourage 2 ketone tests per day if you can catch them. Also it's important to hear a "whole cat report", meaning how he is overall. If a kitty is purring, peeing, pooping, preening and playing, that's important to know.

Is he eating normally today?

eta - did you increase his Lantus dose this morning to 3.5u? The 3.25u was based upon how low the 3.0u had gotten him.

It's important to not change doses more often than every 4 cycles at a bare minimum. Ordinarly it's at least 6 cycles, so the 4 cycle plan is already accelerated.
 
Re: Charlie 8/31 it's a new day Thank God! BGs

Hi Ellie,

Wasn't sure if you saw my post in the thread from yesterday.

Again, wanted to say how sorry I am that you lost a kitty yesterday. Angel wings and hugs.

And here is the post for all to see regarding IM dosing,

On two different occasions when I have used R, the vet recommended giving it IM. The first was a foster I took who turned out to be an acrocat. He has since been adopted by someone who handles acros.

The second was recently after the DKA and the restart of Lantus with one of my current diabetics. So, I have had a bit of experience with R given IM. This type of dosing does impact the time of onset, peak and duration because is causes a quicker absorption of the insulin.

In humans, R onset is 20 min, peak is 2-4 and duration is 5-6 hours. In cats the timing is affected by the higher metabolism rate. What I determined with R in the 2 cats where I was using it for a period of time is that onset is closer to 10 minutes, peak 1-2.5 and duration is about 4 -4.5 hours. Given these numbers, R IM which is a little faster can be given at the time of Lantus and after +8 with little crossover of nadirs (peaks). Basically, these facts bear out Sienne's suggestions as to timing. The IM dosing is apparently a bit more stable dosing method.

Hope this is helpful.

Claudia
 
Re: Charlie 8/31 it's a new day Thank God! BGs

Hello! He peed while I was in the shower (lil devil) but I stuck the strip in the litter (scoop able was still moist). I don't know how accurate that is but it showed no ketones. Will try again to get fresh sample as he's had his 100 mls sc fluids so no doubt he will have to go again soon. He is eating purring socializing and preening but not playing. I think I understand the reasoning behind when not to give humulin thanks to you all so I'm looking forward to his next bg at 130 est. talk soon! And tomorrow afternoon will be one week since starting lantus. He got his last prozinc Monday morning.
 
Re: Charlie 8/31 it's a new day Thank God! BGs

I'm advocating for sub-q injections for a couple of reasons. One is that it's going to be more comfortable for him. Secondly, looking at Charlie's ss, on 8/29, when he got the IM R at +7, he went from 605 to 303 in one hour. That's far too fast of a drop in blood sugar. While it moved it into a better range, at the same time, a drop that fast can cause a bounce because the cat's body perceives that it is having a serious hypo event. Ellie, here is a post (second post in thread) that describes a bounce. A slower onset is better, in my opinion.

At any point after his L nadir it's going to be safe to give the R.

I'm not sure what time you shot, Ellie, but last night it was at 6:30pm. Were you at 6:30am again today? If so, that puts him at +3.25 now, which i believe is too late in the L cycle to safely give an R injection. I would wait until after +5 or +6, then give it sub-q so that it doesn't cause him to plummet.

The 414 AT is about equivalent to a 307 with a human meter.
 
Re: Charlie 8/31 it's a new day Thank God! BGs

I also think I would switch to subq R if his ketones are down and we are getting the Lantus dose up. We've helped many DKA kitties once they are home with Lantus and subq R injections. Fast drops from R can result in some really ugly bounces.

On a different note, your vet has you adding potassium to his LRS. LRS already has potassium added to it. Obviously DKA can cause electrolyte imbalances. Was his Na+/K- ratio way off and his K low? It's not uncommon for diabetic cats to have low K because the insulin pushes the K into the cells. I'd just be sure to get his bloodwork done again sooner rather than later. While you want to get his electrolytes back in balance, you don't want to overdo it on the K.
 
Re: Charlie 8/31 it's a new day Thank God! BGs

hello. we have 350 at +4. Someone asked what time he got is insulin and someone mentioned 630, not sure of the time difference factor but I gave it at 930 am/pm both yesterday and today, eastern time. He is going in Tuesday for more bloodwork I will recheck his electrolytes then. He just ate again as well :) I will test again in an hour
 
Re: Charlie 8/31 it's a new day Thank God! BGs

looking good. thanks for clarifying the time - that would be 6:30 in pacific time - my time zone.

if you could update your subject line - you edit the first post in the thread - so it reflects updated numbers, that lets everyone see what's going on without having to open for each test.

so right now would read:

8/31 Charlie amps 395 +2/414 +4/350 AT

Including the AT notation reminds us all that these are on an AT, and about 30-40% higher than the human glucometers. 350= ~259 on a human meter, so he's not doing too badly. As soon as his BG numbers start to rise, you have the option of giving the R at any point from then to pmps. I think I'd stick with the 2uR again. I'd get hourly tests in again so we can see what it does in the latter half of the cycle. Giving it then provides a lower number for the Lantus to start from, which is good. Lantus works best in lower numbers.

For tonight, I'd stick with the 3.5u you gave this morning. Lantus likes consistency, meaning that when you change Lantus doses, it's a bit like rocking the boat - you can see New Dose Wonkiness and the depot has to readjust to the new dose - so you want to hold the L dose constant as much as you can. If you aren't familiar with the depot, it's an important part to understanding how Lantus works. This sticky explains it - i especially like the link that explains the difference between Lantus and Levemir that's down a couple of paragraphs from the top of the page.
 
Re: Charlie 8/31 it's a new day Thank God! BGs

Great!! Also glad you are having the labs checked again soon.

I think Julie's spot on with her suggestions.

When you have a minute, could you please go back to yesterday's post and take of the 911? Usually we take them off as soon as someone responds to you :-D thanks so much!
 
Re: 8/31 Charlie amps 395 +2/414 +4/350 AT

perfect - he's relatively flat at 367 compared to the +4/350, perhaps slightly up. Meters can have a variance of 20% legally, so this is pretty much the same number as +4. So at your convenience between now and pmps, you can give the R. Choose a time when you can again monitor every hour.

I'll keep watching in to see what's going on. When you shoot the R, would you please add it to the subject line?
 
Re: 8/31 Charlie amps 395 +2/414 +4/350 AT

oh - and when you update the subject line with new tests, you have to update the subject line from the first post in this thread. It's the only one that shows on the main page. That's where people will be watching you.
 
Re: 8/31 Charlie +2/414 +4/350 AT +6 401 time for humulin?

this is fine - he's past the L nadir and he still has room to safely move down from here.
 
Re: 8/31 Charlie +2/414 +4/350 AT +6 401 time for humulin?

We have 346 at +7 with 2 units humulin given sc at +6. He seems great still.
 
Re: 8/31 Charlie e 346 at +7 with 2 units humulin given sc a

Hi there :cool:

Glad to hear ketones are negative.

Julie has provided you with great info.
One thing I'll add at this point is that you develop an R scale to guide you in your dosing decisions.
You develop it as you go along, based on the Charlies reactions and always with his safety front of mind.

See the 2nd tab of BKs ss for some examples of R scales.
 
Re: 8/31 Charlie e 346 at +7 with 2 units humulin given sc a

I'm wondering and a little worried about the supplemental humulin after tomor when I have to go back to work. I'm taking him with me Tuesday for that GI Panel and I'm off Wednesday but my schedule dosent normally allow me to go home to give the humulin. Do you think there is a possibility of him being able to hold the lantus dose after this crisis passes? The other option would be to bring him to work with me every day and I don't know how much he'd love that. What do you guys do in a case like this?
 
Re: 8/31 Charlie e 346 at +7 with 2 units humulin given sc a

We try to get the lantus dose to the best possible fitting dose as safely and as quickly as we can per the TR protocol, generally. The TR protocol is a guideline and sometimes we need to do something different for a specific cat. But first we'd have to see that the protocol wasn't working for Charlie. you can't shoot R and leave because R doesn't always have the same effect each time you shoot it.
 
Re: 8/31 Charlie e 346 at +7 with 2 units humulin given sc a

Hello again :cool:

EllieKozak said:
I'm wondering and a little worried about the supplemental humulin after tomor when I have to go back to work. I'm taking him with me Tuesday for that GI Panel and I'm off Wednesday but my schedule dosent normally allow me to go home to give the humulin.
Click to expand...
There are 7 cycles between now and Thursday AM, which is great since you will have that much more data. There is not a way to know now where he will be then but I will say the data you collect between now and then will go a long way in helping you figure out a strategy for your going back to work.

EllieKozak said:
Do you think there is a possibility of him being able to hold the lantus dose after this crisis passes?
Click to expand...
The question is when is it no longer a crisis.
Personally I recommend CGs of ketone prone kitties to be extra vigilant for the first year following the most recent DKA episode.
An ounce of prevention is worth a pound of cure.
 
Re: 8/31 Charlie e 346 at +7 with 2 units humulin given sc a

The goal is to get the Lantus dose adjusted so it's getting Charlie into good numbers.

I'm uncertain if whatever infection was present with the DKA has been resolved. Ellie, do you think it has been? That's one of the 3 legs that cause ketones. Not enough insulin + not enough food + infection or inflammation.

Are you open to using R with his shot again tonight, or are you exhausted? We're talking about R dose for him, so would you check here before you shoot?
 
Re: 8/31 Charlie e 346 at +7 with 2 units humulin given sc a

How is Charlie tonight? If he seems pretty good and no ketones are present, what do you think about going with the 3.5u lantus and 2.0 u R sub q again tonight? Probably getting a +4, 6, and +10 in the pm cycle. How does that sound?
 
Re: 8/31 Charlie pmps 335 and +1 is 395

Hi! His pmps was 335 and he got 3.5 u L. His +1 is 395. I dozed off for a bit I apologize. I am willing to do the humulin yes. I'll give it now. Thanks again for the support
 
Re: 8/31 Charlie pmps 335 and +3 324 doing well update

8/31 Charlie pmps 335 and +3 324 doing well just ate more. Will do sc fluids in a few min. :)
 
Charlie +4 is 435. Should I be concerned?

+4 is 435. Should I be concerned? He ate quite a bit about a half hour ago I'm sure that plays into it?
 
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