9/18 Shanti AMP 254 +4 52 +5.5 71

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Shantismom

Member Since 2014
Tested at +4 number was 52. Tried again and even lower. Gave him honey and food then he came out for some food. Got a new tester in case mine was faulty, tested +5.5 got 71. More honey and now I am here.
Vet says wait until night shot to test but I know better, what I don't know is what dose to give him tonight. If he is here do ___. If lower than ___ no shot? And my husband wonders why I am so stressed!
 
Re: 9/18 Shanti AMP 427 Not eating

I am hoping someone who gives advice stops by soon. With that said, if it were me, I would hold off on the shot if you think Shanti isn't going to eat. Are you going to be around today?
 
Re: 9/18 Shanti AMP 427 Not eating

I agree with holding off on the shot for now and taking him to the vet as soon as they can see him. Have you been able to get a ketone test?

Sending prayers that Shanti feels better ASAP. Please keep us posted :YMHUG: :YMHUG: :YMHUG: !
 
Re: 9/18 Shanti AMP 427 Not eating

Shanti needs to eat in order to give shot.
I looked back at your other post looking to see if your vet also Rx cerenia along with the mirtazapine, its an anti-nausea. When Lola first started mirtazapine it did not seem to work, then my vet Rx cerenia. After the cerenia took care of the nausea and with the mirtazapine, Lola was a madwomen eating machine. Has the mirtazapine increased shanties appetite at all since giving it.
 
Re: 9/18 Shanti AMP 427 Not eating

Now, see, I have a different thought - the glucose is high enough that I think he needs some insulin to bring it down. Because of the erratic appetite, of course there is a concern about too much. Maybe just give 2 units.

And the erratic eating/glucose levels is difficult to manage with just Lantus, because Lantus works best with nice consistent doses. It may be time to consider adding a supplemental, short-acting insulin to knock down the highs when they happen, since they are not consistent.
 
Re: 9/18 Shanti AMP 427 Not eating

Looks like you are getting good advice from the experts. I just wanted to send you and Shanti some hugs and let you know I'm thinking and praying for you both .
 
Re: 9/18 Shanti AMP 427 Not eating

Actually, I did forget that Shanti is also on baytril...that certainly could be affecting his appy. He very well could use an anti-nausea med as well, at least until he gets through this course of baytril. My Trix is on cerenia long-term, and it has done wonders for her.

Definitely speak with your vet about this....one step at a time. Let us know what the vetty says.
 
Re: 9/18 Shanti AMP 427 Not eating

Yes, I mentioned anti-nausea medicine the other day. I think he needs cerenia daily until he gets over this. Either the antibiotics or the infection if there is one or possibly pancreatitis if no other reason may make him nauseous. I think I remember that your vet gave him a shot for nausea and then he was acting normal. If that is correct then his vomiting once it was out of his system is likely because he isn't getting more nausea medication. When you see your vet I would ask about a fPL test for pancreatitis and make sure you go home with cerenia. It comes as a sub-q injection or a pill. I hope you get to see your vet this morning.
 
Re: 9/18 Shanti AMP 427 Not eating

Shanti got cerenia, fluids and they did all the blood panels. He came home, ate some. Got his shot. They tested his BG and they got 254 about 2 hours after I had a 427. I am using Relion and all his numbers are from what that says, are these numbers not the real one because it is a human glucose meter? Maybe done of these numbers were actual.
I couldn't possibly more stressed out.
 
Re: 9/18 Shanti AMP 427 Not eating

I'm glad Shanti got cerenia. Did they send you home with some? If not you need to get some as it only lasts for 24 hours. You can get either the shots or pills to give at home. The human meter reads lower than the vet ones. My first Relion seemed way higher so I complained and they mailed me another one. It works much better. They also have a solution you can use to test it but you have to call and ask for it. I would ask for a new meter. They will send it with the solution. The stress of the vet visit could have caused the BG to go up.
 
Re: 9/18 Shanti AMP 427 Not eating

Marlene

I've been out of town and haven't had a chance to welcome you and Shanti to the board. I know this is very stressful when he's not 100% his self but try and take a deep breath and we will help you regroup.

I'm glad he's eating and feeling better. Did they give you any cerenia to take home? If it were me, I'd ask for an ondansetron (zofran) prescription and some cerenia. If you can pill him, you can get the cerenia in pill form but the injectable in both is better. The ondansetron is an awesome med for nausea. I think it works much better than cerenia for nausea (cerenia is primarily for vomiting). I got a script from my vet for the injectable and purchased it at ThrivingPets.com. If you scroll down, what you want is the 20ml vial of injectable.

Shanti's BG was coming down on the night of 9/16 and we don't know how far down he came but it looks to me like he is in a bounce. Sometimes when they bounce, they go high before the bounce clears. We call this a "high before the break". It's possible that is what Shanti is doing. Or it's possible he was in pain and not feeling well this morning and the meds helped him. Hard to say but on the SS, it looks like a high before the break.

I want to be sure when you say "got his shot", you mean he got his insulin? His AMPS on the subject line and also on his SS should be the BG before the shot. If the 427 was at +12 but you didn't shoot that number, then you can put it in the previous cycle +11 column and put "427 @ 12". Then in AMPS, you would put the BG you got right before you shot and then put the hours since his last shot. For example, if you shot 1 hour late, in the AMPS, you would put "xxx @ +13" with XXX being his BG.

One last favor to ask, please. Could you please take the 911 down? We ask that once someone has responded to your question, you clear the "911" or "?", etc. Several of us are checking the condos and scanning for questions and if one of us has answered, there's not usually a need for another of us to also do it. We want to be sure you are taken care of though! :-D :-D :-D
 
Re: 9/18 Shanti AMP 427 Not eating

The 427 was before his insulin, because he was vomiting and not eating I held off, he received his insulin 2 hours late at 10:00. He did get an injection of cerenia and brought home pills.
At the vet they tested him and he had a BG of 254, that was two hours after I had tested him and got 427. That is why I am wondering about my glucose meter, if it is reading too high I am posting the wrong number and decisions are being made on those numbers. I would have taken down the 911 but I had a few minutes before I had to leave for a dentist appointment. I thought of it while I was there and removed it at soon as I got home.
Shani has not really eaten very much and now I am wondering about the meter, if I can get an accurate test.
My husband is getting upset with me because I am so stressed but he doesn't understand Shantis life could be in the decision I make.
 
Re: 9/18 Shanti AMP 427 Not eating

I think your meter is likely just fine; if you read my post above, you'll see it's not unusual for a cat to do what he did. Have you tested him again?

Remember that each meter can have up to a 20% variance. So the 427 could have been as low as 350. The 254 could have been 300. That's not that far off.

Here's what I'd recommend:

--go to Walmart and buy a second one; I highly recommend that every member have two meters on hand. there will be times you will need a backup meter so I would try and get one today if you can. I have two Relion Micros and I tested them alongside each other as well as the meter I was switching from. That will tell you if the meter you used this morning is running high. The two Relion meters should be fairly close.

--if the one you used this morning is running high as compared to a second one you purchase, then take Elise's suggestion, call Relion, explain it and ask them to also send you some control solution. I get it from them and test every bottle of strips before I use it.

I'm sure someone has said to you already that FD is a marathon not a sprint :-D :-D I only mention this again (or maybe for the first time) because you will run yourself into a state of exhaustion if you stay really stressed. Yes....this is stressful and I remember being in your shoes as a new member and everything was so overwhelming. But if you burn out early, who will take care of Shanti? All we can do is take it one step at a time.

If you shot two hours late, we need to start getting you back on time tonight. You can't just shoot two hours early unless he's really high. If you can get a couple of tests today, especially a +10, then we can guide you on how to get him back on schedule but typically you would shoot early either 15 mins each cycle until he's back on the time you want him on or shoot 30 mins early one cycle per day.

If you want to adjust your shot times, you can do it now. For example, if you LIKE the time you shot today, then shoot 12 hours from that time and that's your new time. If you like your old time when you should have shot, then back it up as I explained above. Make sense? :-D :-D

Please be sure and scroll back through the condo and read the posts because sometimes we cross post and you will miss things. Thanks so much for taking down the 911. \M/ \M/

And breathe....OMMMMM.....it will be ok. We are here for you and Shanit.
 
Re: 9/18 Shanti AMP 427 Not eating

I will go back 15 minutes until I get back.
The vet said that it wouldn't matter but unless his numbers are really high I do not want to risk anything.
I saw a different vet, very nice but still the same ideas as my regular, that with Lantus there are no big highs and lows and you don't have to worry about shooting early. She said that the people on this board are not vets, I told her all of you have had diabetic cats and have dealt with alot of the issues I am going through. She said they can be a support group but medical decisions have to be left to the vet. Guess all vets feel this way. I really need your help and will continue to for a long time,up until Shanti crosses the rainbow bridge, which is something I am trying to delay.
See Shanti just came in for a drink of water, he vomited up his water this morning, lets see how he does with this.
I have a verse from the Bible " In His hands are every living thing" I try to remember this when I am getting so freaked out.
Thanks and I will let you know as the day progresses.
 
Re: 9/18 Shanti AMP 427 Not eating

I know it's very stressful. It sounds like you're doing the absolute best for Shanti, and that's all you can do! I hope that the meds start helping with his appy and nausea soon. I'm sorry to hear that your husband doesn't quite understand, but this board is full of people who do understand, so you're never alone!

When Billie has appy issues/an upset stomach and doesn't want cat food, she will usually eat boiled chicken or boiled pork. I don't know if that's something you have tried with Shanti, but it may help if he's not eating and you need him to eat something.
 
Re: 9/18 Shanti AMP 427 Not eating

Yes, the vet's response is totally normal from a vet. But, the people on this board have years more collective experience with this exact insulin, plus the foundations of all the advice is based on actual medical research, which you are welcome to show your vet if you would like to continue to work closely with him or her on dosing. Many of us move onto using our chosen dosing protocol with the guidance of people here and just using the vet for the insulin prescription after not too long once we see positive changes in our cats when using the advice here but none or less positive progress when using the vet's advice.

Lantus doesn't have any big highs or lows when it is given in strict 12-hour doses AND the dose is correct for the cat. If you know your cat is getting the right dose (which you don't yet), or you overlap doses and you don't have very good data on how your cat responds, either could be dangerous, which is where the hometesting comes in. It sounds to me like your vet is making assumptions about the insulin being the only factor when actually the situation being referred to (no big highs and low) is the result of the insulin + ideal dosing + timing. If you change any of those, you can't expect the same result.

You are doing great with all this by the way. The beginning and figuring out how this all works in the general sense as well as what works best for your cat is really challenging and often overwhelming. Just breathe. It'll get better, I promise. Even with all the complications. You have a relatively young cat and even with the other medical complications, he has a great chance of living quite a while longer with all of the loving care and attention you are giving to him. Good job!
 
Re: 9/18 Shanti AMP 427 Not eating

When I first joined the board I was skeptical of using their advice over my vet who is wonderful and a Diplomat of Internal Medicine. I realized quickly after a lot of reading that it would be a mistake. Max would have been in serious trouble had I not tested at night as that is when he often drops and I need to stay of top of it with food so he doesn't go hypo. So now I send my vet his spreadsheet at first every week and now every few and he responds if he sees anything concerning. I just don't discuss dosing or how I determine it. It's a bit tricky. He likes the spreadsheets by the way and has told some of his clients about them. I have a special one just for him. Did Shanti keep the water and food down?
 
So you can see by today's numbers a few things:

---you can experience big highs and lows with lantus and levemir

--today the high number was likely the high before the break I explained earlier in the condo.

When you get a lower number like you did at +4, you should feed him 2 tsp of low carb food and recheck in 30 minutes. It's really important to keep an eye on those dropping numbers. It is possible he went lower than that and, if so, he might bounce right back up.

Sorry to disagree with your vet but you are correct in telling her that we live with diabetic cats 24/7. I'd wager that most vets, even IM specialists have never seen what we see on spreadsheets.

Good job!!! Hang in there...it does get better. I hope Shanti is holding down food/water.
 
Shanti is holding down his food but really has not eaten a normal amount today, of course this morning he was sick so he didn't eat then. After his low number I am not sure how much food he ate. I gave him some off of my finger, then he got up and ate some on his own. The only reason I didn't test earlier than +5.5 was I went to get the new tester.
So push food and no more honey, is that what you would recommend? Also when ( if ever) can I relax.
Does anyone have any ideas about a dose change. Shantis morning shot was cycle 5 at 3 units. Is it safe to give another 3 when his numbers have dropped so low?
 
If he hasn't eaten much today at all, it could be contributing to his low numbers. I'd try to get him to eat since he's had cerenia. Even if you perhaps boil some chicken breast and give it to him or baby food that has nothing else in it but chicken and water. Some have vegetable juice or onions/garlic so you want to find the ones like Beechnut that are just chicken and perhaps water.

As long as he is staying above 50 or so, I wouldn't give him any honey. You just want to be sure he is coming up and staying there without honey. I'm not sure where you are in the cycle now since you last tested at +5.5. Keep in mind that honey wears off in 1-2 hours so you must stay on top of the testing until you have a couple of rising, non-food or honey influenced numbers. If it's been a while since the +5.5, I'd get another test. Absolutely you want at least a +10 so we can see where he is. Please don't feed him after +10 unless he's in the 40s. If he's in the 40s, feed one tsp of LC, retest in 20 minutes and post for help.

For his shot tonight, plan to only shoot 15 minutes earlier than when you shot this morning. If you get a 150 or higher that is not food influenced and you know he will eat, you can shoot his normal dose. If you get lower than a 150 or you get any blue number and he's not eating, please post for help since you haven't shot below 150 yet or for advice on what to shoot if he's not eating. Of course, for any number you get, if he's not eating and you don't know whether to shoot, post for help.

Remember that if you are testing (and I do think you need to get more tests when he's running in green like this and you've given him honey) and if he's eating, you are in control so you shouldn't be stressed. Post here and we can help you with the lower numbers. Just be sure to put something in the subject line like "NEED HELP" or if it's an emergency, put the "911" on.
 
The vet called me, Shanti will not be taking baytril this evening.
The vet gave me a guideline for tonights dose of insulin:
Below 150- no shot
150-200- 1 unit
250-300-2 units
over 300- 3 units.
I know this is not something you would recommend so now my head is all messed up again. I like having guidelines that I can feel safe with. My husband is insisting I go with what the vet says. Would this mess Shanti too much if I did go with these guidelines this evening? I am still planning on doing a blood test during the night (even if I have to sneak it). I don't want any of you to feel that I don't need and heed your input.
Let me know what you think about dosing tonight, what would be safe.
 
Great info from Marje. I would add that my guys like Gerber baby food better than Beechnut (both are Stage 2).

As for kitties not experiencing big highs or lows on Lantus, Gabby has gone from the 400s at AMPS to the 40s and back up the the 400s by PMPS. It earned her the name of "Diving Diva!"
 
Sounds like your vet is used to the in and out insulins like Caninsuiln and Prozinc which are dosed on the preshot number. The longer lasting insulins, Levemir and Lantus, are dosed on the nadir and Shanti got a very nice nadir today.

If you get a +10 test as Marje suggested, that will give us a hint as to where he might be at preshot time tonight so we can help you decide.
 
I see Marje has already given me some guidelines. I posted my question before I saw that. I will get back to you all. Shanti is eating but slowly, had honey about 2.5 hours ago none since and I did do another test as you can see. Will try to sneak one past my husband then do another at +10. My husband is upset that I am so stressed and wants me to just listen to the vet. I have told him all about this board but he is not listening, of course he is not the one who is taking care of Shanti either.
 
I am taking some time off but will get back to you all later. The vet has to see just from today the highs and lows. This morning +12 hours Shanti tested at 427. Had his insulin 2 hours later due to his issues then +4 was 52. Really how much more proof do you need! Thank you all and don't get discouraged with me, I am just trying to cope with everything and just like some of you, I just love my vet and it is difficult to ignore her. I have read enough on this message board ( have been looking at the general forum for many months) to know that vets just don't have enough experience with diabetic patients to know what all of you know.
Time for a break. Thank you.
 
Re: 9/18 Shanti AMP 254 +5.5 71 +10 72 Need Help

Just took Shantis BG and was 10 minutes short of +10 - 72. He eats a little once in a while. It is now over 24 hours since he took his last Baytril so maybe his appetite will pick up. Looking at his food now he ate maybe 1/3 what would be normal but it has taken over an hour with a bite here and there and with me encouraging him. Now his BG dropped down 30 points from +7.5 which was 105. Really am beside myself. Let me know what you would dose. Have one hour and 45 minutes until shot time. I can't stay up another night, was up last night because Shanti had issues with the litter box and vomiting. Although as I said before I will do a BG sometime in the night. If you have a time when you think it would be best, I will set my alarm.
 
Hi Marlene. If you go to your first post of the day click edit and hit the bubble next to the question mark, and write Dosing Advice in the subject line someone will get back to you before shot time to help. Do another test about 15 minutes before shot time and post it as well. Okay?
 
I think if he's still hovering around these green numbers at PMPS, you have a couple options:

--don't feed him, stall the shot (but it will put you further behind), see if he comes up and shoot the rise. But you will need to test until he is up high enough that we know he's probably not coming back down. That could be two hours.....or longer.

--shoot a reduced dose; I''m not a huge fan of doing this because of the depot. A depot, especially if it is full, can affect up to six subsequent cycles so the early part of the cycle could be the same as if you shot a full dose. You might see him coming up towards the end of the cycle or tomorrow.

--skip

If he's not had any ketones at all and he's not really eating well (or you wouldn't be able to get food into him if you had to), I'd lean towards skipping. He likely will be really high in the morning but you would have gotten some sleep and he would have had more time to feel better and perhaps eat more like normal tomorrow.

I was just reading all of your notes on your SS and baytril is absolutely not an antibiotic you give for potential dental issues. Baytril can have side effects, like blindness, if not given cautiously but baytril is primarily for urinary tract infections and specifically for kidney infections. For dental issues, you'd look more at an a/b like clindamycin although that tends to make cats feel really crummy. Another one would be a more broad spectrum a/b like clavamox. But not baytril.

Questions?
 
I'd be hesitant in giving anything if his appetite doesn't pick up and his glucose is under 150 mg/dL.
Perhaps, if he is rising and under 150 at pre-shot, a token dose would be safe.
 
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