BG 648: Shoot without meal?!

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Good morning! It's been 30 minutes since I finished syringe feeding him. I just got a BG of 401. Massive improvement from last night. I'm thinking 1 unit of Vetsulin might do him well this morning?

To recap last night's events:


· 7PM BG 648

· Administered 3 units vetsulin

· Still refusing to eat even dry food so syringe fed 3 oz can pate, gave probiotic and 1/8 tsp MiraLax

· 8:00 PM BG 636 (+1)

· 9:00 PM BG 446 (+2)

· 10:00 PM BG 242 (+3) + Bowel movement

· 10:30 PM BG 193 (+3.5)

· 11:00 PM BG 144 (+4)

· 11:30 PM BG 126 (+4.5)

· 12:00 AM Fed small mousse meal

· 12:30 AM BG 116 + Bowel movement

· 12:30 AM fed small mousse meal

· 1:00 AM BG 119 (+6)

· 2:10 AM BG 118 (+7)

· Stopped testing for the night
 
jt and trouble (GA) said:
Please forgive me if this has been asked and answered but would you mind setting up one of these?
FDMB SPREADSHEET INSTRUCTIONS

It really would help us help you faster better and more complete.

If you are having problems setting it up we have really good folks at this that will help.
j.
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I definitely will start doing full curves and a spreadsheet once he's on Prozinc, which is what I mean to keep him on. I should only need to dose him with Vetsulin one more time tonight. :)
 
Nan & Amber (GA) said:
Tagging @Panic and @Critter Mom for Vetsulin advice.

I am not a Vetsulin person so I hesitate to advise here, but I will say that you don't want to reduce insulin greatly so soon after a DKA, and 438 is still fairly high. 3U may be too much given yesterday's acrobatic high dive action, but I'm nervous about going all the way down to 1U...
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I was gonna go with 2 units at 9:30. His ~530 mg/dl dive last night definitely worries me too much to give him 3.
 
alayna said:
I was gonna go with 2 units at 9:30. His ~530 mg/dl dive last night definitely worries me too much to give him 3.
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That sounds good to me-- I don't know what time zone you're in, so that may be 3min from now or an hour or two, so there may or may not be time for a Vetsulin person to weigh in.

You're able to monitor today, all stocked up with supplies (strips, high carb food, etc.)?

So glad he had a good meal-- he's looking good!
 
Nan & Amber (GA) said:
That sounds good to me-- I don't know what time zone you're in, so that may be 3min from now or an hour or two, so there may or may not be time for a Vetsulin person to weigh in.

You're able to monitor today, all stocked up with supplies (strips, high carb food, etc.)?

So glad he had a good meal-- he's looking good!
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I'm ready to give 2U and monitor every 3 hours, maybe 2 if his numbers are alarming. And sorry, it is currently 9:30 here! About to go shoot lol. Guess my time zone is another thing I can add to my signature. ;)

Have all the supplies with me.
 
OK, great!

I have to pop out for an hour or so, but will check in when I get back.

Just to let you know what kinds of things you might expect today: after last night's dive, he may be "bouncing" up into high numbers now. Bouncing is a cat's body's way of reacting to perceived lows, "protecting" the cat by dumping extra sugars into the blood. A bounce can be short/nonexistent (in which case he'll drop back down again soon, perhaps even today) or it can be long (up to three days, in which case you can relax for a while!). But just so you aren't surprised or concerned if he stays high today. As long as he's getting enough insulin and food, the high numbers don't necessarily have anything to do with his risk of relapsing into DKA.

Just keep doing what you're doing in the post-DKA care, and know that it's an extended process. Many caregivers report that it takes a few weeks before their cats seem "themselves" again, but he's on the road to feeling better now!
 
alayna said:
I'm ready to give 2U and monitor every 3 hours, maybe 2 if his numbers are alarming. And sorry, it is currently 9:30 here! About to go shoot lol. Guess my time zone is another thing I can add to my signature. ;)

Have all the supplies with me.
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You have already in your name written you're in Louisana. So don't add that in the signature. Just the short Frankie bio and medical.

Super Excellent Job on Your Own, You and Frankie. Frankie gave you very good data there, even his pee and poo time. Stylish. That's The Way To Do It. :)
 
Okay so here's the rundown for today:

· 8:00 AM Syringe fed 3oz pate

· 8:30 AM BG 401

· 9:00 AM BG 438

· 9:30 AM Gave 2 units Vetsulin

· 11:30 AM BG 358 (+2)

· 2:30 PM BG 233 (+5)

· 6:30 PM BG 124 (+9)

His Prozinc came in today so I was planning to give him 2 or 2.5 units of that at 9:30 PM, about 30 minutes after his meal. I'll check him once before I shoot to see where he's at. I won't be able to stay up all night again to test so I'm a little nervous. Definitely optimistic about his attitude, he got a bath today and he's hanging out and loving on us in the living room. He even fought me earlier when trying to get blood, lol. I also think he might eat on his own tonight because he's been slurping up every little treat I give him. :smuggrin:
 
I think WHAT he eats will also be significant, since he's been showing interest in dry food all day I'm optimistic he'll actually eat his dry food on his own. But there's still a chance I'll have to syringe-feed wet if he does what he usually does and just eats a few bites and then quits, lol. (He does normally love this dry food btw)

I'm thinking 1 unit Prozinc if he eats wet and maybe 1.5 if he eats dry... (the food has lots of carbs) but again I'll be sticking before I shoot. I think he'll be okay no matter what, honestly.

I just hate to not give him enough insulin after DKA.
 
She said Vetsulin was given today, but changing to Prozinc for the PM shot. The dose of Prozinc should be the same as the dose of Vetsulin, or perhaps 80% of that vetsulin dose.

Frankie dropped to 124 at +9. What was his pre-shot BG number for PMPS?

Post DKA, you do not want to skip the insulin shot. Ever. So if syringe feeding is what you have to do, than do that.
Cats recovering from DKA need plenty of food, and enough insulin to help them process that food properly. Plus treatment of any infection/inflammation.

Are you giving subq fluids at home? Any other medications?

Spreadsheet, spreadsheet, spreadsheet. Please, please, please. It's critical for us to be able to have the SS in your user id signature when we are helping a cat in trouble, like Frankie.
 
Deb & Wink said:
She said Vetsulin was given today, but changing to Prozinc for the PM shot. The dose of Prozinc should be the same as the dose of Vetsulin, or perhaps 80% of that vetsulin dose.

Frankie dropped to 124 at +9. What was his pre-shot BG number for PMPS?

Post DKA, you do not want to skip the insulin shot. Ever. So if syringe feeding is what you have to do, than do that.
Cats recovering from DKA need plenty of food, and enough insulin to help them process that food properly. Plus treatment of any infection/inflammation.

Are you giving subq fluids at home? Any other medications?

Spreadsheet, spreadsheet, spreadsheet. Please, please, please. It's critical for us to be able to have the SS in your user id signature when we are helping a cat in trouble, like Frankie.
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Thank you! Yes he ate a little bit of his dry food and walked away. I'm just gonna syringe feed him now so I can shoot hopefully at 9. I'll check his BG before I shoot. I will be making his spreadsheet tomorrow after I finish his first real curve with Prozinc.

Only med I give him is cyproheptadine. No SubQ fluids.
 
He's at 197 30 mins after eating. Normal instructions for Prozinc are to give a token dose (which I think I should do because of the DKA) So... I guess I'll give him 0.25 U. Kinda weird that he's so low an entire 12 hours after his morning dose. (or is it? lol)
 
Okay I just checked again (an hour after eating) and he's at 268. I'm gonna go ahead give him 0.5 unit Prozinc since I can't watch him overnight.

Proper curve and spreadsheets starting TOMORROW!! lol.
 
First off, a housekeeping note.
Would you please insert a line, a row in the SS and make it stand out really well with some color coding, to show when you switched from Vetsulin to Prozinc. It needs to be really obvious. A note at the top of when you switched insulins is important too. Right now, the SS only says Prozinc, but from your thread we know you also used Vetsulin before. Our brains simply can't remember every fact about a particular member we are helping, so SS (spreadsheet) notes become really important. Thanks.

alayna said:
Normal instructions for Prozinc are to give a token dose
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With DKA, you want to give him as close to his normal dose as possible. The "normal dosing" instructions don't apply, to a cat that just came home after a DKA episode, and has spent several days in the vet clinic.

You want to test BEFORE Frankie eats, so the pre-shot test isn't food influenced.
alayna said:
He's at 197 30 mins after eating.
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Food raises BG levels, and you want to check that BG before food, so you aren't giving insulin into a BG level that is still dropping.
30 minutes is too much time between the food and the pre-shot test to get a non food influenced BG number.
Next time STALL if the pre-shot test is lower than expected.
Test, don't feed, retest in 20 minutes. Repeat for up to 1 hour.

I can see the SS now. Looks like Frankie bounced, and bounced hard from last night, 10/29/20.
Three likely causes, and they probably all had a part to play in those black BG levels you got.
1. Different insulin, with the Prozinc you just started. So it can act differently than the Vetsulin you were using.
2. He dropped lower overnight, to a BG level his body isn't used to, which can cause a bounce.
3. Token dose last night. Not enough insulin, so his BG levels were high this morning.


p.s. Thanks for getting the SS setup. It's so important to be able to see those BG numbers so we can help you better. Our standardized format SS is how we do that.
 
Deb & Wink said:
First off, a housekeeping note.
Would you please insert a line, a row in the SS and make it stand out really well with some color coding, to show when you switched from Vetsulin to Prozinc.
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Done!

Deb & Wink said:
You want to test BEFORE Frankie eats, so the pre-shot test isn't food influenced.
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Oh my goodness, I had no idea. I thought you wanted to know what they were at after they ate this whole time :facepalm: I'll be changing that tonight...

Thanks so much for your help!
 
Ok, so the general idea is to get a pre-shot test, with no food given for 2 hours before that test. Any tests after that pre-shot test, we expect to be food influenced. (Unless you are stalling, to see if the pre-shot test number is rising or falling. Then no food until you have tested at least once more, perhaps twice more before you give insulin.)

Alayna, sometimes we aren't clear on what is needed. Sorry for the confusion.

Would you please go back into your SS and put in the date at the top, where it says "Insulin: Prozinc" and put the date you were using Vetsulin, and then the date you switched to Prozinc.

So something like this:

Insulin: Vetsulin 3/1/19 to 10/29/20, Switch to Prozinc 10/29/20

It's a lot, but it will fit and just makes the cell larger. I think.
 
Deb & Wink said:
Would you please go back into your SS and put in the date at the top, where it says "Insulin: Prozinc" and put the date you were using Vetsulin, and then the date you switched to Prozinc.

So something like this:

Insulin: Vetsulin 3/1/19 to 10/29/20, Switch to Prozinc 10/29/20

It's a lot, but it will fit and just makes the cell larger. I think.
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He's only ever been on vetsulin for the 2 shots indicated in the spreadsheet. I just hopefully made that a little bit clearer. (It was all my previous vet had and I needed something until I could get a new vial of Prozinc in the mail.)
 
alayna said:
Done!



Oh my goodness, I had no idea. I thought you wanted to know what they were at after they ate this whole time :facepalm: I'll be changing that tonight...

Thanks so much for your help!
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I can’t believe none of us brought that up! I’m so sorry. It’s usually one of the first things we go over when teaching about home testing I think we were so focused on the hospitalization that no one thought to ask if you knew the 101 of testing. Thank you @Deb & Wink for catching that! And good to hear from you friend :bighug:
 
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