? BG 73, time to shoot, recent DKA, help?

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AliceMeowliss (GA)

AliceMeowliss (GA)

Member Since 2019
I got her sample 20 min late and it's 30 minutes past time now. Still doing the NPH 3x/day. 3.5u but I can definitely lower it and feed gravy foods. Thoughts? I'm setting up the SS again so it's not ready but there are numbers in another post I'll go get. Thanks!

ETA numbers:

4/10

BG 392, 8AM shoot
+ 10:50 - 227

Antibiotic at noon

BG 148, 4PM shoot
+ 6:12p - 294
+ 10:03p - 236

4/11

BG 305, Midnight shoot
+12:49 - 338

BG 343, 9AM shoot (overslept :( )
+ 11:24 - 177

Antibiotic at noon

BG 313, 5PM shoot ??? (Wet shot?)
+ 9:18p - 419
+ 9:55p - 385

4/12

BG 436, Midnight shoot
+ 2:12 - 487
+ 2:36 - 475
+ 3:00 - 476
+ 3:53 - 447
+ 4:56 - 397

BG 356, Morning shoot
+ 10:06 - 196
+ 1:35p - 100

Antibiotic at 1PM

BG for 4PM shoot, 73... No shoot yet.
 
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With her lower numbers, it might be good to go ahead and switch to the Lantus now.

You'd also need to decide what you want your shot times to be since Lantus is only given every 12 hours

What do you think?
 
What if she gets too high again? Im not sure I fully understand the cycle process with it yet!
8-8 are my preferences. That would just mean waiting a little over 3 more hours.
 
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I think it's probably a good time to go ahead and change over to Lantus since she's been running lower lately and there's no ketones in the picture right now....she also seems to be eating pretty well, right?

How much Novolin is she currently getting?
 
She is eating quite well, except when she was testing high last night, then I had to encourage eating. I also literally just got a urine sample and ketone test right before BG check (which is what made me a little late). Still trying to interpret. The strips are good, I timed it, photographed it. Still confused.
 
Well it's not safe to shoot 3.5 of Novolin when she's only at 73, so I think it's probably as good a time as any to switch.

If you shoot at 8pm, I'd start at 3U of Lantus....now it can take up to 5-7 days before you get the depot full enough to know for sure how well that dose is working, but some cats respond much sooner.

In her case, if the Lantus doesn't kick in fairly soon, we can discuss fast-tracking her.

If you shoot at 8 (depending on what her PMPS ends up being), you'd want to test again at 10pm (+2) and then you could get a +4 in at midnight and (hopefully) be able to get some sleep tonight!

I used to shoot at 6am/6pm so I'd be able to test until +6 at night without having to stay up too late
 
CassandraCatface said:
What does that mean to fast track?
Click to expand...

It's something we occasionally recommend in cats that aren't responding ….it basically means to suggest increasing the dose more often than we usually would but it's not something we suggest lightly.

Usually several of us will discuss it before we recommend it.
 
Okay. Got a call back from the vet office recommending against doing 3u, because a typical dose is usually lower.... But again, she doesn't have this experience specifically with switching insulins. Will need to shoot 30 min from now. Pressure. :eek:

What do you think? Obviously will also be good to have her next BGL.

I have 0% freeze dried chicken, 2% ff, 4% friskies, 14% friskies w gravy, and 14%?? purina dm dry. And syrup. And cerenia, mirtazapine, antibiotic.....

How long will I be able to try bro sleep if she tests okay at +4, safely?
 
Well there's no way to predict for sure, but usually, there's not much action on the first dose of Lantus.

It sounds like you're ready for anything though!!

I truly believe you'll probably be able to get some sleep from around midnight until morning but we always tell people if you happen to get up in the middle of the night, grab a quick test!! Lots of us would drink a big glass of water so we'd have to get up!..LOL

We do take into consideration the dose the cat has been on before switching and if she's been on 3.5U of Novolin three times a day, I really think starting at 3U is a reasonable starting dose.

She could prove us wrong and be one of those cats that didn't read the "handbook" but that's why we home test! So we can intervene early and stay away from those expensive ER vets!
 
Alright she tested BG 206 just now. 3u Lantus still sounds okay? How high carb should I start out feeding?

Thank you.

I just fed her 1.5 oz ff 2%. And she's soooooo hungry right now!!!
 
Chris & China (GA) said:
That's fine.....and yes, I still think the 3U is where you should start.

Grab a test at +2 and let's see how she's doing.
Click to expand...
Although it’s too late now, IMHO, 3u bid is too low. We need to be prepared to fast track Alice up. On Wednesday, you were shooting 4u TID or a total of 12u/day and she dipped to 148 which is a safe number.

As Jill posted the other day, we normally transition from NPH to Lantus at close to the same dose. However, we are at a disadvantage by not seeing any numbers while you were dosing TID. Is 73 the lowest BG you’ve gotten on 3.5u TID? If so, I won’t be surprised to see her needing more Lantus than 3u bid.
 
Chris & China (GA) said:
Yes, I mentioned that earlier.
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Thank you...I saw that. General rule of thumb when changing from a shorter duration insulin like the Novolin, Humulin, Vetsulin, Caninsulin, and even PZ is to start as close to the dose that was working on that insulin.

Of course, it’s a challenge here without having a SS to look at. Let’s hope she does well and we won’t have to fast track.
 
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I'm going to update! Let me know what sorts of negative signs and symptoms to be looking for though, please? Am I more worried about her being high? Better to feed the 2% pate? ...... ?
 
Low numbers can kill quickly so we want to avoid those, but with the DKA in the picture, we also need to keep a close eye on the high ones.

Anything under 10% is considered low carb.....some cats are very carb sensitive though so if they are, some keep them under 5% (we don't know about Alice yet so don't worry about it right now)
 
CassandraCatface said:
What would be ideal in theory? For this particular period of time.
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Anything less than 10% so the 2% and 4% are fine as long as she's eating them well.

If she's not eating well, feed her whatever she wants but try to keep it as low carb as possible. It's important to get as many calories as you can into her for now
 
Alright then I'll stick towards the 2%. I can also rehydrate some freeze-dried chicken bits for 0%, though they may not be complete, nutritionally.
 
There is nothing you can do about the higher numbers this cycle. The depot has to load and that takes up to 6 cycles. It is a different type of insulin and does not bring the BSL down as hard as the Novolon.
I'd just make sure Alice is eating and drinking plenty and getting another ketone test in.
And try and get some sleep
 
She is eating and drinking, has urinated and had a bowel movement. She's chipper and hungry and she doesn't talk as much if she is uncomfortably high. So I am super groggy and stopped pricking her poor ears. Just waking up for a snack for her again before I withhold for 2 hours....
 
Chris & China (GA) said:
How's she doing Alice?

That's a pretty big drop for so early in the cycle.

How much did you end up giving? It doesn't say on your spreadsheet
Click to expand...

3u, and I corrected +2, it was 30 points higher than my partner told me when I checked meter history. She's back in the 400s now. She's had almost exclusively ff 2% mixed with water, but I did give her some friskies at 4% (w/water) when she was lower. She is thirsty and drinking a fair amount, urinating, had another (solid!) bowel movement with a good rich color to it. (This was previously an issue.)
 
She's back up though, 422 @ +6.

Should I assume to give her 3u tonight? I mean obviously waiting to see numbers. Can I drop back from testing every two hours, or should I continue since it is climbing again?
 
I think it's fine to not test for a while. How about testing at +9?

As for the dose tonight, I'm consulting with a few folks. The minimum dose would be 3.0u. I tend to agree with Marje that Alice should have been started at the same dose of NPH.
 
Okay. 4u? 3.5u? Just let me know what y'all think is best.

I have been napping all night and day but haven't gotten a complete sleep cycle so it's not very recuperative. The exhaustion is starting to catch up as I've been extremely nauseous and had to take meds since yesterday.

My point being, I will stay up and I absolutely will do whatever she needs, whatever I have to do, but I desperately do need rest if possible for 4 solid hours tonight. Whatever is going to stabilize her best so I can rest and be able to continue her care.

Thank you all so much.
 
First things first. You have to take care of yourself or you won't be able to care for Alice. If you're exhausted, that's when mistakes happen. I'm going to lay out some options so you know that you have choices and can think things through.

The first really isn't an option. It's a suggestion. You may want to start posting on the Lantus board. Many of us Lantus regulars confine our time to that Board given its size. The reason I stopped by was Chris asking me to lend a hand.

As I understand Alice's history, you were shooting 3.5u of NPH three times/day -- 10.5u per day. As Marje and Jill noted, when transitioning from a shorter acting insulin to Lantus, we get the Lantus dose as close to your previous dose as possible. As such, 3.0u twice a day is a lot less insulin than Alice was getting. Too little insulin in a cat that is recently post-DKA can be a concern. My foremost question is whether you're testing for ketones? If not, please get some Ketostix and start doing so. If you are, can you put the information on Alice's spreadsheet in the comments section?

Dose... Here are our collective thoughts:
  • You've shot 2 cycles at 3.0u. Numbers are not lovely -- not awful, but not lovely. You can either
    • raise 0.5u every 2-4 cycles
    • or shoot 4u starting tonight
    • or leave things as they are and raise the dose tomorrow
Marje and I are both veteran Tight Regulation Protocol people -- which is what I'd recommend as a dosing approach given Alice's DKA history. Even with TR, we would modify a bit given the DKA and the previous 10.5u dose.The TR voice always leans towards increasing the dose by 0.5u every 2-4 cycles to fast track. But, the out of the box, the DKA-worried voice wants you raise the dose to 4 or 4.5u tonight. Of course, we want to take your level of fatigue into account before you raise a dose at night. Still....the depot has barely begun to fill which may mean you won't see much movement for at least 5 days.

Given how you're feeling, you need to decide what makes the most sense.
 
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