Chloe at 368 at +4, 340 at +8

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Critter Mom said:
@Red & Rover (GA) -
@Christie & Maverick
@Panic

Hi all,


With Chloe's history of throwing ketones and, I believe, DKA, it's important to ensure that she gets enough insulin.

However, bearing in mind that Chloe's numbers Just. Would. Not. Budge. last night and also Roberta's difficulty measuring accurate doses, I'm afraid I would not feel comfortable assisting Roberta today if the dose is 0.25IU this morning, so I'm going to duck out of this situation now. (I would have felt less uneasy about a dose of 0.1IU.)

Also, it's 3pm in the UK and I've still to break my fast (getting lightheaded).

Please can someone else take over the lead on this?


Mogs
.
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Thanks Mogs, I wouldn't even know how to measure a dose of .1. I'm doing .25 now and I think I'm getting better with the pen.
 
Roberta and Chloe said:
Thanks Mogs, I wouldn't even know how to measure a dose of .1. I'm doing .25 now and I think I'm getting better with the pen.
Click to expand...

From the following Lantus sticky post:

https://www.felinediabetes.com/FDMB...info-proper-handling-drawing-fine-dosing.151/

Fine dose gradations:
  • 0.5U = exactly half a unit
  • 0.4U = skinny 0.5 touching the line
  • 0.3U = skinny 0.5 with daylight under the line
  • 0.2U = fat zero with daylight over the line
  • 0.1U = fat zero barely touching the line
Pictorial guide using a U-100 syringe marked with half units:
49823504036_be8b19dcbc_o.jpg

49822973598_f0540f7a37_w.jpg

49822973683_0559ae843a_o.jpg



Mogs
.
 
Critter Mom said:
From the following Lantus sticky post:

https://www.felinediabetes.com/FDMB...info-proper-handling-drawing-fine-dosing.151/

Fine dose gradations:
  • 0.5U = exactly half a unit
  • 0.4U = skinny 0.5 touching the line
  • 0.3U = skinny 0.5 with daylight under the line
  • 0.2U = fat zero with daylight over the line
  • 0.1U = fat zero barely touching the line
Pictorial guide using a U-100 syringe marked with half units:
49823504036_be8b19dcbc_o.jpg

49822973598_f0540f7a37_w.jpg

49822973683_0559ae843a_o.jpg



Mogs
.
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Thank you. This is very helpful. The video was especially helpful!
 
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jt and trouble (GA) said:
Thank you SO MUCH Christie:bighug:
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Jeanne @jt and trouble (GA) woukd youmind helping Roberta fix her link to the SS in her signature? She just needs to rehighlight the full words "Chloe's SS" and relink to the SS, but I need to get my pup out for his walk, he's giving me nose bumps in the butt, which means he is getting impatient with me. If I don't go soon, he'll start nipping me o_O lol
 
Roberta and Chloe said:
That was nasty.
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I really don't understand why it's nasty?
I was simply asking if you knew Lantus is a depot insulin, since you're dosing differently. If you dosed like that on prozinc it wouldn't be such a big problem.
Like others have said she nearly died last night.

Help me, I really don't see why my comment was nasty?
Is my concern for your cat nasty?
Did you read something into my comment that wasn't there?
I was literally just asking you a basic question, since I don't understand why you're dosing the way you do...

Like really....wow... I'm sorry I stepped on anyone's toes, it wasn't my intention. And I don't need slack, like you said Jeanne, I've been here since April. I'm not new anymore.
 
SashaV said:
I really don't understand why it's nasty?
I was simply asking if you knew Lantus is a depot insulin, since you're dosing differently. If you dosed like that on prozinc it wouldn't be such a big problem.
Like others have said she nearly died last night.

Help me, I really don't see why my comment was nasty?
Is my concern for your cat nasty?
Did you read something into my comment that wasn't there?
I was literally just asking you a basic question, since I don't understand why you're dosing the way you do...

Like really....wow... I'm sorry I stepped on anyone's toes, it wasn't my intention. And I don't need slack, like you said Jeanne, I've been here since April. I'm not new anymore.
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Advice is welcome, but any mention of my cat dying is not. My getting freaked out doesn't help me or my cat.
 
Christie & Maverick said:
Jeanne @jt and trouble (GA) woukd youmind helping Roberta fix her link to the SS in her signature? She just needs to rehighlight the full words "Chloe's SS" and relink to the SS, but I need to get my pup out for his walk, he's giving me nose bumps in the butt, which means he is getting impatient with me. If I don't go soon, he'll start nipping me o_O lol
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Understood I will try and if I fail I know who to contact.;)

Roberta it looks like we are all bailing on you but we're not. I have only one ride to these stores (no car of my own) so I have to get this stuff done. I will DEF be back in a little while. ;)
 
Roberta and Chloe said:
Thanks to everyone for all your help. I've emailed my vet about all this and to let her know that I'm reducing the dose to .25. I'm not sure if she's working this Saturday, but she always responds promptly.
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I'm glad you're putting a call in to the vet, Roberta. I'd also suggest discussing Chloe's recent inappropriate toileting behaviour. I worry that this could possibly be an outward sign that she has been getting too much insulin. I think it's definitely something that needs to be highlighted to the vet.


Mogs
.
 
Roberta and Chloe said:
Advice is welcome, but any mention of my cat dying is not. My getting freaked out doesn't help me or my cat.
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But thats the reality..
You were asked why do dose the way you do, you didn't answer. Hence my question.
It didn't seem to me that you understood how serious it was. In case you didn't know Lantus being a depot drug, since you've used prozinc before.
 
SashaV said:
But thats the reality..
You were asked why do dose the way you do, you didn't answer. Hence my question.
It didn't seem to me that you understood how serious it was. In case you didn't know Lantus being a depot drug, since you've used prozinc before.
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I dose the way I do because I follow the instructions of my vet, who I trust implicitly. I am in constant contact with her and I have already emailed her about the reduction to .25.
 
My vet already responded to my email. Here's what she said:

Go to the store and buy some Karo syrup. That's much better for getting low blood sugars up quickly - honey just isn't as good. If Chloe has a blood glucose less than 50, you can put a little Karo syrup on her teeth, every 5 minutes, until her blood sugar is above 75.


How much insulin did Chloe get before she dropped so low? And what was her blood glucose before that episode?


In terms of causing damage to Chloe, the low blood sugar episodes are more damaging than temporarily high blood sugar episodes. Low blood sugar is hard on the brain - that's why some cats that go really low will have seizures. Remember, it's fine for Chloe's blood sugar at any random test to be between 100 and 300. Higher than 300 for a short time is not great, but not life threatening. DKA occurs when the blood sugar is over 400 for a longer period of time (like days).


I really don't trust anyone on your FDMB - they've led you astray previously, and Chloe ended up in the ER with DKA more than once.


Please let me know what the blood glucose readings were before Chloe went low, and how much insulin you gave each time.


I'll be here today until noon.
 
SashaV said:
Help me, I really don't see why my comment was nasty?
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Shasa, One thing to keep in mind is every cat mom or dad KNOWS their cat., Roberta is a LONG time member. She quit because of comment that were piled on some like yours. This thread was starting to look like the one that drove her off in the first place. Telling someone thats being bombarded (with good intentions) that shes going to kill her cat is NOT helpful. Try to put your self in her shoes. Always try to walk in others shoes to get the full benefit of whats currently happening. You just MAY see things a little differently.
best wishes
jeanne
 
jt and trouble (GA) said:
Shasa, One thing to keep in mind is every cat mom or dad KNOWS their cat., Roberta is a LONG time member. She quit because of comment that were piled on some like yours. This thread was starting to look like the one that drove her off in the first place. Telling someone thats being bombarded (with good intentions) that shes going to kill her cat is NOT helpful. Try to put your self in her shoes. Always try to walk in others shoes to get the full benefit of whats currently happening. You just MAY see things a little differently.
best wishes
jeanne
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How am I supposed to know she's a long time member? Her profile is made 20 September. So really, how could I know? Put yourself in my shoes there.

I didn't say that she would kill her cat. You read into that on your own. Try reading what i write, not what you think I mean.
 
Some people need things spelled out for them though.

Your vet is blaming us for putting Chloe in danger but the board has begged multiple times for the dose to be lowered. You're going to have a hard time trying to listen to both.

I can't get any more invested in this, it's too emotionally stressful to me to see Chloe in hypo numbers every other day. Wish you luck.
 
This is my vet's latest instructions:
Hello again --


Let's change the insulin dosages again:


If Chloe's glucose is less than 200 give NO insulin

If she's between 200 and 300 give 0.5 unit of insulin

If she's over 300 give 0.75 unit of insulin


Make sure Chloe is eating something around the time of each insulin shot.


Is Chloe showing any signs of a urinary tract infection? Sometimes, if a cat has a UTI, it will make the diabetes much more difficult to control. If you think she's having any urinary problems (small, frequent urination; blood in the urine; straining to urinate), then I'll have you pick up an antibiotic. But, if she's fine, we won't do that.


Try the above insulin schedule over the weekend, get some Karo syrup from the grocery store, and send me another update on Monday. I'll be here then after 8am.


I hope the weekend goes well for you!

cleardot.gif
 
Panic said:
Some people need things spelled out for them though.

Your vet is blaming us for putting Chloe in danger but the board has begged multiple times for the dose to be lowered. You're going to have a hard time trying to listen to both.

I can't get any more invested in this, it's too emotionally stressful to me to see Chloe in hypo numbers every other day. Wish you luck.
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I appreciate that you were there when my vet was not, outside of office hours. Please don't be offended. I appreciate the info I get from everybody. I weigh all sides, then come to my own decision. I gave her .25 this morning and will test again ina couple minutes. I will do a curve and see how she does throughout the day. If it seems good, I will keep the .25 dose for a cycle. If not, I will go by what my vet suggests.
 
Couldn't you suggest your vet to read up on treatment?
A cat shouldn't go low so often and lantus is a depot drug, you can't do sliding scale with it like your vet is telling you to do.
Your vet might not know how Lantus is working in cats, and the longer duration it has.
Just a suggestion. I just want whats best for Chloe.
 
SashaV said:
Couldn't you suggest your vet to read up on treatment?
A cat shouldn't go low so often and lantus is a depot drug, you can't do sliding scale with it like your vet is telling you to do.
Your vet might not know how Lantus is working in cats, and the longer duration it has.
Just a suggestion. I just want whats best for Chloe.
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My vet knows that Chloe has never been regulated and probably won't ever be. That is why she gives me the dosing instructions she does. This vet has plenty of experience with diabetic cats-- she's been in practice for 40 years. How much experience do YOU have at age 28?
 
Red & Rover (GA) said:
I agree with your vet that Chloe is a difficult case. Low numbers, a history of DKA, sometimes a long duration (the cycle is lasting a lot more than 12 hours). Taking all this into consideration, it might be wise to ask your vet to recommend you and Chloe to an internal medicine specialist.
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It took me a long time to find this vet and I trust her. She has seen Chloe for the past 3 years and knows her well. I believe she even has or had a diabetic cat herself. She is an excellent veterinarian. She only sees cats.
 
We can help guide you through Chloe's low numbers.
Please read and re-read the hypo stickies.
TREATMENT

During treatment for hypoglycemia, try to test every 15 - 20 minutes until you see the bgs begin to rise. Then continue to test until you are satisfied that the cat is out of danger.

VERY LOW NUMBERS – WITHOUT SYMPTOMS
Retest glucose using a large blood sample to make certain you have enough blood, and if you still get a very low number (under 40 mg/dL or 1.9 – 2.2 mmol/L) administer a teaspoon of corn syrup, liquid glucose, pancake syrup or honey, or INSTA-GLUCOSE and follow with food until the blood glucose numbers rise to acceptable levels. The syrup can be mixed with wet food or poured over dry if the cat will eat the mixture. If using liquid glucose, dilute with water for a thinner consistency.

LOW NUMBERS – WITHOUT SYMPTOMS
Retest glucose using a large blood sample to make certain you have enough blood, and if you still get a low number (40 – 60mg/dL or 2.2 – 3.3mmol/L) give food or treats until the blood glucose numbers rise to an acceptable level. If the cat refuses to eat even his/her favorite foods, you can syringe feed or administer a small amount of syrup.

LOW NUMBERS – MILD SYMPTOMS
Try feeding first or give a little syrup or honey followed by food until the blood glucose numbers rise to an acceptable level and the symptoms disappear. The syrup can be mixed with wet food or poured over dry if the cat will eat the mixture. If the cat will not eat, syringe feed. If your cat will eat dry food. the high carbs will help to increase his/her bgs quickly, but remember the effects of dry food usually takes longer to clear kitty's system once the crisis has passed. Feeding a high carb canned food is preferable to feeding a high carb dry food because the effects will clear kitty's system faster. You can then follow with his/her favorite canned food. Keep in mind that giving syrup (Karo, etc.) or honey is not enough because the effects wear off quickly. You need to follow with food.
IF IN ANY DOUBT, TELEPHONE YOUR VETERINARIAN.

LOW NUMBERS – MODERATE SYMPTOMS
Give a tablespoon of syrup, a teaspoon of liquid glucose, a tablespoon of honey or a tablespoon of sugar syrup followed by food and continue doing so until you see the blood glucose numbers rise to an acceptable level and all symptoms disappear. The syrup, honey, or glucose can be rubbed against the inside of the cat’s cheeks or on the gums for quick absorption. You can also mix the syrup with wet food or pour over dry if the cat will eat it. Continue to give syrup and food as needed and observe your cat for signs of recurring hypoglycemia. Keep in mind that giving syrup (Karo, etc.) or honey is not enough because the effects wear off quickly. You need to follow with food.
IF IN ANY DOUBT, TELEPHONE YOUR VETERINARIAN.

LOW NUMBERS – SEVERE SYMPTOMS
Rub syrup, honey, or glucose on the gums and cheeks if your cat will allow it. Another option for administering syrup, diluted liquid glucose, honey or sugar syrup to a cat who is seizing is to fill a needleless syringe with the mixture and insert via the rectum.
NEVER TRY TO SQUIRT SYRUP, HONEY, OR GLUCOSE TO A CAT WHO IS SEIZING AS THE CAT COULD CHOKE ON IT! RUSH TO EMERGENCY.

AGAIN! ANYTIME YOU CAT IS SEIZING OR LIMP, RUB KARO, GLUCOSE OR HONEY ONLY ON GUMS OR ADMINISTER RECTALLY AND GET TO EMERGENCY OR YOUR NEAREST CLINIC IMMEDIATELY!!!

Remember that syrup or any other sugared syrup/preparation will spike the blood glucose ONLY for a short period of time, so food is really important with mild and moderate symptoms. Dry food (high carbohydrates) will keep the blood glucose numbers elevated longer.

After a hypoglycemic episode cats may be more sensitive to insulin, so a reduction in dosage is generally required, especially considering too much insulin – whether due to dosage, inadequate food intake, or the cat’s changing insulin requirements – caused the hypoglycemic event in the first place. With moderate to severe episodes, your Vet may have you skip the next injection altogether.
IT IS VERY IMPORTANT THAT YOU DISCUSS YOUR CAT’S HYPOGLYCEMIC EVENT WITH YOUR VET, SO TOGETHER YOU CAN DECIDE UPON THE NEXT COURSE OF ACTION.

Always keep in mind that with low blood glucose and no symptoms, the BG you get is not as important as where it is headed. In other words, if you get a BG of 100 mg/dL or 5.6 mmol/L or less and there are still several hours or more before the insulin peaks, your need to watch your cat (and the numbers) carefully and take appropriate steps. With very low numbers and NO SYMPTOMS, a cat can be fine one moment and seizing the next.

BE PREPARED! KNOW THE SYMPTOMS AND KNOW THE TREATMENT!​
 
Is steering these numbers with food an option? I was reading a thread the other day where they were trying that. I know nothing ok? Just wondering.
 
Hi Roberta, thanks for getting that +2, let's see where she is at with +4.

Roberta and Chloe said:
Go to the store and buy some Karo syrup. That's much better for getting low blood sugars up quickly - honey just isn't as good. If Chloe has a blood glucose less than 50, you can put a little Karo syrup on her teeth, every 5 minutes, until her blood sugar is above 75.
Click to expand...

Tomato tomatoe. Sure, karo syrup may have a higher glycemic index, but the fact of the matter is they are both concentrated sugars, and more to the point, Chloe did not react at all to it.

Roberta and Chloe said:
In terms of causing damage to Chloe, the low blood sugar episodes are more damaging than temporarily high blood sugar episodes. Low blood sugar is hard on the brain - that's why some cats that go really low will have seizures. Remember, it's fine for Chloe's blood sugar at any random test to be between 100 and 300. Higher than 300 for a short time is not great, but not life threatening
Click to expand...

okay, we are mostly on the same page on this one, although ideally most of us have the goal of trying to safely achieve numbers that keep the cat under renal threshold, where the cat isn't dumping excess sugars in the urine. That can be problematic for the kidneys, as well as cause UTIs, although someone can correct me if I am wrong.

Roberta and Chloe said:
DKA occurs when the blood sugar is over 400 for a longer period of time (like days).
Click to expand...

I respectfully disagree. We have found here that The basic recipe for developing DKA = an insufficient supply of insulin + inappetance + infection OR other systemic stresses.

I have seen cats who have consistently lower blood sugar levels develop DKA.

I would continue to test her for ketones, especially since you have had a few skips in dose recently, and ketones can build up quickly to the point where they can quickly lead to DKA. Since Chloe has had DKA previously, she is likely more prone to developing ketones. You likely know this, but it is worth mentioning. Skipping is not a good idea with past history of DKA.

Roberta and Chloe said:
Let's change the insulin dosages again:


If Chloe's glucose is less than 200 give NO insulin

If she's between 200 and 300 give 0.5 unit of insulin

If she's over 300 give 0.75 unit of insulin
Click to expand...

Again, the problem with this is we do not dose Lantus based on preshots, we dose based on how low it is taking the cat. The reality is that the TR protocol wasn't plucked out of thin air, whatever your vet may think of us on this forum. Again, I think you know this, since you have been here previously, so IMHO dosing based on preshots like your vet has recommended has basically gotten you to the problems with low numbers which you have encountered multiple times.
 
tiffmaxee said:
Steering with food is definitely helpful. You test and feed according to the bg reading. Roberta, do you pick up the food two hours before insulin so the test is not food influenced?
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Okay, here's the thing: I've always believed that my body tells me what to do. I think it is the same with cats, which is why they don't eat lizards or poisonous plants. If Chloe wants food, she gets it.
 
Roberta and Chloe said:
Chloe did react to it eventually. Plus, she ate food at 3 am.
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well...not really. I'm not sure where 3:00 a.m. is in relation to your last test, but what I saw was a cat who was given honey multiple times over a period of 2 hours with no effect. When she finally came up is a good question, and it likely had nothing to do with the honey since that wears off very quickly.

I suppose the reaction to syrups is somewhat tied to how carb sensitive your own cat is, but most people here who use syrups I think would agree that you would usually see an immediate effect (ie. within minutes, not hours). Just some more food for thought for you on a Saturday :)
 
Christie & Maverick said:
Hi Roberta, thanks for getting that +2, let's see where she is at with +4.



Tomato tomatoe. Sure, karo syrup may have a higher glycemic index, but the fact of the matter is they are both concentrated sugars, and more to the point, Chloe did not react at all to it.



okay, we are mostly on the same page on this one, although ideally most of us have the goal of trying to safely achieve numbers that keep the cat under renal threshold, where the cat isn't dumping excess sugars in the urine. That can be problematic for the kidneys, as well as cause UTIs, although someone can correct me if I am wrong.



I respectfully disagree. We have found here that The basic recipe for developing DKA = an insufficient supply of insulin + inappetance + infection OR other systemic stresses.

I have seen cats who have consistently lower blood sugar levels develop DKA.

I would continue to test her for ketones, especially since you have had a few skips in dose recently, and ketones can build up quickly to the point where they can quickly lead to DKA. Since Chloe has had DKA previously, she is likely more prone to developing ketones. You likely know this, but it is worth mentioning. Skipping is not a good idea with past history of DKA.



Again, the problem with this is we do not dose Lantus based on preshots, we dose based on how low it is taking the cat. The reality is that the TR protocol wasn't plucked out of thin air, whatever your vet may think of us on this forum. Again, I think you know this, since you have been here previously, so IMHO dosing based on preshots like your vet has recommended has basically gotten you to the problems with low numbers which you have encountered multiple times.
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I totally agree with you, when I started out my vets associate gave her the same thing to use a sliding scale and Tyler dropped very low , scary numbers.

If it wasn't for the members here and their knowledge and guidance Tyler wouldn't
be where he is today, he is doing great!
 
oop
Roberta and Chloe said:
Okay, here's the thing: I've always believed that my body tells me what to do. I think it is the same with cats, which is why they don't eat lizards or poisonous plants. If Chloe wants food, she gets it.
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Oh I dont mean withholding food actually the opposite. Just giving low carb at one point then High or med. at another. I dont believe in withholding food from a diabetic.
 
jt and trouble (GA) said:
oop

Oh I dont mean withholding food actually the opposite. Just giving low carb at one point then High or med. at another. I dont believe in withholding food from a diabetic.
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I thought that switching foods is not a good idea. Chloe seemed to like Tiny Tiger, except for the turkey. I ran out and went back to the 9-Lives, but none of the cats are enthusiastic about it since running out of the Tiny Tiger. I have Tiny Tiger seafood flavor on order now, along with FF gravy-lovers for when she goes too low.
 
Christie & Maverick said:
Sure, that is one of the symptoms. But inappetance can be also be a symptom of many other things; however, when your cat isn't getting enough insulin, isn't eating enough, and has some sort of systemic stress or infection, those combined can lead to DKA.
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If the cat isn't getting enough insulin, then its BG numbers would be high. I can go back to where I saved Chloe's old spreadsheets on my other computer.
 
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