Do we shoot? Tommy 9/13 BG 106

Like Mary, due to the DKA, it’s best to shoot. Have you fed him or did Mary catch you first?

He seems to be headed up but I’d like to see another rising number. He earned a 0.25u reduction today so his next regular dose is 3.75u. But I’d like to see another non-food influenced number before you shoot.
 
Mary & Jude said:
Can you grab another test to see what direction he's headed in?
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Marje and Gracie said:
Like Mary, due to the DKA, it’s best to shoot. Have you fed him or did Mary catch you first?

He seems to be headed up but I’d like to see another rising number. He earned a 0.25u reduction today so his next regular dose is 3.75u. But I’d like to see another non-food influenced number before you shoot.
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Wendy&Neko said:
What Marje said. I gave you the general SLGS guidelines, but recent DKA changes the picture.

Please stick to one post per day, so we can all follow the current picture.

Link to previous post for continuity: Is this is an emergency?
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Sorry if I did that wrong. Not sure how to properly tag.

First of all, thank you so much for the responses! This is all so stressful and I’m not sure what’s going on. I promise to be better about checking this app and responding.

We are in panic mode again tonight.
If you see the spreadsheet from tonight you’ll see what I mean. We gave Kyro syrup when his number hit 44. Just tested again now (20 minutes later) and it’s still 44. I don’t believe this is the nadir even (if I’m using that right).

Struggling and not understanding why his numbers are either really high or really low and nothing in between. We’ve been feeding him extra fancy feast too tonight since we are worried. I know it’s low carb but thought it was better than nothing. Before tonight, the numbers were back to normal/too high. This keeps happening out of nowhere and we can’t understand why or what it means or how to fix it.

More kyro needed? Is this danger zone?

edit: PLEASE SEE MY 2nd MESSAGE below.
*we are to blame for tonight
 
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Nevermind. You won’t be able to help. My boyfriend messed up. I just looked at the spreadsheet to make sure it would make sense to guys and when I asked about the pre-shot number he said he didn’t do it.
This won’t happen again. And it’s entirely our fault for the situation we are in now. I thought it was clear that we didn’t shoot without a test anymore but he forgot. It’s now a huge fight, which isn’t relevant. I apologize for wasting your time.
Still worried about the number we are currently at, regardless. So perhaps you can offer guidance with that, if at possible.
 
TommyTheCat said:
Sorry if I did that wrong. Not sure how to properly tag.

First of all, thank you so much for the responses! This is all so stressful and I’m not sure what’s going on. I promise to be better about checking this app and responding.

We are in panic mode again tonight.
If you see the spreadsheet from tonight you’ll see what I mean. We gave Kyro syrup when his number hit 44. Just tested again now (20 minutes later) and it’s still 44. I don’t believe this is the nadir even (if I’m using that right).

Struggling and not understanding why his numbers are either really high or really low and nothing in between. We’ve been feeding him extra fancy feast too tonight since we are worried. I know it’s low carb but thought it was better than nothing. Before tonight, the numbers were back to normal/too high. This keeps happening out of nowhere and we can’t understand why or what it means or how to fix it.

More kyro needed? Is this danger zone?
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Food (or karo) is the tool to bring him up. Do you have high carb food on hand? If so, you want to feed him a couple of tsps of HC food, and then test in 30 mins. to see where his bg is. DO NOT OVER FEED.
 
After karo and LC food he’s finally back up. To 59. I’m assuming this is from the syrup? So I’m not sure if that number is reassuring or deceiving based on what we gave him. How long does the syrup last? Should he not drop again if he’s already higher? Sorry… just very unclear on how it works.
We will be getting HC food to have on hand first thing in the morning.
Thanks so much for the quick replies!

(Edit: typos)
 
TommyTheCat said:
After kyro and LC food he’s finally back up. To 59. I’m assuming this is from the syrup? So I’m not sure if that number is reassuring or deceiving based on what we gave him. How long does the syrup last? Should he not drop again if he’s already higher? Sorry… just very unclear on how it works.
We will be getting HC food to have on hand first thing in the morning.
Thanks so much for the quick replies!
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It’s okay—you’re okay. So, the karo/HC food bump should last 1-2 hrs. So, you’ll want to keep testing to ensure he doesn’t drop into lower numbers. If he does drop again, you need to re-feed karo/LC.
 
Mary & Jude said:
It’s okay—you’re okay. So, the karo/HC food bump should last 1-2 hrs. So, you’ll want to keep testing to ensure he doesn’t drop into lower numbers. If he does drop again, you need to re-feed karo/LC.
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Thank you! So we are okay to wait to test again in an hour or 2? He’s getting very irritated by the ear pricks but we will do it as necessary. Maybe just an hour
 
In the very worst case where you’re having trouble keeping up, do you have any of his old dry food (if he was eating it) on hand? You don’t need to break it out quite yet but dry food lasts a lot longer (which is why it’s sort of a last resort).
 
Connie & Parker & Moonie said:
In the very worst case where you’re having trouble keeping up, do you have any of his old dry food (if he was eating it) on hand? You don’t need to break it out quite yet but dry food lasts a lot longer (which is why it’s sort of a last resort).
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He had most of his teeth removed. So we tossed the dry food. But thanks for the suggestion.
 
TommyTheCat said:
So instead of 4 units in the morning we shoot 3.75? Regardless of the number, if it’s over 150? Am I understanding correctly?
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If he is lower than 150, I suggest you come on the forum to ask for guidance. Here is the standard protocol:

How to handle a lower than normal preshot number:

Until you collect enough data to know how your cat will react, we suggest following the guidelines in the FDMB's FAQ Q4.4:
Q4.4. My cat's pre-shot level was way below the usual value. Should I give the injection?
A4.4. There's no hard and fast rule, but if you don't have data on how your cat responds to insulin, here are some general guidelines.
  • Below 150 mg/dl (8.3 mmol/L), don't give insulin.
  • Between 150 and 200 (8.3-11.1 mmol/L), you have three options:
    • a.) give nothing
    • b.) give a token dose (10-25% of the usual dose)
    • c.) feed as usual, test in a couple of hours, and make a decision based on that value
  • Above 200 (11.1 mmol/L) but below the cat's normal pre-shot value, a reduced dose might be wise.
  • In all cases, if you are reducing or eliminating insulin, it's wise to check for ketones in the urine.
  • Above the normal pre-shot value, give the usual dose, but if the pre-shot value is consistently elevated, it's a good idea to schedule a full glucose curve to see whether a change in dose or insulin is appropriate. In most cases, the target "peak" value should not be below 100 mg/dl (5.6 mmol/L), and for some cats it might be higher.
 
Mary & Jude said:
And for clarification, every time he has fallen below 90, under SLGS, he has earned a dose reduction. These reductions are very important to keep Tommy safe.
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Just tested and he’s doing down again. 49. And we only have 2 test strips left. We had lots of failed tests earlier tonight. Not sure what to do.
 
TommyTheCat said:
Just tested and he’s doing down again. 49. And we only have 2 test strips left. We had lots of failed tests earlier tonight. Not sure what to do.
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I don’t know where you guys are located but can one of you go to a nearby pharmacy store and pick up more strips? If the pharmacy has any Friskies or Fancy Feast gravy - might be worth picking those up as well since it’ll be higher carb.
 
Connie & Parker & Moonie said:
I don’t know where you guys are located but can one of you go to a nearby pharmacy store and pick up more strips? If the pharmacy has any Friskies or Fancy Feast gravy - might be worth picking those up as well since it’ll be higher carb.
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We are looking to see what are options are at midnight. We will figure it out. Even if we have to drive far. So tired though…
 
Connie & Parker & Moonie said:
I don’t know where you guys are located but can one of you go to a nearby pharmacy store and pick up more strips? If the pharmacy has any Friskies or Fancy Feast gravy - might be worth picking those up as well since it’ll be higher carb.
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This is Dr. Lisa’s food chart - most pharmacies have a small pet section and might carry Fancy Feast or Friskies. Ideally get something on this list with 20 percent carbs or higher. But it sounds like anything above 10 percent will be better than what you have tonight to bring him up.

https://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf
 
TommyTheCat said:
Just tested and he’s doing down again. 49. And we only have 2 test strips left. We had lots of failed tests earlier tonight. Not sure what to do.
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Okay, just bump him up a bit with karo/hc, and then test in 30-45 mins. He’s moving away from onset (which is at +2/+3) and he should start going up. What you are doing is bumping him up gradually to get him into safer numbers with the karo/lc. if you can get to a pharmacy to pick up strips, that would be good.
 
If he's less than 150 in the morning, please post for help. And start a new thread, this one is now old. We don't want people to have to read through all the old posts to get to the current action.

He has recent DKA so you need to give insulin. Skipping is not an option. The instructions given above are just general ones for SLGS and those need to be modified with recent DKA in the picture. Delay or partial dose may be options. Lauren, have you been testing at home for ketones?

When you buy more test strips, buy two packs. Put one in a separate spot for a hypo kit, along with the high carb food. Along with the instructions on Handling Low Numbers.
 
Thanks everyone. We gave more Karo and tested again. He’s back to 68. Plan on testing again in an hour.
We DoorDash ordered more test strips for our glucose meter, HC food and keto-strips. We will start testing for ketones tomorrow. Is it easier to test in the stream or try to catch urine in a container? Not sure how this is going to work but determined to do everything right. The vet made no mention of testing for these at home. He didn’t even want us testing BG on our own. He said it was unnecessary. Very disappointing advice from a professional
 
I found this link helpful for how to catch urine because ngl I was lost at the thought of how to. Personally, I tried the foil spoon first and since bought a big dedicated metal spoon that is specifically to catch cat pee just so I didn't go through a ton of tin foil. It feels odd at first! But at least Crowley was like mom this is so weird but whatever I guess.
 
Connie & Parker & Moonie said:
How did the rest of the evening go? I hope that Tommy kept his blood glucose up and you guys were able to get some sleep last night
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His BG went back up so we were finally able to go to sleep. But this morning before giving insulin his number was 562! The highest it’s ever been. So confused. We still gave 3.75, as instructed but it seemed like he didn’t need the dose reduction. No idea what’s going on and it’s very frustrating.
 
The new dose 3.75u under SLGS is held for 7 days before reassessing unless Tommy earns another reduction. We dose based on nadirs with only some consideration given to preshots, and 4u took Tommy way too low last night.

I know it’s frustrating seeing the high number this morning but Tommy is bouncing.

When a cat's body is used to running on high sugar levels, the liver can panic when those levels fall, even if they are still high or fall to normal levels. The liver and pancreas release stored sugar, spiking blood glucose levels. And Tommy’s blood glucose dropped a lot last night.

I know it’s tempting to raise his insulin dose, but you don't want to dose for the bounce. You want to change doses based on the lowest mid-cycle readings. A bounce usually clears itself up in a few cycles. And over time, as Tommy’s body gets used to lower normal numbers, he will hopefully bounce less as his body learns that these numbers are safe.
 
Connie & Parker & Moonie said:
The new dose 3.75u under SLGS is held for 7 days before reassessing unless Tommy earns another reduction. We dose based on nadirs with only some consideration given to preshots, and 4u took Tommy way too low last night.

I know it’s frustrating seeing the high number this morning but Tommy is bouncing.

When a cat's body is used to running on high sugar levels, the liver can panic when those levels fall, even if they are still high or fall to normal levels. The liver and pancreas release stored sugar, spiking blood glucose levels. And Tommy’s blood glucose dropped a lot last night.

I know it’s tempting to raise his insulin dose, but you don't want to dose for the bounce. You want to change doses based on the lowest mid-cycle readings. A bounce usually clears itself up in a few cycles. And over time, as Tommy’s body gets used to lower normal numbers, he will hopefully bounce less as his body learns that these numbers are safe.
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Got it. Thank you so much!
 
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