Dosing advice? AMPS 183 skipped dose PMPS 373 Post DKA/HL

KatieBDZ

KatieBDZ

Member Since 2020
Was hoping for some advice on how much insulin to shoot - my cat Arya has only been home 1 day, last night I gave her 4 units of lantus as recommended by my vet, this morning AMPS was at 183 and she wasn't eating so I skipped dose on advice of vet. Later in the day I got her to eat (higher carb dry food) PMPS was at 373 and she then ate about 1/2 cup of new food (tiki cat born carnivore dry - lowest carb dry food I could find as she won't eat wet food - I'm trying to transition her at each meal but also want to make sure she eats something as she has HL and DKA). The vet had initially told me to cut her dosage in half to 2 units but now when I called she said to do the full 4 - I'm worried as this is a high number and she's still not eating fully/is eating more low carb than she has been - any advice? Thanks!
 
That is a very high dose. I suspect the vet is concerned because your cat recently came through DKA and hepatic lipidosis. Bottom line, your cat has to eat. Did the vet send Arya home with an appetite stimulant? If not, please talk to your vet about getting some meds to stimulate her appetite if she's not eating well. The basic recipe for DKA is an infection or inflammation + not enough calories + not enough insulin. Also, if you haven't already done so, please get some Ketostix at any pharmacy. This is a way to test Anya's urine for ketones. Since she's just out of the hospital, this is an important piece of prevention. You want to make sure her ketones are below "trace." Alternatively, there are blood ketone meters.

Do you know whether the vet was using Lantus when Arya was in the hospital and what the dose was there?

Frankly, I'd be hesitant to even give 2.0u but I'd be more comfortable with that than 4.0u. It sounds like you are able to home test. I would feed your kitty whatever she will eat at this point and go with a lower dose. Please monitor Anya's blood glucose (BG) carefully Do you have any high carb food on hand? If not, Karo (corn) syrup, maple syrup, honey, etc. can be used as a way to raise numbers if necessary. Since we have no information on how your cat responds to insulin, it's important that you have a supply of strips for your meter and high carb food/syrup to raise numbers.

Also, you may want to consider getting a human meter. The strips for the AlphaTrack are very expensive. The strips for a human meter are much less costly. Many people here use Walmart's Relion meter.

A final request. Please set up a spreadsheet.This will allow you to track Anya's progress and allow us to provide you with help. This
post that Bron linked in your thread on Health will provide a link to the spreadsheet instructions and other important information for getting started.

Your thread on Health
 
KatieBDZ said:
Was hoping for some advice on how much insulin to shoot - my cat Arya has only been home 1 day, last night I gave her 4 units of lantus as recommended by my vet, this morning AMPS was at 183 and she wasn't eating so I skipped dose on advice of vet. Later in the day I got her to eat (higher carb dry food) PMPS was at 373 and she then ate about 1/2 cup of new food (tiki cat born carnivore dry - lowest carb dry food I could find as she won't eat wet food - I'm trying to transition her at each meal but also want to make sure she eats something as she has HL and DKA). The vet had initially told me to cut her dosage in half to 2 units but now when I called she said to do the full 4 - I'm worried as this is a high number and she's still not eating fully/is eating more low carb than she has been - any advice? Thanks!
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Hi Katie,
Wow, overwhelming isn't it? Sienne knows what she is talking about, follow her advice.
I'm not one to give dosing advice so I'm sending strength and hugs, you can do this.
Darcy
 
Thank you Darcy! Hi Sienne - I got my spreadsheet up..I'm still new at testing the blood glucose so doing my best (also will have to go back to work tomorrow) but always testing before the shot. As you can see they vet keeps telling me to do the 4 units at night and then in the morning she is too low and I'm skipping the dose so I think that's too high, they told me when I called this morning that they think she had insulin resistance at the beginning and is just responding now I told them I will call tonight before her shot (after taking blood glucose) but that it has to be less than the 4 units since that's clearly not working properly. When she was there they started her on 1 unit, then 2 units, then 4 units of lantus which they monitored for 24 hours - when she was there they said she wasn't ever getting below 300 which is why they went up to the 4 units and even on 4 she was not below 300. I got her home at around 3 pm on 2/17. Since she's been home she hasn't been able to have the 2 shots 12 hours apart yet. Any advice (see SS for exact numbers but she keeps being too low in the morning)? She has been eating better now that I found a new food - for now just mixing a low carb dry food (tiki cat born carnivore) and a higher carb that she will eat a lot of (orijen cat and kitten chicken flavor), she ate about 1/2 cup this morning (she still won't touch any wet food - will work on that more once she's more settled). I did also purchase ketostix and will try to get a reading today. Now a second vet from the same office called me back and said to give her 2 units this morning and 1 unit if she wasn't eating well and said to never skip shots - he said I should only take advice from one doctor or otherwise I'll be going crazy/she won't get regulated..even more confused now!
 
KatieBDZ said:
Thank you Darcy! Hi Sienne - I got my spreadsheet up..I'm still new at testing the blood glucose so doing my best (also will have to go back to work tomorrow) but always testing before the shot. As you can see they vet keeps telling me to do the 4 units at night and then in the morning she is too low and I'm skipping the dose so I think that's too high, they told me when I called this morning that they think she had insulin resistance at the beginning and is just responding now I told them I will call tonight before her shot (after taking blood glucose) but that it has to be less than the 4 units since that's clearly not working properly. When she was there they started her on 1 unit, then 2 units, then 4 units of lantus which they monitored for 24 hours - when she was there they said she wasn't ever getting below 300 which is why they went up to the 4 units and even on 4 she was not below 300. I got her home at around 3 pm on 2/17. Since she's been home she hasn't been able to have the 2 shots 12 hours apart yet. Any advice (see SS for exact numbers but she keeps being too low in the morning)? She has been eating better now that I found a new food - for now just mixing a low carb dry food (tiki cat born carnivore) and a higher carb that she will eat a lot of (orijen cat and kitten chicken flavor), she ate about 1/2 cup this morning (she still won't touch any wet food - will work on that more once she's more settled). I did also purchase ketostix and will try to get a reading today. Now a second vet from the same office called me back and said to give her 2 units this morning and 1 unit if she wasn't eating well and said to never skip shots - he said I should only take advice from one doctor or otherwise I'll be going crazy/she won't get regulated..even more confused now!
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Sadly, you're being put through the proverbial wringer that we ALL have gone through with our vets. Know this . . . you will get THE VERY BEST ADVICE for YOUR CAT from this forum, not from your vet/s. I know that is hard to believe, we WANT to trust our vets. Heck, that's what we pay them for, right? But in reality, they usually get about a half day's worth of training on Feline Diabetes. That's it. So they all follow the same protocol and if it doesn't work for the cat, it gets blamed on insulin resistance, or the owner, or whatever . . .

You WILL get the hang of this and things will settle down. I promise you that. I'm not one to give dosing advice (hell, I'm still ASKING for it ;) ) but I have 10000% faith that the people giving advice here KNOW their stuff. They've lived and breathed it. They're here to help.

As somebody else mentioned, it sounds like the vets don't understand Lantus and the "depot". Those blue numbers are pretty good actually! But you're right, she's sort of bouncing around, but that IS due to the different dosages that have been given! So don't panic, some of the angels here will give you great advice as to what dose you should be sticking with for a bit. I anticipate it will be closer to 1 unit, or 1.5. But that is NOT my call, wait for the smart ones! heehee

Off topic, you need to learn the symptoms of a hypo and have ON HAND an emergency kit. Will find the link for you . . .

I see you're using an AlphaTrak. Have you considering buying a human meter? I also have an AT (as the vet highly suggested it) and it now collects dust in my cupboard. You'll find that the price of the strips alone will start you thinking about using a human meter.

Hang in there, you're doing great!!
Darcy
 
Hi Darcy - thank you for all the kind words/support <3 I really appreciate it - I've been very stressed since the diagnosis (she had DKA and HL and they had told me they weren't even sure if she would make it and she's only 4) and friends/family/boyfriend have all just been telling me to listen to the vet and she'll be fine and that I'm overreacting. But I think you're right the vet is just not giving me great advice right now. I'm so glad I've found this board/you all to help because I've been going crazy! I did just give one more call, this time to my regular vet (who I trust much more than the emergency vets) and he told me he agreed 4 was too high and it wasn't good that she was bouncing around so much, he said to start her at 2 units and stay at that for 1 week even if she had high numbers during that time before we make any other adjustments but hoping someone here can let me know what they think too. I did get honey in case of hypo but will maybe stop at CVS and get packets or something instead. The reason I got the alphatrak 2 was because it seemed the most approachable to me since it was calibrated for pets and I was already nervous about doing it/getting the correct numbers - I think after I get more comfortable I'll consider switching because you're right the strips are expensive!
 
Katie has been asked to keep posting over here in the Lantus ISG forum.
She had a duplicate post over in the Feline Health forum.
She is getting good recommendations here, and this is the best place for her to be right now.

Thank you Katie for continuing your posting efforts over here.
Darcy is already helping you lots. Hang in there. It does get easy and better. Promise.

Remember your mindfulness breathing to help relieve some of the stress. Deep breath, hold. release, deep breath, hold, release, clear your mind of all thoughts and concentrate on your breath.

Lots of knowledgeable, friendly, supportive people here to help you. You've got a great support network now. You are part of the "Lantus Land" family. :)
 
Katie, since you skipped this morning, you can pick your own shot time for tonight. I tend to agree with your vet that you should try 2 units next, definitely not 4. On your post on Feline Health, you said you would only be able to get a +1 tomorrow morning. If you shoot tonight one hour earlier, you'll be able to shoot tomorrow morning at one hour earlier, and be able to get a +2 as you head out the door. With Lantus, the +2 test is often a good indicator of how the cycle will go. If it's about the same or less than the preshot number, you will get a downward curve in the numbers. A bigger drop from preshot means an active cycle that will need more monitoring. Since you are going to work, the answer would be to put out some higher carb food out for her to keep safe if she's dropping a lot. The saying is that with DKA they have to eat, we don't really care the carbs at this point, as long as you can get enough food to get insulin into her.

Shooting one hour earlier tonight, if you can do it, will also let you get a later test in the cycle before bed, and give us a heads up on what 2 units might do.

Sienne also gave some good advice about anti nausea and appetite stimulants. How is Arya's appetite today? What I've suggested above depends on her being willing to eat.
 
One other thing, are you testing for urinary ketones daily? If so, it'll help us if you put the test results on the spreadsheet.
 
Wendy&Neko said:
Katie, since you skipped this morning, you can pick your own shot time for tonight. I tend to agree with your vet that you should try 2 units next, definitely not 4. On your post on Feline Health, you said you would only be able to get a +1 tomorrow morning. If you shoot tonight one hour earlier, you'll be able to shoot tomorrow morning at one hour earlier, and be able to get a +2 as you head out the door. With Lantus, the +2 test is often a good indicator of how the cycle will go. If it's about the same or less than the preshot number, you will get a downward curve in the numbers. A bigger drop from preshot means an active cycle that will need more monitoring. Since you are going to work, the answer would be to put out some higher carb food out for her to keep safe if she's dropping a lot. The saying is that with DKA they have to eat, we don't really care the carbs at this point, as long as you can get enough food to get insulin into her.

Shooting one hour earlier tonight, if you can do it, will also let you get a later test in the cycle before bed, and give us a heads up on what 2 units might do.

Sienne also gave some good advice about anti nausea and appetite stimulants. How is Arya's appetite today? What I've suggested above depends on her being willing to eat.
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The only way I could do a +2 tomorrow would be if I give her insulin at 5:30 pm/5:30 am and while I can do that tonight/tomorrow morning I'm not sure I could stay on that schedule consistently - would I be able to move it later again if I needed to? Her appetite is better today she's almost eaten a full cup of food and seems more interested in eating now. I'm hoping that I can get her to eat another 1/2 cup at dinner time - can post an update here when I see how much she is willing to eat
 
I just meant to try the schedule as a one-off tomorrow morning while we try to find a dose you can shoot every day.

Did the vet say anything about giving fluids? Fluids can help flush ketones. Trace can be managed at home, but can escalate quickly so it'd be good to get rid of them. Water usually helps, but hard to do with a dry food diet. Glad she's eating though. :) How many calories do you figure she's had so far? Also meant to ask, how much does she weigh?
 
Wendy&Neko said:
I just meant to try the schedule as a one-off tomorrow morning while we try to find a dose you can shoot every day.

Did the vet say anything about giving fluids? Fluids can help flush ketones. Trace can be managed at home, but can escalate quickly so it'd be good to get rid of them. Water usually helps, but hard to do with a dry food diet. Glad she's eating though. :) How many calories do you figure she's had so far? Also meant to ask, how much does she weigh?
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Oh ok yes I will try 5:30 pm/5:30 am for now and see how it goes. The vet did not mention giving fluids but I will say that she has been drinking on her own a lot..I tried to add tuna water to her dry food so she'd get more fluids but that just made her not eat it at all so I'm leery of messing with it too much. As far as calories I'd estimate around 241 so far (mixing two foods so not 100% accurate but that should be close) and she weighs approx 10lbs, she's definitely underweight/lost a lot from the DKA/HL. Thank you so much for all of your help :) this community has already been such a lifesaver my anxiety is going down.
 
With a DKA kitty, insulin is critical for keeping ketones at bay. Like I said yesterday, I'd go with the 2u and monitor as best you can. Are you able to leave food out for Anya during the day? You've also got good instincts about getting fluids into your kitty. Anything that she will drink is good!

(I suspect that her numbers were high at the vets office because they weren't feeding her a lower carb food. You're seeing a difference given you're feeding a better quality and likely a lower carb food than she was getting at the vet's office.)
 
Just a thought, have you every tried giving her all meat baby food (Gerbers or Beechnut)? Some cats find it hard to resist. It's not a complete food, but might be a way to get more liquid, and calories into her.
 
update: her PMPS was 381, she ate about another half a cup of food (working on hand feeding to get her to eat more) and is drinking water - ok to do the 2 units?
 
Awesome ty! Yup I will stay up later too to try to get more time if there are any other than +2 that will be helpful? I got her to eat a little bit more so calories total today probably close to 460 now
 
Sienne and Gabby (GA) said:
With a DKA kitty, insulin is critical for keeping ketones at bay. Like I said yesterday, I'd go with the 2u and monitor as best you can. Are you able to leave food out for Anya during the day? You've also got good instincts about getting fluids into your kitty. Anything that she will drink is good!

(I suspect that her numbers were high at the vets office because they weren't feeding her a lower carb food. You're seeing a difference given you're feeding a better quality and likely a lower carb food than she was getting at the vet's office.)
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Yes I can leave food out during the day the only problem is I have two cats - I could segregate them if needed though to make sure she'd have food available. I also have a friend that is going to stop by at 10 am (but she's just going to check in on her no testing or anything). Yes I think you're right about the food at the vets they just told me they were feeding her a "bland dry food". The carbs are still high on the one food that she's now preferring (20%) but she's at least eating more of it and it is orijen which at least has higher end ingredients. Thanks for all of the help again to everyone :)
 
Wendy&Neko said:
Just a thought, have you every tried giving her all meat baby food (Gerbers or Beechnut)? Some cats find it hard to resist. It's not a complete food, but might be a way to get more liquid, and calories into her.
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I can try to pick some up tomorrow to see what she'd think - I tried the purebites treat mixer which was just tuna mixed with water and she was not interested at all. I do also have some chicken flavored broth from tiki cat I thought about trying but with her once there's something she doesn't like about a food offered to her she kind of gives up on eating and walks away (even if I then offer her plain food without the gravy). I then resort to feeding her food by hand piece by piece until she gets bored of me.
 
Can your friend who is dropping by offer some more food.
Yes. I think I would separate Arya from the others while you are gone so that she has food there she can eat.
Several small meals during the day as well as her before shot meal is the best thing if you can manage it.

If the urine test is showing traces of ketones, try and get another test in the same day to make sure they are not increasing.
Well done getting the SS up and running and with all the info in the remarks column.
 
Katie, can you put 'Post DKA and HL' in your subject line please as that will alert us all to that fact. Thanks

Also, I may have missed it, but just wanted to check that you were given some cerenia to bring home for nausea.
 
Bron and Sheba (GA) said:
Katie, can you put 'Post DKA and HL' in your subject line please as that will alert us all to that fact. Thanks

Also, I may have missed it, but just wanted to check that you were given some cerenia to bring home for nausea.
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Ok I added that - let me know if I'm supposed to start new threads also not sure how this works! And they did not give me anything for nausea, she hasnt thrown up and has had normal bowel movements today - do you think I should still ask my vet for some tomorrow? She is not great with pills - struggling to get her to take her antibiotic tonight.
 
Probably safe for the night. Leave a bit of food out.

I won’t be on in your morning (west coast). Start a new post for the day, and link back to this one if you have questions.
 
KatieBDZ said:
Ok I added that - let me know if I'm supposed to start new threads also not sure how this works! And they did not give me anything for nausea, she hasnt thrown up and has had normal bowel movements today - do you think I should still ask my vet for some tomorrow? She is not great with pills - struggling to get her to take her antibiotic tonight.
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Hi Katie,
You're doing great!! In regards to starting new threads, you would start a new one each day :D

So this is the procedure (at least, my procedure ;) heehee)
  1. I open up my spread sheet, then also open up the FDMB page (both are bookmarked on my computer)
  2. I fill in my amps (let's use that as an example) and enter the dose I shot
  3. I then go over to the FDMB and go to the Lantus forum.
  4. I find MY thread from the previous day and open that up. I then copy and past that link.
  5. Go back to the forum and hit "Post New Thread" (upper right hand corner, little blue button)
  6. Enter the "title". This next part is very important! You'll see where it says " (No Prefix) ". If it is a normal day, nothing crazy happening, you don't need to ask any questions, you would leave this blank and move to the right where it says "Thread Title". BUT, if you have questions? Or, you are FREAKING OUT AND NEED HELP ASAP ;) (LOL) you would click on the drop down menu and you'll see either a red 911 tag, or a blue ? mark tag. If it is critical, use the 911. If you just have questions and need eyes on your post, use the blue ? . Then you'd move onto the Thread Title.
  7. Enter the date ( 2/19 for today); Your cat's name; then your AMPS number; and the dose you shot. (You can see examples of titles in the forum)
  8. Now to the body of the thread, I first toggle down a couple rows, type "Yesterday - " and then paste the link from my previous day's thread.
  9. Toggle back up to the top and tell us what's going on! Good day, bad day, questions, or leave it blank.
  10. Then, throughout the day or night, whenever you can get an inbetween test, enter that into your spread sheet, AND update the title of your thread.
I hope this helps some? Getting into the habit of posting daily is the challenging part, but it DOES help you (me) to keep focused, and more importantly, those here with knowledge can help us when we're wondering what the heck we're doing (definitely me ;) LOL) The more info they have, the more they can help us, help our cats.

Again, good job!
Darcy
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