Dosing help for Jake 02/28/2010

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drjsiems

drjsiems

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I am not very well versed on how to use this forum so I apologize for that. Since +14 BG=152, I thought I had sent a message indicating that +15 BG is 187, but can't find that message. So anyway, that is what it is and his 1-1/2 ounces of Fancy Feast (about three hours ago) no longer appears to be responsible for the rise in blood sugar. It seems to be the concensus that Jake should get at least some insulin so I just gave him a scant 1U at +15-1/2 and gave him some more food. I will be here all day for spot checking and monitoring just in case. My concern about not giving Jake any insulin, with the obvious rapidly rising BGs, is the redevelopment of ketones that he just recovered from. This injection is about three hours later than what would have been usual and I will adjust that accordingly for tonights shot and so on. Did I do the right thing?

Thanks,
Judy & Jake
 
I must have been typing in your other thread as you were typing in this one!

Here is what I wrote:

Thanks, Ronnie, for linking the past threads, now I remember you!

Jake needs insulin. The DKA is too recent to take a chance on letting him develop ketones again. You're probably now several hours past your usual shot time. If you shot now, would you be able to shoot 12 hours after this tonight? What about tomorrow morning, do you have to get back on a particular schedule for work?

92 is a good number, but you're right, you don't have the data to be able to shoot at that number yet. The 152 is probably shootable, though, and I'm guessing he's even higher now. Can you get another test and then let us know what your schedule needs to be for the next few cycles? We need to get some insulin into him, even if it's not the full amount.

So you did good by shooting today! What schedule do you need to get back to, and when do you need to get back to that schedule? And if you have time today, please get started on a spreadsheet so we can help you better. You're doing great, this is actually very exciting because it looks like Jake is responding to his insulin!
 
Hi Judy,

You did do the right thing, and I am proud of all you have done for him. I found your thread about the recent DKA and it is here for others who'd like your history: http://felinediabetes.com/FDMB/viewtopic.php?t=5319

Let's get you a spreadsheet set up so we can review your numbers with you and give you a hand with fine-tuning your dosing. You can find information on how to do that in this sticky: http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=157 Please read the stickies on the lantus forum explaining lantus action, storage, handling and other valuable information. It's not necessary to commit it to memory immediately, but it will give you a pretty good idea what we're talking about when we tell you that your shed isn't full yet. :mrgreen:

Welcome to Lantus Land, I hope you and Jake will have much fun here!
 
Hi Judy and Jake. Just wanted to welcome you to LL. We're glad you are here. Thanks to everyone for posting the history on Jake. It already looks like he has made significant progress. Just sending my support your way. Loads of people in LL to provide you with support and advice.
 
Welcome Judy. I am glad to see you here and hear that you did end up giving Jake a shot. (((hugs to you and Jake))) He has come a looong way.
 
I have not had time to do a spread sheet yet, but I will soon. This is what happened yesterday and today.
After much thought and anguish and considering all of the input I received, this is what I ended up doing yesterday keeping in mind that Jake has just VERY recently recovered from DKA. Yesterday at 6:30 a.m. Jake was 92. We know that. I did not give him insulin. Two hours and 1-1/2 ounces of food later, his BG was 152 – rise probably due to the food. I did not give him insulin. I tested Jake an hour later – BG was 187 with the food probably not an influence. Holding my breath I gave a scant 1U insulin (instead of 1-1/4U) at 9:45 a.m. He ate 5-1/2 ounces more food throughout the rest of the day. Post 2-1/2 hours he was at 196 and post 6 hours he was at 182. Post 11 hours he was 308. I then gave Jake 1-1/4U. Post 11 hours (this morning) Jake BG was 85! I fed him a little and have not given him any insulin. I tested him post 2 hours and he was 107 - probably an influence from the food. I will test him again at 3 hours as I did yesterday. So far I have not given Jake any insulin and it is almost 11:00 a.m. making for a shot schedule later and later into the middle of the night. Even though I work from home, for the most part, I still need to maintain day hours. I do not know what to do in the meantime or how to correct this unless I give him 1/2U now (which would be scary especially if he did not eat) and feed him some more. If I do that do I have to stay up until 11:00 p.m. for the pm check/shot?

Thanks,
Judy & Jake
 
Hm.. you've got a little quandary here. He's probably going to go up pretty high. From now on, when you see a low number, try and get a post up here and get some input at the time of the pending shot. We have some basic steps we follow when we get a low preshot, but we've really got to see all your numbers so we can compare patterns. Last night was a full moon so it's hard to say that high number wasn't from that, or got into some food he shouldn't have, a result of the late shot yesterday, etc etc etc.

I think it's a bad idea to skip a shot with DKA so recently in his past. So right now he is at +14? I would probably shoot 1/2u. He's on the rise, albeit a slow one.
 
I just tested Jake again and now his BG is 158 and probably not due to the little bit of food he ate earlier. The BG rose 50 mg dl during the past one hour so I just gave him a scant 1-1/4U (probably 1-1/8th) insulin. I must be getting brazen, but the rise seems to be very rapid now. This took place +14-1/2 hours (or 11:30 a.m. CST - Monday). Please tell me that I did the right thing in this situation. But if he gets a low preshot number again, should I shoot sooner but in a smaller dosage?

Thanks,
Judy & Jake
 
I can't say it's the wrong thing because you don't quite know how Lantus works yet, so let's just say "no harm, no foul" and let's see where he goes. At the dose you're at, I don't think it's going to be a problem, but I think we do need to come up with a dose that calms down the lows and highs a bit. Since the shot is so late, my guess is that he'll ride it out just fine.

It's hard for us to advise you re: doses at low numbers without number history, do you think you can make up a SS for him? Even if you can just do the last week of numbers, that would be very helpful to us. I realize it can be a daunting thing to think about starting, but once it's up and running, I think you will understand what he's doing better. Just having that pattern laid out in front of you is often all it takes to start having those AHA! moments.

Judging by where he is tonight, we may have you shoot a reduced dose at +11 or a regular dose at +11.5 to get you started getting back on schedule.. but if he's low, that's outta the question of course.
 
I have created a spreadsheet for Jake, but am having trouble uploading it because it does not show me the option of "publish as a web page" under "Share." Can someone direct me. Thanks. Judy
 
Is it uploaded to google docs? Up in the top right corner you should see a button that says "Share" with a tiny arrow next to it. When you click that, you will see a drop down menu with the option Publish as a Web Page. A window should come up and you will be able to put a check in the box next to "Automatically republish when changes are made" and click the button to Publish Now (or Republish Now, can't remember what it says there) -- down below will be a URL address to your SS. You need that so you can direct us to your sheet, so copy that address and paste it into your sig line.
 
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