Emergency vet continued.

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Hi Patty, here is your previous post from yesterday, the way he you have is not it :cat:
https://www.felinediabetes.com/FDMB/threads/at-emergency-vet.259693/#post-2917366

I will also tag Elise
@tiffmaxee

Wendy
@Wendy&Neko

Sienne
@Sienne and Gabby (GA)
Bhooma
@Bandit's Mom

Bron
@Bron and Sheba (GA)

Hi Ladies I know you haven't used Vetsulin , but Patty's kitty Kloey is at the ER since yesterday and had ketones ,the ER started her on Lantus which Patty will be using now

Can you take a look at her previous post here

Thank you so much ladies :cat:
 
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trudy66 said:
How do you link to the thread?
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Go to your name and tap it, then tap profile page ,tap that, then tap posts
You will see all your previous posts
Tap on the one you want ,then go all the way to the top of the page where the pic of that cat is and you will see that previous post above it, in that long box , press on it and hit copy, then go to your new post and press down and tap paste
@trudy66
 
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Please get a report of what insulin and what dose she got when, as well as any BG readings they took. I'm guessing they might have doses Lantus too high and also used the fast acting insulin.

I would not take her home until I was sure the fast insulin is out of her system and they didn't do anything weird with the Lantus (it's supposed to be 12 hrs apart, her Vetsulin dose was pretty good so the Lantus dose should have been pretty close to it). You have hypo stuff at home right?

Reason being - Lantus hypos can last awhile, especially if they gave too large a dose or more than 2 doses 12 hrs apart, adding in the fast insulin and it's rough. Even though her depot isn't built up, I'd like to know what you're up against before getting her discharged

Edit: the other thing to consider is they're feeding her glycobalance, which is 14% carbs, much higher than she's used to. So when she gets home and you back to her normal food that willa ffect things
 
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Thanks Melissa :cat:
This is from her previous post looks like they started her a n 2 units of lantus, but you're right Patty needs all that information you told her to get and not to take her home yet until the fast acting up insulin is out of her system

This is what Patty posted from yesterday about the lantus dose
My understanding is since it is a depot it won't help her for 3-4 days until the depot is built up. Is that correct? So during those 3-4 days what will help keep her BG down?
They are starting her on 2 units.

@FrostD
 
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FrostD said:
Please get a report of what insulin and what dose she got when, as well as any BG readings they took. I'm guessing they might have doses Lantus too high and also used the fast acting insulin.

I would not take her home until I was sure the fast insulin is out of her system and they didn't do anything weird with the Lantus (it's supposed to be 12 hrs apart, her Vetsulin dose was pretty good so the Lantus dose should have been pretty close to it). You have hypo stuff at home right?

Reason being - Lantus hypos can last awhile, especially if they gave too large a dose or more than 2 doses 12 hrs apart, adding in the fast insulin and it's rough. Even though her depot isn't built up, I'd like to know what you're up against before getting her discharged
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They told me they gave her 2 units lantus last night. Didn't say if they gave fast acting also. But they did say yesterday evening they stopped the fast acting and were just giving fluids. I'll get a full report when I go at 12.
How long does fast acting take to get out of her system?
 
Patty if you ever want to tag a member that has been helping you
Either in the beginning or end of your posts start to type @then the first 3 letters or so of the member you want to tag , you will see a list of members come up, tap on the one you want. After you are done and post it you should see the tag appear in blue, then you will know it worked
 
trudy66 said:
They told me they gave her 2 units lantus last night. Didn't say if they gave fast acting also. But they did say yesterday evening they stopped the fast acting and were just giving fluids. I'll get a full report when I go at 12.
How long does fast acting take to get out of her system?
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Ok

I really am not the expert but it's definitely less than 12 hours. I suspect it's ECID. But if she's hasn't had any since last night then that's good
 
Diane Tyler's Mom said:
Patty if you ever want to tag a member that has been helping you
Either in the beginning or end of your posts start to type @then the first 3 letters or so of the member you want to tag , you will see a list of members come up, tap on the one you want. After you are done and post it you should see the tag appear in blue, then you will know it worked
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It doesn't go to them if I hit reply?
 
trudy66 said:
It doesn't go to them if I hit reply?
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It might depend on how notifications are set up. I do get notifications if someone replies directly to my post, but I only get an email alert if someone private messages me
 
trudy66 said:
It doesn't go to them if I hit reply?
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You don't hit reply, if you want to tag a member after you post something you just start to type the first 3 letter or so of that member and a list will come up, when you see the member you want tap on it
After you are done and post it you should see the tag appear in blue, then you will know it worked

I see your tag worked above when you tagged Melissa
What are you talking about the reply?
 
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I wouldn't worry too much about it. When you got reply, yes you are replying. I just looked at alert preferences and that is one of them. I think most of us get the alerts when you reply directly to us.

But if it's a new thread, or the person you need hasn't posted on it yet, always best to tag
 
FrostD said:
I wouldn't worry too much about it. When you got reply, yes you are replying. I just looked at alert preferences and that is one of them. I think most of us get the alerts when you reply directly to us.

But if it's a new thread, or the person you need hasn't posted on it yet, always best to tag
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Ok thanks, they said she came up in the 200's after eating so they gave her the 2 units. I am heading to get her. So I'll update when I get all the info.
 
Well she's home. She looks much better. They kind of pushed Purina DM so I purchased a few cans. She ate it very well, almost a half a can when we got home. They have the libre on her back between shoulder blades. She went potty after eating and I checked ketones - not quite neg but not quite trace. Much better than instant purple.
They are supposed to email all notes to me. They had an emergency momma dog not able to deliver come in just as I got called back to get Kloey so she was probably going Into surgery. So it might be late tonight or tomorrow before I get them.
She did not have any regular insulin after her lantus shot last night at 9pm.
These were her readings after her dose last night.
913pm 205
1102pm 155
130am 188
251am 205
452am 159
709am 123
900am 94
938am 82
1042am 100
1122am 152
1159am 234. 2 units Insulin given
1238pm305
225pm 311
416pm 337
438pm 336
448pm 346
451pm 341
550pm 334
609pm 339
They told me if she was <250 to not give shot and call them.
Unfortunately she is on 12 and 12 schedule but that is not going to work so I've got to start moving her shots earlier.
I am so happy she is home.
@FrostD
@Diane Tyler's Mom

https://drive.google.com/file/d/1Rawq4kQOc96B0qDcaj9zfRGnudUGYcUo/view?usp=drivesdk
 
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With Lantus you can move each shot back by 15 minutes, or one shot back by half an hour.

I'm going to re-tag @tiffmaxee @Wendy&Neko @Sienne and Gabby (GA) plus @Bandit's Mom.

Ladies - Kloey has been in the hospital with ketones. Previously on Vetsulin, they switched her to Lantus. You can see SS for Vetsulin history. We know ER gave fast acting insulin, but no idea when or how much - we do know she did not have it after first Lantus shot. Her first shot of Lantus was 2U last night at 9pm, then another 2U at noon today. The BG history that Patty has is post 2 posts back, waiting on full report from vet. She is a ketone-prone cat. Not sure if it's best to hold the 2U, or if you recommend something else at this point.
 
I am glad she is home. I suspect the 2 units was too high a dose of Lantus. I thought at the time that they had increased the dose because she was on 1.75 units of vetsulin before the change over. One usually decreases slightly when changing insulins or stays the same…definitely not increase……however with ketones in the picture it could be a good dose.
 
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From the numbers you have posted it looks as if she could be bouncing from the low BGs the cycle before.
Can you update the SS as best you can so we can see please with the BGs from the vet? and also get some tests in before the next dose.
How long before the next dose?
We certainly don’t want to skip any doses. If you can get a +10 or +11 so we have a bit of time to decide what’s best to do..that would be great. Also if you can get a nadir for this cycle?
 
FrostD said:
With Lantus you can move each shot back by 15 minutes, or one shot back by half an hour.

I'm going to re-tag @tiffmaxee @Wendy&Neko @Sienne and Gabby (GA) plus @Bandit's Mom.

Ladies - Kloey has been in the hospital with ketones. Previously on Vetsulin, they switched her to Lantus. You can see SS for Vetsulin history. We know ER gave fast acting insulin, but no idea when or how much - we do know she did not have it after first Lantus shot. Her first shot of Lantus was 2U last night at 9pm, then another 2U at noon today. The BG history that Patty has is post 2 posts back, waiting on full report from vet. She is a ketone-prone cat. Not sure if it's best to hold the 2U, or if you recommend something else at this point.
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Her nadir was really late is that normal with lantus. Tonight we are at +8 and she is still 317.
 
trudy66 said:
Her nadir was really late is that normal with lantus. Tonight we are at +8 and she is still 317.
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Yes late nadirs can be normal, but may change as she settles into it/depot builds. Bounces also change things a bit.

I would put a line above yesterday's date stating she was switched to Lantus with PM dose (see how I did it on mine on 1/21/21)
 
trudy66 said:
Her nadir was really late is that normal with lantus. Tonight we are at +8 and she is still 317.
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So she is due for the next dose in about 3 1/2 hours, is that correct? I am in Australia so have no idea of your time.
Are you able to monitor the next cycle?
How is she eating? Are you giving her lots of snacks?
 
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Bron and Sheba (GA) said:
So she is due for the next dose in about 3 1/2 hours, is that correct? I am in Australia so have no idea of your time.
Are you able to monitor the next cycle?
How is she eating? Are you giving her lots of snacks?
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Yes, due in 2.25 hrs. I am going to try to move her time up to get it earlier, can't do the midnight schedule. So will gradually move up. She is eating well. I am going to try to stay up but have had little sleep the last few days. But will set alarm if I need to. Every 2 hours?
 
trudy66 said:
Yes, due in 2.25 hrs. I am going to try to move her time up to get it earlier, can't do the midnight schedule. So will gradually move up. She is eating well. I am going to try to stay up but have had little sleep the last few days. But will set alarm if I need to. Every 2 hours?
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Let’s see what the preshot BG is and go from there.
 
Bron and Sheba (GA) said:
Let’s see what the preshot BG is and go from there.
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I feel like she still was processing the IV regular insulin in that first cycle. That may be why she was low.
Just now +10 - 299.
Ill do a +11 and then I plan to shoot if ok at +11.75.
Do I need to feed her 30 minutes before like with vetsulin?
I really have not had a chance to read all about Lantus yet.
 
I don't think the fast acting was in play. If they didn't give it after that 9p shot (going off trust here, but my faith in ER vets is...poor), and those low numbers were at 9am, that fast insulin would have been well out. It's possible they gave it a bit before 9p and it helped keep things down, then Lantus kicked in. Either way Bron is right today is a bounce from the lows.

No with Lantus you test/feed/shoot. All in succession, no spacing needed. Exception of course being if you get a number lower than 200, you stall without feeding and ask for help on the Lantus board.

They gave you the U100 syringes right?
 
FrostD said:
I don't think the fast acting was in play. If they didn't give it after that 9p shot (going off trust here, but my faith in ER vets is...poor), and those low numbers were at 9am, that fast insulin would have been well out. It's possible they gave it a bit before 9p and it helped keep things down, then Lantus kicked in. Either way Bron is right today is a bounce from the lows.

No with Lantus you test/feed/shoot. All in succession, no spacing needed. Exception of course being if you get a number lower than 200, you stall without feeding and ask for help on the Lantus board.

They gave you the U100 syringes right?
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They told me to use the pen needles. But I stopped and bought some U100, but all they had were the 6mm. Will those be long enough. They look awfully short.
 
Bron and Sheba (GA) said:
Can you colour the AMPS column in the SS green please so we can see how low the BG went…thanks
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+11 - 304
Did I list that correctly in the AMPS column. I know it wasn't +the shot but just want to list how long after the normal shot time until they gave the insulin.
 
trudy66 said:
+11 - 304
Did I list that correctly in the AMPS column. I know it wasn't +the shot but just want to list how long after the normal shot time until they gave the insulin.
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Yes that looks great thanks. Now we can see at a glance that the BG went down to 82.
I’ve asked a couple of others what they think about the dose moving forward but haven’t heard back yet.
Post here before you give the dose with the PMPS if you don’t mind please.
 
Bron and Sheba (GA) said:
Yes that looks great thanks. Now we can see at a glance that the BG went down to 82.
I’ve asked a couple of others what they think about the dose moving forward but haven’t heard back yet.
Post here before you give the dose with the PMPS if you don’t mind please.
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PMPS - 306
 
trudy66 said:
PMPS - 306
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I haven’t heard back from anyone but I think that because of the very recent ketones we should stay with the 2 units for now……..when she comes off the bounce she might need to reduce to 1.75 U depending on what is happening with the ketones.
So I would stay with the 2 units providing you can monitor her……I know you are tired…..and if necessary you can give some higher carb food to keep her from dropping too low.
If she starts to drop lower, she may be coming off the bounce, so you would need to monitor more closely.
Are you comfortable with that?
 
Bron and Sheba (GA) said:
I haven’t heard back from anyone but I think that because of the very recent ketones we should stay with the 2 units for now……..when she comes off the bounce she might need to reduce to 1.75 U depending on what is happening with the ketones.
So I would stay with the 2 units providing you can monitor her……I know you are tired…..and if necessary you can give some higher carb food to keep her from dropping too low.
If she starts to drop lower, she may be coming off the bounce, so you would need to monitor more closely.
Are you comfortable with that?
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When do you think her nadir would be. Right now it looks like it will be tomorrow day time. But because I'm not familiar and haven't had time to study up on lantus
Not sure when nadir should be.
 
trudy66 said:
When do you think her nadir would be. Right now it looks like it will be tomorrow day time. But because I'm not familiar and haven't had time to study up on lantus
Not sure when nadir should be.
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The nadir is normally around the +5 to +8 mark but ECID. And the nadir can move around. And it depends when she comes off the bounce. Bounces can last from 1 to 6 cycles.
If tomorrow the pre shot BG is too low to shoot we will probably need to reduce the dose as we want you to be able to shoot both cycles on time……providing there are no ketones.
Because there are ketones in the picture it changes what we would normally do with dosing.
 
Bron and Sheba (GA) said:
The nadir is normally around the +5 to +8 mark but ECID. And the nadir can move around. And it depends when she comes off the bounce. Bounces can last from 1 to 6 cycles.
If tomorrow the pre shot BG is too low to shoot we will probably need to reduce the dose as we want you to be able to shoot both cycles on time……providing there are no ketones.
Because there are ketones in the picture it changes what we would normally do with dosing.
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ok I will wake up at +4 and +6 and check her then I should be up after that.
 
Bron and Sheba (GA) said:
I will be around for the next 7 hours so will keep an eye out.
Can you leave some food out for her?
I would feel more comfortable if you could check at +3 and +5…is that possible?
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Yes I will. Thank you all for caring for all these pets and owners who you have never even met.
You all are wonderful. I don't know I would do without you all.
 
I see a lot of tags, but not specific questions. So what I can answer, fast acting insulin is just that. It depends which one they specifically used, but can be in and out in as little as 6 hours. I think you said regular (also called R) so that could be 6 hours. Some places will have it on a drip instead of a shot, so a continuous action. Without more details on when it was discontinued I can't say more. If you give R, it can lower the numbers enough to give Lantus a lower number to work with.
trudy66 said:
Her nadir was really late is that normal with lantus. Tonight we are at +8 and she is still 317.
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She's bouncing today, numbers wobble around during a bounce. The cycle might not look like a normal Lantus cycle when bouncing.

As for Lantus dose, I agree with Bron. Let's see what 2 units does for her for now.
 
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