Help with micro- dosing?

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JanetMR

JanetMR

Member Since 2017
I was able to convince my vet my Bella needs insulin!
We’ ve had a rough couple of starts.. with vetsulin initially and then .25 units of Lantus ( exactly three doses of Lantus before she stopped eating and developed loose stools ) She’s super sensitive.. planning on starting her on “ some” Lantus this weekend and see how it goes. She loses her appetite when her blood sugar drops to
“ normal” levels, so this has been very challenging.
I’ve read and seen the info about fine dosing and the “start low go slow method”
Can anyone give me advice about how to fine dose and follow the protocol with a micro dose?
Bella’s blood glucose levels tend to be higher in the evening and below 200 in the morning. Would I hold the am dose?
She has ketones AND glucose in her urine ( I asked the vet to test her urine)
This is why she FINALLY agreed that she does need insulin!
Vet gave me some cerenia to take home for her so perhaps this will help with her decreased appetite when on insulin. ( nausea?)
Info and advice appreciated!
Janet
 
JanetMR said:
cerenia
Click to expand...

Cerenia is for nausea.

JanetMR said:
I was able to convince my vet my Bella needs insulin!
Click to expand...

Did your vet indicate a dose? Are you sticking with the Lantus or will you be trying something else?

Looking at that .25 dose - using the SLGS method which is specific to Lantus/Lev- that 64 would of earned her a reduction to 0.10units. She does look like she needs some help with insulin especially with the keytones. If you look at the micro dosing sheet it does show the 0.10unit. If she earns another reduction it is to a drop.


JanetMR said:
She has ketones
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Do you have any keostix at home so you can test for keytones at home? They are available at any drugstore. Just need a drop of urine. I have a metal ladle that I scoop under Jones when he is going then test from there.
11RH8SF5MSL.jpg


With the keytones - does Bella happen to have an infection of any sort?
 
I will stay with Lantus at this point.
I have test strips for ketones.
( I’ve been testing... vets have dismissed my findings. Today I had the vet test)
I took her to the vet for a work up today just to see if she has something underlying going on. Pancreatitis was my suspicion.
Nothing obvious showed up in lab work.
So I would start with .1 unit Lantus?
 
JanetMR said:
She’s super sensitive.. planning on starting her on “ some” Lantus this weekend and see how it goes. She loses her appetite when her blood sugar drops to
“ normal” levels, so this has been very challenging.
I’ve read and seen the info about fine dosing and the “start low go slow method”
Can anyone give me advice about how to fine dose and follow the protocol with a micro dose?
Click to expand...
What level ketones is she throwing (trace, small, medium, large or what numerical value)?

You may not have the luxury of giving a tiny dose and following a protocol to the letter with ketones in the picture. The recipe for developing diabetic ketoacidosis is an insufficient supply insulin + an inappetant cat + infection or other systemic stress.

When ketones are in the picture, the "rules" or "guidelines" for any protocol often get tossed out the window in an effort to get as much insulin and food into the cat as possible. If you're available to monitor carefully, my suggestion would be to start with 0.25u every 12 hours unless she drops below 50 (human meter) or 68 (pet specific meter).

To do that safely, you'll probably have to feed foods with a slightly higher percentage of carbs in them to prevent Bella from bottoming out. When Alex would throw ketones, I'd pretty much feed her whatever she wanted just so I'd be able to safely get as much insulin in her as she needed. I'd also add as much water to her food as she'll tolerate, try to feed her more than usual, and test urine for ketones twice a day (if at all possible). If she's throwing anything above trace ketones you may want to talk to your vet about administering subcutaneous fluids.

Make sense?

 
I will leave the dosage question to an expert...which looks like Jill just answered.

I just wanted to make a note on the testing in that a pre-shot test should be taken every time, make sure Bella is high enough for a insulin, as well some mid-cycle tests to help us figure out how low the Lantus is taking Bella. Like 1 during the day and 1 at night.

Is it possible to get a curve this weekend?
 
Tracey&Jones said:
I will leave the dosage question to an expert...which looks like Jill just answered.

I just wanted to make a note on the testing in that a pre-shot test should be taken every time, make sure Bella is high enough for a insulin, as well some mid-cycle tests to help us figure out how low the Lantus is taking Bella. Like 1 during the day and 1 at night.

Is it possible to get a curve this weekend?
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She’s not on insulin yet so not sure doing a curve would make a lot of sense?
 
Here’s a link to your previous post, it helps others know what has already been discussed and helps you be less confused because others can see what’s previously been discussed:

http://www.felinediabetes.com/FDMB/threads/1-24-need-advice.190136/#post-2118280

I know it was already suggested you give a drop and that she was having small keytones. Hopefully the cerenia will address any nausea if that was the reason for her inappetance.
 
Jill & Alex (GA) said:
What level ketones is she throwing (trace, small, medium, large or what numerical value)?

You may not have the luxury of giving a tiny dose and following a protocol to the letter with ketones in the picture. The recipe for developing diabetic ketoacidosis is an insufficient supply insulin + an inappetant cat + infection or other systemic stress.

When ketones are in the picture, the "rules" or "guidelines" for any protocol often get tossed out the window in an effort to get as much insulin and food into the cat as possible. If you're available to monitor carefully, my suggestion would be to start with 0.25u every 12 hours unless she drops below 50 (human meter) or 68 (pet specific meter).

To do that safely, you'll probably have to feed foods with a slightly higher percentage of carbs in them to prevent Bella from bottoming out. When Alex would throw ketones, I'd pretty much feed her whatever she wanted just so I'd be able to safely get as much insulin in her as she needed. I'd also add as much water to her food as she'll tolerate, try to feed her more than usual, and test urine for ketones twice a day (if at all possible). If she's throwing anything above trace ketones you may want to talk to your vet about administering subcutaneous fluids.

Make sense?
Click to expand...

She tested small (15) for ketones at the vet.
I’ll have to read this a couple of times to have it all sink in. I am more comfortable doing .1 unit as best as I can measure... she had side effects from .25 of Lantus. I understand about ketones... but this is a cat that is super sensitive!
I will increase her food to a higher carbohydrate content while on Lantus. Is this correct?
Jill & Alex (GA) said:
If you think she's too low to shoot, please post for advice. When a kitty is actively throwing ketones, skipping a shot is one of the last things we'd want to suggest.
Click to expand...

What is too low to shoot?
 
JanetMR said:
I am more comfortable doing .1 unit as best as I can measure... she had side effects from .25 of Lantus.
Click to expand...
You can certainly start there and hope 0.1u will be enough. Continue to check for ketones. If the ketones get worse, the dose will have to be increased in order to get rid of them.
JanetMR said:
What is too low to shoot?
Click to expand...
If under 150, please post and ask for advice.
JanetMR said:
I am starting her back on insulin on Sunday.
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I can't emphasize this enough... it's important to start insulin as soon as possible. My own cat went from trace ketones at diagnosis to being in DKA the very next day... followed by a week long hospitalization... things were touch and go.
Just sayin'...


 
Juliet said:
She’s not on insulin yet so not sure doing a curve would make a lot of sense
Click to expand...

Was just thinking if she started insulin again today, the data that has been collected shows she went lower on .25u, so close monitoring(curve) may be warranted. Checking availability. Which was a comment made before reading the prior condo, so my bad.


There is the keytone and low appy issues, so I will leave this to the experts that have experienced keytone issues and just send @JanetMR some hugs for now and some vines for Bella! Will be keeping tabs.
 
JanetMR said:
I understand about ketones... but this is a cat that is super sensitive!
I will increase her food to a higher carbohydrate content while on Lantus. Is this correct?
Click to expand...
The higher carb food will allow you to get more insulin into Bella safely than you could if she were consuming a low carb diet.

Edited to add:
Once she's ketone free that will change.
 
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Jill & Alex (GA) said:
You can certainly start there and hope 0.1u will be enough. Continue to check for ketones. If the ketones get worse, the dose will have to be increased in order to get rid of them.

If under 150, please post and ask for advice.

I can't emphasize this enough... it's important to start insulin as soon as possible. My own cat went from trace ketones at diagnosis to being in DKA the very next day... followed by a week long hospitalization... things were touch and go.
Just sayin'...
Click to expand...
I wouldn’t wait two more days if I were you.
 
Juliet said:
She’s not on insulin yet so not sure doing a curve would make a lot of sense?
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Sandy and Black Kitty said:
Plenty of folks here who have successfully battled ketones, myself (as indicated in my signature block) included.


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That is good to know. I feel like I’ve been banging my head against the wall...no one took me seriously.
Jill & Alex (GA) said:
You can certainly start there and hope 0.1u will be enough. Continue to check for ketones. If the ketones get worse, the dose will have to be increased in order to get rid of them.

If under 150, please post and ask for advice.

I can't emphasize this enough... it's important to start insulin as soon as possible. My own cat went from trace ketones at diagnosis to being in DKA the very next day... followed by a week long hospitalization... things were touch and go.
Just sayin'...
Click to expand...
I understand. I’m doing the very best that I can for my cat, and me.
Thanks for the help and advice.
 
I’m from Virginia, I don’t know if you are in northern Virginia or not, but if you are, there are a lot of options for high quality vets. Might be worth considering finding a vet that takes you, and keytones, more seriously. :bighug:
 
Stacy & Asia said:
I’m from Virginia, I don’t know if you are in northern Virginia or not, but if you are, there are a lot of options for high quality vets. Might be worth considering finding a vet that takes you, and keytones, more seriously. :bighug:
Click to expand...

I’m near Winchester ( born and raised in Northern VA) it’s been difficult with vets
( not unlike my experience with human medicine)
I felt like I finally had my vets support and back up today... it’s been difficult. I look at it as a collaboration.. if they are open and willing to work with me that helps a lot. I came equipped with a plan and information to back it up. Ego often gets in the way.. I find compassionate cooperation most helpful. You don’t have to know everything.. just be open and willing to learn.
Driving into northern virginia is counter productive. But thanks so much for the suggestion.
 
My kitty J.D. survived DKA. They came on suddenly and he had to be hospitalized for 8 days. He was in critical condition when he went in.
I too agree with the starting of insulin as soon as possible. Maybe, you can start feeding her more now and tomorrow. Do you think that would be smart @Jill & Alex (GA) ?
 
JanetMR said:
Started on Lantus .25 unit 1/16/18 for three nights.
( held the am doses because of BG below 200)
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JanetMR said:
Bella’s blood glucose levels tend to be higher in the evening and below 200 in the morning. Would I hold the am dose?
Click to expand...

Since ketones are in the picture and a huge part of avoiding full blown DKA is getting enough insulin into your cat Its important we speak the same language.

When we use/see the phrase ‘hold the dose’ it means that whatever dose one is shooting should be maintained-no increases or decreases.

Please correct me if I'm wrong however in the above quotes I believe what you are referring to is withholding insulin , which in the vernacular of FDMB is referred to as ‘skipping the shot'.

It is a critical distinction
 
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Dyana said:
My kitty J.D. survived DKA. They came on suddenly and he had to be hospitalized for 8 days. He was in critical condition when he went in.
I too agree with the starting of insulin as soon as possible. Maybe, you can start feeding her more now and tomorrow. Do you think that would be smart @Jill & Alex (GA) ?
Click to expand...

I understand the importance of staring her back on insulin as soon as possible.
I will increase her food tonight and tomorrow and start her back on insulin tomorrow night.
I’m doing the best that I can.
It makes no sense to put a sensitive/ side effect prone cat on insulin when I cannot be around to adequately monitor her.
Sandy and Black Kitty said:


Since ketones are in the picture and a huge part of avoiding full blown DKA is getting enough insulin into your cat Its important we speak the same language.

When we use/see the phrase ‘hold the dose’ it means that whatever dose one is shooting should be maintained-no increases or decreases.

Please correct me if I'm wrong however in the above quotes I believe what you are referring to is withholding insulin , which in the vernacular of FDMB is referred to as ‘skipping the shot'.

It is a critical distinction
Click to expand...
Sandy and Black Kitty said:


Since ketones are in the picture and a huge part of avoiding full blown DKA is getting enough insulin into your cat Its important we speak the same language.

When we use/see the phrase ‘hold the dose’ it means that whatever dose one is shooting should be maintained-no increases or decreases.

Please correct me if I'm wrong however in the above quotes I believe what you are referring to is withholding insulin , which in the vernacular of FDMB is referred to as ‘skipping the shot'.

It is a critical distinction
Click to expand...

I understand.
What would my parameters be for not giving her insulin? Her blood glucose levels tend to run lower in the am ( this morning she was 175) and she has had hypoglycemia on insulin in the past.
I understand about ketones.. but I want to keep her safe and alive.
 
JanetMR said:
When she hit 64 I was really nervous.
I would say: 80
The challenge is getting her to eat when her blood glucose drops...she loses her appetite and then we begin a vicious cycle
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So, important considerations under the current circumstances are:
  • Getting enough insulin and calories into your kitty to combat ketone formation by maximizing conversion of food calories into energy that will reach her cells.
  • Keeping Bellas BG above 80 (human meter)
Regarding food - In your signature block you indicate you feed FF classics. According to the catinfo.org food chart-
  • The FF classics run from 0-3% carbs and 82-96 calories per 3oz. can.
  • The FF roasted/flaked/chunky flavors fun from 4-6% carbs and 80-107 calories per 3oz. can.
All things considered how do you feel about switching to the roasted/flaked/chunky flavors while resuming insulin at 0.10u and seeing how it goes?
 
Sandy and Black Kitty said:

So, important considerations under the current circumstances are:
  • Getting enough insulin and calories into your kitty to combat ketone formation by maximizing conversion of food calories into energy that will reach her cells.
  • Keeping Bellas BG above 80 (human meter)
Regarding food - In your signature block you indicate you feed FF classics. According to the catinfo.org food chart-
  • The FF classics run from 0-3% carbs and 82-96 calories per 3oz. can.
  • The FF roasted/flaked/chunky flavors fun from 4-6% carbs and 80-107 calories per 3oz. can.
All things considered how do you feel about switching to the roasted/flaked/chunky flavors while resuming insulin at 0.10u and seeing how it goes?
Click to expand...
That sounds reasonable. I will change her to the fancy feast with a bit more carbs. I’ve also given her Friskies Pate.

Any idea what blood glucose guidelines I should use for safely not giving insulin? Below 200? 150?
This is confusing to me.
 
When you start her back on insulin, tonight, test her, and post the number. We will help you. On this forum, when a person is new, we usually advise them to not feed and post for guidance, if their kitty's preshot BG test is below 150. Eventually, they learn to shoot lower numbers than that. Because of the ketones in the picture, normal guidelines may go out the window.
Is she eating well? How is she acting? Have you tested her for ketones this morning, yet? I'm hoping some of the extra food will reach her cells and slow the production of ketones. It's the insulin that helps the food get into the cells to be used by the body.
 
Dyana said:
When you start her back on insulin, tonight, test her, and post the number. We will help you. On this forum, when a person is new, we usually advise them to not feed and post for guidance, if their kitty's preshot BG test is below 150. Eventually, they learn to shoot lower numbers than that. Because of the ketones in the picture, normal guidelines may go out the window.
Is she eating well? How is she acting? Have you tested her for ketones this morning, yet? I'm hoping some of the extra food will reach her cells and slow the production of ketones. It's the insulin that helps the food get into the cells to be used by the body.
Click to expand...

She’s eating fairly well. Got a shot of cerenia yesterday that has helped with appetite ( past several days her appetite was off) I can give her another half a pill this afternoon.
She’s acting the same. Not lethargic but not energetic either.
I will start her insulin up again this evening.
Her morning BGs are usually low, evenings are almost always above 200
How’s the best way to post? To this thread or start another?
Thanks
 
JanetMR said:
She’s eating fairly well. Got a shot of cerenia yesterday that has helped with appetite ( past several days her appetite was off) I can give her another half a pill this afternoon.
She’s acting the same. Not lethargic but not energetic either.
I will start her insulin up again this evening.
Her morning BGs are usually low, evenings are almost always above 200
How’s the best way to post? To this thread or start another?
Thanks
Click to expand...

I haven’t been able this morning ( as of yet) to catch her peeing to check ketones.
 
JanetMR said:
Any idea what blood glucose guidelines I should use for safely not giving insulin? Below 200? 150?
This is confusing to me.
Click to expand...
You are going to have to take it one shot/cycle at a time. It will be a balancing act you have to feel your way through.
Keep meticulous notes on carb percentages and calories fed, monitor BG closely and the data will gradually build and be your guide.
Under the circumstances feeding higher carbs is preferable to withholding insulin so stock up on foods of varying carb content levels above the 4-6% of the FF roasted/flaked/chunky flavors you are going to try for starters.

What are your shot times?
You are in the eastern time zone,correct?

 
JanetMR said:
She’s eating fairly well. Got a shot of cerenia yesterday that has helped with appetite ( past several days her appetite was off) I can give her another half a pill this afternoon.
She’s acting the same. Not lethargic but not energetic either.
I will start her insulin up again this evening.
Her morning BGs are usually low, evenings are almost always above 200
How’s the best way to post? To this thread or start another?
Thanks
Click to expand...

Having very recent experience with inappetence and cerenia, take it from me, you want to get ahead of nausea, I would give the cerenia a little advance of the time she got the shot yesterday, being a pill, it will take a little longer to kick in, and it's easier to keep the nausea at bay than to let it happen again and try to reel it back in.

I'm glad to hear your vet is being more supportive, and I hope this round of starting insulin goes much better than the last time and the cerenia makes all the difference. :bighug:
 
Sandy and Black Kitty said:
You are going to have to take it one shot/cycle at a time. It will be a balancing act you have to feel your way through.
Keep meticulous notes on carb percentages and calories fed, monitor BG closely and the data will gradually build and be your guide.
Under the circumstances feeding higher carbs is preferable to withholding insulin so stock up on foods of varying carb content levels above the 4-6% of the FF roasted/flaked/chunky flavors you are going to try for starters.

What are your shot times?
You are in the eastern time zone,correct?
Click to expand...
6am 6pm EST
 
Stacy & Asia said:
Having very recent experience with inappetence and cerenia, take it from me, you want to get ahead of nausea, I would give the cerenia a little advance of the time she got the shot yesterday, being a pill, it will take a little longer to kick in, and it's easier to keep the nausea at bay than to let it happen again and try to reel it back in.

I'm glad to hear your vet is being more supportive, and I hope this round of starting insulin goes much better than the last time and the cerenia makes all the difference. :bighug:
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Thanks. I hope so too
 
JanetMR said:
How’s the best way to post? To this thread or start another?
Click to expand...
Please use one thread for all your comments and questions you have that day since this forum is so busy. This will keep all pertaining to your cat together everyday.
Start your thread with the date, kitty's name, and AMPS. Your thread will be bumped to the top of the list when you or anyone else posts on your thread.
We also ask that you link the previous days thread each day so that we can quickly get up to speed on history.
 
Sandy and Black Kitty said:
Please use one thread for all your comments and questions you have that day since this forum is so busy. This will keep all pertaining to your cat together everyday.
Start your thread with the date, kitty's name, and AMPS. Your thread will be bumped to the top of the list when you or anyone else posts on your thread.
We also ask that you link the previous days thread each day so that we can quickly get up to speed on history.
Click to expand...
Sandy and Black Kitty said:
Please use one thread for all your comments and questions you have that day since this forum is so busy. This will keep all pertaining to your cat together everyday.
Start your thread with the date, kitty's name, and AMPS. Your thread will be bumped to the top of the list when you or anyone else posts on your thread.
We also ask that you link the previous days thread each day so that we can quickly get up to speed on history.
Click to expand...

So... today I keep replying to this thread.. tomorrow I make a new one? How do I link previous threads?
It’s hard enough to keep everything straight with my cat.
I have a brain cramp
 
JanetMR said:
Just to clarify: tonight I will test her, don’t feed her and post the number for guidance. Is that correct?
Click to expand...
If she is below 150, or any time you are worried about shooting, don't feed, and post for guidance.

I would post whatever number she is, as there are people concerned about her, and want to know how she is doing.

Normally, we say to open a new thread ("condo") each day (only one condo per cat per day) as that keeps everything and all the questions for that day together in order with the responses. We copy the URL link to the previous condo to the first post in the new condo, so that others can quickly go back to search for what was said in the previous condo(s) without having to do manual searches.
If you want to start a new condo for today, make the Subject Line 01/27 Bella AMBG 175 - ketones - starting insulin tonight, or something like that, and in the first post copy the link to this condo from "yesterday" http://www.felinediabetes.com/FDMB/threads/help-with-micro-dosing.190228/#post-2119802.
If you get more tests during the day, you can change the Subject Line in the first post to add those tests like , +9 225, or if you have questions you can add the ? icon to the Subject Line in your first post and people will know you have a question. Once you are satisfied that the question is answered, please remove the ? icon.
Tonight, when you post your pm numbers, you could change the first Subject Line to something like 01/27 Bella AMBG 175, PMPS 250 - starting 0.10 tonight or whatever the test number is when you shoot.
Be sure to let us know if you were able to get a ketone test. Often people will add a layer of plastic wrap on top of the litter hoping to catch a drop of pee to test. I always used a small plastic cup and just put it under my cat's tail when he was peeing, but he didn't squat too far down, so it was easy. Also please let us know how she is doing and acting (the five Ps: Peeing, Pooping, Preening, Purring, Playing).

I agree with going out and buying all kinds of different carb foods. At one time, I labeled mine with a marker on the top of the can with the carb percent of that can like 5 7 8 10 22 or whatever they were. In order to combat the ketones, you will need her to eat to keep her BGs up enough so she can get the insulin which will in turn help her cells to use the food for nourishment.
 
Sorry, I cross posted. To link "yesterday's" thread, just copy the URL address from that post and then click on the icon that looks like a chain link and paste the URL address in the box.
 
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