Lizzie 08/13/2012 AMPS 45

Status
Not open for further replies.

Jacquie & Lizzie

Member Since 2012
Um I don't know what to say. Liz's preshot number was 45 this morning. I didn't check her in the middle of the night so I have no idea how low she went. Obviously I skippied the shot. She is acting normal, very vocal and lovey. I did feed her a full can of food and she scarfed that down. I have to go back to work today & won't be home until after 1:30. I'll have my daughter watch over her. I think we're out of the danger zone for now but...I'm still a little freaked out!

Can a cat suddenly need a reduction in dose when their teeth are better?
 
Skipping the shot was absolutely the right thing to do. And the answer to your question is yes, a cat can have much less of a need for insulin as a result of a dental. If a cat had gingivitis or other dental condition that involves inflammation or infection, once that clears up, insulin needs can drop.

I have a question for you. You noted on Lizzie's SS that yesterday, you shot 1.75u at +6. I'm not sure if that was AM or PM +6. No matter when it was, your next shot would be due 12 hours from that +6. It doesn't matter that you shot half of Lizzie's usual dose -- you can't adjust dose and time that way. Did you make the adjustment for having shot late or did you shoot at your usual time? If you shot at your usual time, I'm concerned about the overlap. You will have Lantus onset and nadir occurring at the same time. Can your daughter test? If not, I'd ask her to leave some medium carb food out for Lizzie.

Also, please remember to link you condo from the previous day. Here's Lizzie's Sunday condo.
 
Wow. That is frightful to wake up to that number.
Do you know how to adjust your ss when you skip a shot?

Looks like you should start seeing changes for the better :smile:
 
Hi guys .. wow indeed! That is a nice low number, good think you skipped the shot .. seems like lizzie's teeth must be feeling much better! Have a great day guys!
 
Re: Lizzie 08/13/2012 AMPS 45 +8 104 UPDATE

What would've been +8 was 104

I have to go out of town tonight, so I won't be home at shot time, my daughter is going to test her. If she is 200 or below I told her not to shoot. But what if she's hovering around 200-250? What kind of dose should she do? I think it should be lower than 3.5 I'm half tempted to just have her skip the shot altogether & see where she is in the morning.
 
jacquie, please clarify when you shot yesterday.

it looks like the day might have gone like this, but we can't be sure without clarification:

yesterday
amps 136 - no shot given
+3 162
+6 (actually it's a +18) 357 - shot 1.75u?
+9 (or +3 if you shot above) 261

pmps 239 - shot 3.5u <----------- shot at your regular shot time?... six hours after you shot 1.75u?
no night time spot checks

today
amps 45 - no shot given
+8 (actually it's a +20) 104


we need to figure this out before we can possibly suggest anything for tonight.
one more thing... if your daughter shoots tonight when you're gone, will she spot check at all? when will you be back in town?
 
Jill & Alex said:
yesterday
amps 136 - no shot given
+3 162
+6 (actually it's a +18) 357 - shot 1.75u?
+9 (or +3 if you shot above) 261

pmps 239 - shot 3.5u <----------- shot at your regular shot time?... six hours after you shot 1.75u?
no night time spot checks

today
amps 45 - no shot given
+8 (actually it's a +20) 104

"if" the above is correct, lizzie has likely experienced a prolonged hypoglycemic event due to the timing of shots (too much overlap & carryover).
she's probably on the rise, but please continue monitoring to make sure.
 
jacquie, i snuck a peek at lizzie's spreadsheet and saw the 30 at +7.

is everything ok? how is lizzie acting?

please post if you need help.

if you haven't already, please give her a little hc with gravy and retest in 20 minutes.

if she won't eat, rub some karo/honey/syrup on her gums.


let us know how things are going when you can. we worry...
 
jacquie, in case you see this...

i have an appointment in 5 minutes so i can't stay online. if you need help, change the subject line of your first post to let people you need help.

here's the "DON'T PANIC! or HOW TO HANDLE LOW NUMBERS" post sienne wrote:

First, try to not panic. Post to the Lantus Insulin Support Group or on the Health Board. Make sure your subject line indicates you are concerned about a possible hypo and/or add the 911 icon to the first post in your condo. People who are experienced in dealing with low numbers will be there to help. After posting, remember to refresh your browser periodically to see if people have replied.

It’s important to recognize that just because your cat may be experiencing low BG numbers doesn’t mean that your kitty is critically hypoglycemic. Many cats will have low numbers and never have symptoms. It’s important, though, to bring those numbers up into a safe range. ALWAYS make sure you have a stock of test strips, high carb (HC) canned food that contains gravy and is over 15% carb such as Fancy Feast grilled, marinated, or Gravy Lovers varieties (see Janet & Binky's Food Chart for a full list of options), and/or a simple sugar solution such as Karo/corn syrup, honey, maple syrup, etc.

If your cat is experiencing symptoms, especially if those symptoms are severe, you need to rub Karo syrup, honey, or maple syrup on the gums or, if symptoms are very severe, administer rectally and get your cat to the nearest 24-hour emergency facility. Take the bottle of syrup with you to administer on the way if necessary. (Note that it is rare that we see episodes of symptomatic hypoglycemia with Lantus and even rarer to see severe symptoms. But, you need to know what to do should they occur.)

The symptoms to be concerned about include but are not limited to:

staggering, uncoordinated movements, 'drunken' walk, wobbling, balance problems
ataxia - usually lack of muscular coordination, but maybe changes in head and neck movements
disorientation (yowling, walking in circles, etc.)
twitching
stupor
convulsions or seizures
coma

If your cat is testing in low numbers and you are not getting a quick response to your post, there are several things you need to do. (Low numbers are under 50mg/dL or 2.8 mmol/L.)

Depending on how carbohydrate sensitive your cat is, feed approximately a teaspoon or less of food with high carb (HC) gravy or HC food only. (If you have a cat with GI issues, using syrup plus LC food is an alternative.)
Test again in 15 – 20 min. Depending on the numbers, give more HC food.
Repeat the above steps every 15 – 20 min. until your cat tests in the 50 mg/dL (2.8 mmol/L) or above range for 2 consecutive tests. Continue to feed in small amounts to keep numbers in a safe range.
Test in 30 - 40 min. and repeat the test and feed process until there are 2 consecutive tests where numbers are stable or rising.
Test in an hour and follow the same steps.

DO NOT become complacent. If number have risen after one or two tests, it’s important to continue testing. Numbers may bobble up and down as the HC food and/or Karo wear off. DO NOT get one test where your cat has risen from low numbers into the 50s and go to sleep or leave the house. You are putting your cat in a risky situation. When in doubt, leave HC food out.

In the case of an accidental overdose or should there be symptoms of hypoglycemia, even if you have caught this in the early stages, you may need to monitor for literally 16 or more hours. Lantus and Levemir are long acting types of insulin. This means if your cat is over dose, you will need to stay alert for hours in order to closely monitor and to keep your cat safe.

Please post your numbers. Those people who are helping you will not abandon you. In fact, they are staying up with you. The experienced people will even work in shifts to make sure your cat is safe and you have the support you need. Remember to refresh your browser to see new posts and keep posting so we know all is well.
 
Sorry not to respond earlier. It's been a little hectic around here the last couple of days. I went back to work & my schedule is a little wonky until the beginning of September. Adding on to that running the kids around to their various appts and sports...

We got through yesterday w/o any major upsets. I did give Liz her reg dose last night. Woke up this morning & she was 90. I fed her and gave her less than half a dose, 1.5 units. My husband was home this morning & my daughter was keeping an eye on her. I got home & tested her at +7 & she was 30. I fed her some hc food and have been watching her carefully. She is acting completely normal, actually more alert than normal. Not stumbling, falling down or any of that. She wouldn't let me near her mouth with Karo, so I let that one go. Her appetite is huge but I'm guessing it's from being so low, 'm letting her graze as needed. It's now +9 and she's 49. I'm planning on checking +11 & then again at pmps. I hate to skip shots but I think I need to re-evaluate her dose. I'm trying to keep her on a tight feeding schedule so we don't have food spikes but today I had to let that go too.

It seems like she's going a lot lower now that her teeth have been taken care of & the antibiotic has kicked in. Our vet is out of the clinic this week & has a sub in, but I'm waiting for her to email me after she looks at the spreadsheet.

Idk...I know I screwed up her shots the other day, and maybe I shouldn't have given her a shot this morning, but I don't want it to wear off completely when we are finally getting some greens and blues. I guess I figured a small dose is better than a large dose and by the time the overlap kicks in her numbers should have risen more. I'm treading on shaky ground right now with her. Do some cats do well with just once dose a day? If that's the case I need to change it so I can shoot her in the morning instead of night. It's much easier for me to monitor her during the day than at night. I mean I can drag my butt out of bed, but it's hard to go back to sleep & I have to be up very early.

Ok so that's where we are right now. Not sure what to do with tonight's preshot if she's low. But I'll cross that bridge in a couple of hours...

Thanks everyone & again I'm sorry I didn't get back sooner.
 
please post before you shoot anything tonight. In fact, if you can get a +11 and post that, that will give us a change to brainstorm about her dose.

I see a +9~49 on her spreadsheet - is that where she is now? If so, I would go ahead and feed her a couple tsp. of low carb and test again in 30 minutes. She *should* be starting to rise now, but you want to get her into at least the 50s (or preferably 60s) before backing off on testing, even this late in the cycle. Ok?

It is pretty rare for a cat to do better on once a day dosing. I can think of one or two cats here who have done that in the years I have been here, and that was when they were down to such a tiny dose that the caregiver couldn't shoot any less, but the cat still needed some insulin. Right now Lizzie is still running on some of the depot from last night's 3.5 unit dose, which is clearly too much for her now. There is still a lot of room for dose reductions before you hit the point where she needs once a day dosing, in my experience. Let's see where she is tonight.
 
I'm back. :smile:

I've been reading through this condo and studying your spreadsheet. It looks like on 8/12 you initially skipped the AM shot, then gave a partial shot 6 hours later when she was high, then gave ANOTHER shot 6 hours after that, correct?

If so, then I think your current low numbers are more because of that than because of the dental. If you read the sticky on the insulin depot, you'll see that Lantus works on sort of a delayed basis. It creates overlap and carryover. Each shot affects not just the next 12 hours, but the next several days. By giving extra insulin at +6 that night, you caused a lot of extra overlap, resulting in that 45. Then last night's 3.5 unit dose was too much for her because it was given while that extra dose from the night before was still working. We can't say for sure whether the 3.5 would be too much if it didn't have that much momentum behind it.

It is very possible that the extra shot on 8/12 is still affecting today's cycle. So while we would normally think that numbers will go up after +9, please do not assume that will happen today! Keep testing to be sure. She could dip down again.
 
08/14 UPDATE +11 59 Re: Lizzie 08/13/2012 AMPS 45

+11 was 59. One more hour until shot time, but I'm thinking of skipping it altogether. Hubby is taking us out to dinner so I'll check the board when I get home.
 
I have to agree that skipping tonight's shot (and maybe tomorrow morning's too, we'll see) is the only way to keep Lizzie safe, especially given that you have not been able to test frequently enough when she is in low numbers. Waiting for two hours to re-test after a 30 is not safe, no matter how closely you are watching for physical symptoms. By the time they are showing symptoms, it can be too late to help them. You HAVE to be sure you don't let your cat get into a hypo situation. A 30 means feed high carb NOW and test every 20 minutes until she is out of danger.

I know the low numbers appeared all of a sudden and that she has always run high until now, but if you had posted when you saw the 30 someone would have walked you through it. We don't expect you to learn everything all at once. We're here to help, but you have to ask.

Let's give her insulin depot a chance to drain, get her numbers up into a higher range, then go from there.
 
i see a 56 in the PMPS column tonight along with the notation no shot given.
how many hours after this morning's shot did you get this 56?
 
I guess I figured a small dose is better than a large dose and by the time the overlap kicks in her numbers should have risen more. I'm treading on shaky ground right now with her. Do some cats do well with just once dose a day?
I'm not sure you understand overlap or your not communicating it clearly. With overlap, as the insulin from the previous cycle is wearing off, the next dose is starting to work. This is why as a cat becomes better regulated, you see a flat cycle. When overlap "kicks in," numbers tend to drop or stay level, not rise.

For the vast majority of cats, you need to give Lantus twice a day. If you don't, you can see big swings in the numbers. It's better to reduce the dose so you can shoot twice a day.

What has us all concerned is that with numbers in the 30s and 40s, you have no idea how low Lizzie's numbers were. By shooting partial doses at mid-cycle and then a full dose, you can easily, very easily, overdose your cat. This is a dangerous practice. Jill and Libby are the most experienced people here when it comes to Lantus use. I would listen very carefully to their suggestions and cautionary notes. We have been exceedingly worried about Lizzie throughout the day.
 
Status
Not open for further replies.
Back
Top