Missed dose: Vet says give 1u at +6.5 ???????????

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max&emmasmommie

max&emmasmommie

Member Since 2012
Now, I'm afraid I forgot to give him his shot this morning. I don't know how, but the baby was fussy, I was trying to get ready to go to a memorial type thing, I'm starting to get a sore throat and a cold . . . So, now I don't know what to do.
My cats BG values have been very high for the last couple of days. Twenty eight hours ago he was at 260, and Twenty-one hours ago, his reading was 481. He's been in the BLACK every time I've been able to test him since including twice at "HI" -- 600 plus. Before that he was bouncing around all over the place. I've been waiting for him to level out.

Generally, if I missed a shot, I would wait until the next shot time, but the +6 reading was "HI." I thought I had some proof that I had given the shot at the AM time when at +2 the reading was about 50 points lower than the AMPS time reading. Apparently not.

My regular vet is not in the office today, and will not be in until Wednesday. Another doctor spoke with us. I suggested that we bring Max in to get a fast acting insulin shot that will get him through until his shot time tonight. The doctor also said that he wonders if 2u is actually too much insulin. Then, he suggested that we give Max 1 unit of Lantus right now, and give him 2u at his regular shot time tonight. He said to test Max every 2 hours, and bring him for an emergency visit if he starts to act like he is sick. He we need to see his regular vet soon as something is not right if Max has been on 2u for over a month with no improvement in his test scores.

I don't like the idea of giving him an extra 1u at +6.5. Any comment?
 
On occasion we ALL push the trigger of a syringe and find the cat's fur wet and smelling if insulin. OOOPS! It is called a fur shot. That is what you did, ok?! Do not give insulin at +6.5 and again at +12.

Now let me go back and read the rest. ;-)
 
The note on his ss says you did shoot. So are you saying you do not know if you shot, or you for sure did not shoot?

He really is sitting high. Are you able to check for ketones with the urine strips? How is he acting the last 2 days?

Did you get a amps number for yesterday? That is blank on your ss
 
I wouldn't recommend the shooting at +6.5 either. Lantus has a 12 hour effect so if you shot at +6.5 and then again 6 hours later at your regular pre-shot time you would in effect have a 6 hour overlap of two injections. One that would be kicking in right at pre-shot time and then piggybacking with the other all the way through kitty's onset of the second injection basically acting as a double dose. :o

I am not a "Relaxed" Lantus regular visitor, I am usually in the "Tight Regulation" forum but saw the post for help. Unfortunately, that's all the advice I feel comfortable giving because I don't know anything else about your cat like, what he normally eats, what his usual routine is, etc.
 
I agree with Cathy. Giving a half dose at +6 could be very dangerous. Also, if I understand your question, you are not entirely sure you didn't give Max his AM shot. Is that correct? How many hours till your regular PM shot?
 
Cini MIni's Mom, That's what I thought, too. The last thing he needs is a double dose if he's bouncing around, but maybe with high BG values and a missed dose, there could be a reason. I'm not going to do it unless I hear a good rationale for it. Well, in fact, I can't do it now. We are at +8.5 now.

Linda, No, I'm not entirely sure. I can't be sure. We have 3 1/2 hours to go.

Carolyn,

At +11.5 his BG reading was 481, and I gave him the shot at +11.75. Thus, I let the 481 double as the AMPS, but I didn't write it into the ss twice in two different places.

He acts ok except that he lay down between my head and my husband's head at about 4 am. He never does this. I got up, and he led me downstairs. I tested him immediately after he ate a little. Then he ate more. He is eating normally which means often - every 2 hours if I'm home, and his bowl was clean when we came back after being out for 3 hours. He wanted to go outside three or four times today even though it is raining steadily. He likes to drink the rainwater better than using his fountain.

He hasn't been playful in months, but he's sitting up normally instead of lying with his head down all the time. He did that before he started getting insulin. He is walking slowly and not perfectly, but not poorly either.

(My internet connection is slow today.)

Dale
 
I meant +7.5 in my response to Cini Mini's Mom Now at +8, the reading is "HI." He's resting, and he didn't try to pull his head away from the ear warming thingamabob.
 
Dale --

I'm from the TR forum. Carolyn asked if we could take a look. It does look like Emma is bouncing off of the blues. However, the bounce should have cleared by now. I really think you need to increase your cat's dose.

Is your cat's behavior as usual? Whenever I see these kind of numbers I always want to make sure there's not some infection brewing. You may want to schedule a vet visit to rule out any health issues.
 
Hi, CATHY,

He is eating Wellness Beef and Chicken wet food. Just today, I finished gradually switching him from HIlls m/d wet. He eats about 6-8 ounces of food per day. This is way down from 11 ounces of the HIlls food.

I use a ReliOn meter. He gets two chewable pills for renal support made by Standard Process each day; one pill of solidago crushed in his food, and 2 units of Rehmannia Eight tincture everyday. I quit using the Rehmannia Eight just in case it has sugar in it, but I haven't had a chance to find out whether it does. It is made by my vet's office, I think. Max uses a water fountain. Occassionally, I give him subcutaneous fluids. I have ketone strips when I can catch him peeing. I tried to use BB gun pellets in his box, but he eventually peed on my bed, twice. So, I went back to corn litter -- World's Best.

When I "may" have missed the dose this morning, I was in the process of moving his shot time from 10 to 8 via a process of giving the shot 15 minutes earlier each time. We made it to 9:30 if I gave the shot this morning.

At +9 his urine was Neg for Ketones, and at +10.75 his BG reading was "HI."

I checked all his claws. The skin around them is the normal pink, but two of them are dark brown under the nail right next to where the nail and skin come together. Both of those are his "ring fingers." His gums don't look good. They are red. I can't have his teeth cleaned. The vet said he has had a lot of old cats die within 3 months of having their teeth cleaned. This happened to my mom's cat just a few months ago. Besides, Max had a diagnosis of CRF in Sept of 2011. In early February, his CRF tests showed very good scores as if it had cleared up. I think I need to take him in for White Blood Cell test to check for infection in his gums or maybe just get antibiotics.

Thank you for taking a look. Let me know if there is anything else you need to know.


SIENNE, Yes, the first bounce should have cleared by now. I agree, but what about the second bounce when he went into the yellow? I'm not sure what to think about that-- if the first bounce doesn't clear then can we decide that the dose is too low, or can he bounce again and again, and we wait 72 hours to see if he's cleared the last bounce? If so, we have some time to go after the bounce into the yellows. Another issue is that the gradual food switch is complete -- shouldn't I have seen some lower BG readings from that? I was seriously considering dropping him back down to 1u for the next three days, and going up in .25 unit increases from there. However, if I can get some sort of second or third on your idea to increase his dose that feels more right -- anybody? I had posted on Lantus "Relaxed" here http://www.felinediabetes.com/FDMB/viewtopic.php?f=32&t=66378, but I got only one response. I cant' trust my vet to decide between increase or decrease, I don't believe -- he raised the dose to 3u from 2u on March 8th. I gave that dose only one time until I found out on this forum that such a jump is ill advised.

Thank you all for your responses. I'm going to shoot 2 units at +11.5 (assuming I gave the shot this morning at 9:30.) So, that is 30 minutes from now.

Dale
 
Dale-
I think Sienne was suggesting an increase to 2.25u. Do you have those new syringes yet if you chose to go that route?

How long before you go on vacation?

I cannot remember the specifics, but I believe we determined the crf dx may have been a bit premature. Let me go back through that tomorrow and see what those results were.

This is a great place to get suggestions/advice about dentals. I have never been part of a board with such collective knowledge on this topic. I would strongly recommend posting it as a topic/question in health.

I see you are looking for a good vet. YES! If you have any university vet hospitals around you (and can afford it) they are often the best.

Hurray on the food change!!!!! :) That is awesome!

Hang in there. I know how much you care about this little guy. And I know you have a lot on your plate right now. We are here for you!
 
I can get the syringes tomorrow. I hope they are the right ones. The woman at the vet's office told me they called in .3 syringes that are "30U." I don't think there is such a thing - I think there are only 40U or 100U, so I have my fingers crossed that they are 100u with .3 demarcations? Who knows!

We actually leave, I find out today, March 23 right after his PM shot. I thought it was the 25th.

HIs BUN was 38 and his creatinine was 2.04.

I called the Univ of Calif San Diego hospital and was told they don't treat diabetes. They only treat a few specific diseases. We used to live about an hour from Univ. of Calif Davis Vet Hosp. That was wonderful, but it's over 500 miles away now. Do you mean some private hospital called "University Vets"?
 
fwiw, here in california we don't have to have a prescription for syringes, at least not at walmart. you can just go to walmart and pick them up at the pharmacy. if you want to do that, they run about $12.50 for 100 of the walmart brand Relion (just picked up 200 of them a week ago). they have you sign a book as to what you are buying them for but that's the only requirement i've ever had to deal with. write this down and just give it to whoever is working in the pharmacy:

Relion brand 3/10cc, 5/16" needle, u100 syringes, 30 or 31 gauge, preferably with 1/2 unit markings on the syringe.

the boxes don't say they have the 1/2 unit markings but if you open the box there and pull out a bag of 10, you can see the 1/2 unit markings on the syringes. look at them before you pay. that way you can make sure they are what you want. once you pay, they're yours.

the 3/10cc means they have the capacity of 30 units, 1/2cc means they will be marked up to 50 units, etc....
u100 means they are for u100 insulins like lantus, humulin, or levemir. u40 would be for u40 insulin which would be prozinc and if i remember correctly you can't buy u40 syringes at a human pharmacy

where are you at in so cal? maybe i can help you with something? i live in xxxx and work in xxxx so if i'm close enough to help you with something, just yell :-)
 
Cindy,

Thank you. It sounds like she called in the right syringes, but I had no idea I didn't need a prescription. That's a relief. The tip you gave me that I have to open the box - invaluable. I would not have understood why the box isn't marked to say they are 1/2 u syringes.

You are 67 miles away on I-15. That's pretty far in Calif traffic. It's very kind of you to offer your help. If I can think of anything that doesn't require you to drive, I'll holler.

Dale
 
dale, i'm sure you're despairing with these high numbers! any of us would hate that.

i'm glad you're getting regular ketone tests.

i posted on your condo in the TR forum - i'd strongly encourage you to arrange a dental with someone else. your mom's experience is very sad, but that's not the norm for most cats. punkin's had a dental and i would guess most of the diabetic cats here get them done. a good vet dentist will protect max and keep him safe.

this vet's advice about lantus is exactly wrong. you would NEVER give a shot mid-cycle, not unless you were then going to shoot 12 hours after that. this is dangerous advice - the shots need to be kept 12 hours apart because of the way lantus works - think of it as timed release, slower acting, cumulative - it is not quick in and out like older insulins. that very quality is what makes it so good for a cat's fast metabolism.
 
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