New Member- Moo Bounced Last Night

Values are back to what they normally are in the morning (430s). Concerned someone in the house fed her a small amount in the 2-hour fasting time frame because she got sick a little. They think about 1 hour 40 minutes before testing so hopefully okay considering her bg is raised and I think she is higher DKA risk than hypo at this point. She immediately ate after getting sick and then the food was removed. Gave 1.25U at 12:08. It was a bit skinny. Have a timer set for +2. She seemed bright-eyed but mellow this morning. No signs of illness and she is eating right now.

@Bron and Sheba (GA)

I'm testing too often to be able to rest and it puts things at high risk of me making an error so I've made a plan of how to proceed:

If at +2 her BG change is like what I saw on the PM cycle of 4/29/22-4/30/22 with rapid drops, I'll have more frequent tests to catch an early nadir.

If at +2, her BG change is a sluggish drop like the AM cycle on 4/30/22 -5/1/2022 at ends up at close to the same value as that date test again at +5 or +6.


If she bounces, no idea what to do really. Still look at +5 or +6.


Prior Thread:
https://www.felinediabetes.com/FDMB/threads/new-member-and-new-diagnosis.262484/#post-2944559

 

About 1/3 of the way down this post is an approximation of what a typical Lantus cycle looks like. Lantus onset generally begins at around +2. The numbers usually drop until nadir (somewhere around +6) and then start to rise.

It would be very helpful if you could get a spreadsheet set up. The instructions are in this post on helping us to help you. I'm tagging Bhooma, @Bandit's Mom in case you need a hand getting a spreadsheet set up.

 

My spreadsheet should be in my signature?

 

I’m not around for your AMPS. I live in Australia and it’s about5 am around your AMPS so best to tag @tiffmaxee if you have a problem.
You don’t mention it in the thread but in the SS you say that you gave 1.75 units by mistake and add in the remarks column you were using the 1/2 unit syringe for the first time. Can you clarify what happened?

 

Yes. Sorry I'm still monitoring her. I recently got syringes with half markings and I read them completely wrong. I read 1.5 as 1 on the left even though all tick marks are evenly spaced should have noticed i saw a label on the package that made me interpret marks on the left all go up by 0.5 units. So i counted 0.5 then 1.5, as 0.5 then 1. My mind isn't working right.

I went over her dosage by 0.5U. At around 3+ i started to detect she was dropping at a faster than normal rate. I ended up giving some syrup and dried catfood and a little bit of sweet bread as it started dropping hard and hit 107. It was the rate not the level that scared me. I did end up calling the emergency vet and decided if she dropped to 80 despite syrup and what i had at home I would run her in.

I've been monitoring every 20 min since to watch the rate of decrease slow down. I plan to keep watching till she increases for a while.Im no longer giving her anything high carb just watching. I will need advice on how to dose her tonight.

I feel like I'm at the end of my rope.

 

Oh poor you! Don’t worry. These things happen. You are not the first and you won’t be the last.
Just go back to the correct dose next time unless you are concerned. Ask for assistance if you are worried.

 

I cant imagine losing her from a mistake like that. I would never get over it.

I'm going to look at the forum's half unit image guide from now on before dosing. Im spooked so i might just use the normal syringes for a while. I was okay at estimating 0.25, i think. If anything a bit conservative.
The images on here should work for any 1/2 unit u100, i hope?

https://www.felinediabetes.com/FDMB...info-proper-handling-drawing-fine-dosing.151/

Looking at the rate of onset at 2 and 3 hours is something Im going to do from now on too. I wouldn't have caught what was happening without it. Advice on here really makes a difference.

 

What time do you shoot? I have to leave early tomorrow morning but might still be around when shoot and should be tomorrow night.

 

12 a.m pacific time (California). We are on a bad schedule at moment.

 

I’m in California as well. I remember now your crazy to me shot your and why. I will be asleep. Tag @Bandit's Mom if you need help.

 

@Bandit's Mom

Could you help me figure out a safe dose for Moo tonight (12:00 a.m pacific) if her Bg is lower than usual? I'm not familiar enough with the effects of lantus to predict how this will affect her next cycle. I overdosed her today (unfamiliar with 1/2 unit syringe markings) and avoided a hypoglycemic episode with carbs but i don't know what that did to her system. I heard i can dose her normal amount. Can i be more conservative for tonight?

 

@Bron and Sheba (GA)

@Bandit's Mom
Please see post #11
Thanks ladies
Ariah shot 1.75 by accident this morning instead of 1.25 she's looking for advice on the dose for tonight

 

I would stick with the half unit syringes
1.25 units would between the 1 unit line and the 1.5 unit line

 

We need to see the PMPS BG before we can help with the dose.
How many hours until the PMPS @Mookitty's Mom?

 

@Diane Tyler's Mom.
Diane, Mookitty had DKA and I want her to stay a bit longer here while we get everything sorted out.

 

2 hours till I test.

 

Okay. Ill do that

 

I’ll be around for that…..take the PMPS test about 10 minutes before it is due and post the result and I’ll watch for it.
It looks as if she is heading back up again so I don’t expect a low PMPS.
Are you able to monitor the cycle at all tonight?

 

I have been awake except for two hours this morning before her shot. I can stay up another night but its not a good idea.

 

Under normal circumstances. I would have monitored till +2 or +3 tonight.

 

Let’s see what the BG preshot is. I’d rather she got her normal dose if possible. Are you any good at setting the alarm, testing and then going back to sleep?

 

Of course , I'm going to delete my post

 

I can do that.

 

277 mg/dl
@Bron and Sheba (GA)

 

I just repeated that test and got 309 mg/dl.

 

The preshot is high enough to shoot the 1.25 units. However it is the lowest preshot you have shot and you did increased dose by mistake this morning. **** Just saw you retested and got 309.
I would like to see you give the 1.25 units but you would need to monitor until we are sure she wasn’t going to drop too much. The main reason she might drop is that the depot is fuller from the 1.75 dose you gave this morning.
You would need to get a +1 and a+2 to see how it is going and then go from there. How do you feel about that.? You need to be comfortable doing it.

 

What is the downside of going down to 1 unit?

 

I can montitor at 1 and 2, its just im not mentally equiped to handle a rapid drop again

 

1. It is best not to chop and change with Lantus as it likes consistency.
2. With DKA we want to give the best dose to keep those ketones at bay.
3. Whatever dose you give, you will have to monitor for the first half of the cycle anyway because it will be influenced by the previous dose.
However if you are Uncomfortable with the 1.25 units we can do 1 unit. But you will need to get used to shooting lower numbers at some point.
I will be around for the next 6 hours and if you post every hour I will be here. And after that bandits mom is around to help.
Remember you are in control as long as you are monitoring and you can feed the curve to slow it down.
Up to you.

 

Okay. Ill do 1.25.

 

Ok. Make sure she eats a good meal before the shot and then get a +1 and we’ll see how she goes.
I will watch for the update.
It won’t always be like this. You have had a rough start to the journey, and the first few weeks after DKA are busy and tiring.
Things will settle down and get much better I promise.

 

I jumped the gun and gave it before she finished eating and gave it prior to seeing the message. Hopefully things will be okay.

 

That’s absolutely fine. I used to give Sheba her food as she ate as I knew she would always eat it…..very food motivated!
See you in an hour

 

@Mookitty's Mom did you get the +1?

 

Yes. Im a little slow getting bloodnout still. 206

 

Was that just now? So +1.5?
I was hoping for a bit of a food bump but it is a drop. So I would give a good snack now.

 

By the time i measured the shot it was 12:12. That's our starting time. First measurement i more like +1.16.
I am keeping her food next to her.

 

Ok. So next test in just under 1 hour?
Make sure she eats now if you can. I would like to bump up her BG a bit if we can or at least hold it steady.
What carbs is she eating?

 

The food i have available is friskies, the diabetic prescription food (higher carb but she doesnt like that much), and fresh dried meow mix.

As far as sugars: karo, cake, and brioche.

 

Current feeding friskies and offering the prescription food.

 

Not eating much though. Earlier today when she went close to 100 she did like the dried cat food.

 

Ok let’s see how she goes at +2. If she has dropped quite a bit again, and it’s early in the cycle, we will need her to eat something so if it is some higher carb food or dry, that is OK. Number one priority is keeping her safe.

 

Should have added, we don’t want to fill her up though as we may need to get her to eat a bit later in the cycle.

 

Okay. If she doesnt start eating that what do I do?

 

She just ate some. Im not sure where is the fill up point with her. When she was on mirataz and no insulin she could eat a lot.

 

Offer her something else. Just a couple of teaspoons.

 

We don’t want to fill her up ….just a snack

 

184. Slightly early.

 

More exact times:
From dosing at aprox 12:12 to 1:16 she went down 103.

From 1:16 to 2:08 she went down 22.

 

Ok I would feed her some of her higher carb food. Now becasue it’s early in the cycle and she’s dropping.

 

I don’t understand what you are saying here?

 

Im just stating the exact times on the glucose meter from shot time to when i got a "+1" measurement and then from +1 to. +2. The rate is slowing down.

She is drinking a lot of water.

 

Offered two or so tablespoons of dry

 

One tablespoon is enough. Not too much please. We don’t want to fill her up.

 

Okay. She has eaten maybe 5 to 8 pieces only.

 

She has been drinking more than eating the past 20 minutes. I've been having a hard time predicting nadirs on her and have been unsure when a subQ drop is safe.

 

You are both doing well.

 

I wouldnt give it when the insulin is at its strongest as SubQ fluids can sometimes lower the BG.
Maybe at around +10 would be a good time as long as the BG is still not dropping.

 

Its strange that almost always she has the most rapid drop at +1 or +2. Is it common to drop this fast and does it get better?

 

You will get to know how she reacts to insulin. Every cat is different (ECID). Sheba often used to drop early in the cycles but normally after the onset which, for Lantus is around +2. You will also get to know what to feed her to slow the drop.

 

Would it be terrible to try feeding her a teaspoon to tablespoon of kibble 30 minutes or 1 hour into her dose tomorrow, especially if her AM test is not that high like this one? She consistently drops fast at the beginning regardless of me ODing her.

 

162

 

I’m not fond of dry food at all. Do you have any canned higher carb food?
I would try normal low carb food first at +1 and +2 to see if that worked.

 

I’d give her a normal low carb snack….hopefully she will eat some. She’s slowed down and looking good.
Can you get a +4?

 

She has been on the low carb but this still occurs. I don't think she is that fond of the wet higher carb I have.

 

Yes

 

You need to find some higher carb wet food that you can use for drops and low numbers. Medium carbs….11-16%. High carb…..17 % and up to around 23%. It’s better to use than dry food for many reasons, especially if she has some early kidney issues.

 

She is going for the food now

 

How are you holding up?

 

Im okay. Want reasurance before sleeping

 

Well that’s up to Mookitty and what she does with the BGs.
Are you any good at sleeping for an hour and waking with the alarm?
Some people don’t trust themselves to wake up. I was lucky and was always able to get up with the alarm, and that is how I survived when Sheba spent many nights having a pyjama party.

 

I dont trust myself that well. Its to the point where im too anxious about not waking up to sleep.

 

I get that.

 

141

 

It’s actually a really nice cycle. That’s +4 right?

 

Yes minus 3 min.

 

When you get some time and are not too tired, would you mind colouring in the squares in the SS that are uncoloured at the moment please?
Colour each square in the colour of the lowest number in that square.

 

Done.

 

I think it is safe to nap. The drop is at a fairly slow rate and she has plenty of food next to her

 

Wow, that was quick! Thank you. It’s much easier to see the trend with the colours.

 

How long until the next test? I’d like to see the +5, mainly because of the extra insulin this morning. Can you manage that?

 

Yes

 

Test is in 30 min.
On a normal night when nothing has happened to the prior cycle and no dosage was upped a pattern and BG range like this would be okay to go to sleep on after +4?

What would satisfy you to stop checking?

 

On a normal night, you may only need to get a +2. If the +2 is higher than the preshot, that normally means an inactive cycle where not much will happen. If the +2 is about the same or lower than the preshot BG then it is most likely an active cycle like tonight and you will need to keep testing.
You will get to know how he reacts to insulin. Some cats are big droppers. My Sheba was a champion diver and bouncer. Some cats settle down early and have read the rule book and do everything right, others bounce and dive. Others go down slowly and others fast.
If you put the type of carbs you feed in the remarks column, it will be useful to you later when you look back in how you managed cycles.

What would satisfy you to stop checking?
Depending on how fast a cat is dropping, I like to see the nadir and where the next BG has gone back up a bit or the BG has slowed right down. I don’t like to stop testing when the BG is still dropping quite a bit especially if there is not much data.. Also when you have more data, you can look back and see what he normally does…. at the moment we don’t have much data on what he will do. Does that make sense?

 

Yes it make sense

 

200

 

There you go…there’s the turn around. Good data to have.
Well done tonight. I think you can sleep soundly now.
I would stay with the 1.25 units tomorrow. We know now that she likes to drop early in the cycles so we don’t need to worry quite as much if she does that.

 

Thank you so much for tonight. Have a good day.

 

It’s a pleasure to help. I hope you can get some sleep now. I’m heading to bed here in Australia.

 

I would start a new thread tomorrow as this one is starting to get a bit long…see you tomorrow.