On the brink of DKA 3rd time in 3 months 2 year old Charlie

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Re: On the brink of DKA 3rd time in 3 months 2 year old Char

Jill,

Actually, my vet's advice for my cat post DKA was to dose the R every 2 to 3 hours. I was sharing my experience. I'm sorry you think my advice is so dangerous. Ellie is a vet tech and capable of testing and assessing any changes in Charlie.

If you look at the spreadsheet, you will see that the Lantus is still not fully working for Charlie given that it has only been 5 days.

I made it clear that this is not normal dosing advice, but specific for Charlie based on the information presented. Every cat and every circumstance is different.

The goal for Charlie is regulation, not remission. He is likely a "type 1" cat, and I as a human Type 1 diabetic have plenty of experience and expertise in that area. I used Lantus along with a fast acting insulin long before the Rand Tilly protocol. Cats are mammals with an endocrine system similar to ours, which is why Lantus works so well for them.

I wish that you would learn to listen to other opinions in this forum. It would help many of your cats and their owners if people like me didn't get shut down. I have fostered approximately 20 diabetic cat in 9 years. Many of them went into remission. Others have gone on to other homes and lived long lives.

Claudia
 
Re: On the brink of DKA 3rd time in 3 months 2 year old Char

I think you could sleep for an hour and if he has stopped going down or his blood sugar is essentially flat, then you might be able to sleep the rest of the night,.

When I had to do this, I slept on the sofa, light on, cell alarm set loudly so I would wake up.

Just keep 68 in mind. That is your intervention number.
 
Re: On the brink of DKA 3rd time in 3 months 2 year old Char

Ellie,

Charlie's last number was great. Sorry for all the drama over my suggestion. If they had sat on their hands, it would have all been fine because Charlie came down instead of going up.

I wish you and Charlie the best. I'm going off to get some sleep.

Claudia
 
Re: On the brink of DKA 3rd time in 3 months 2 year old Char

cjleo said:
Actually, my vet's advice for my cat post DKA was to dose the R every 2 to 3 hours. I was sharing my experience. I'm sorry you think my advice is so dangerous. Ellie is a vet tech and capable of testing and assessing any changes in Charlie.
Click to expand...
it's one thing to follow/take such aggressive measures with your own cat. it's quite another to take them with someone else's cat.

cjleo said:
The goal for Charlie is regulation, not remission. He is likely a "type 1" cat, and I as a human Type 1 diabetic have plenty of experience and expertise in that area. I used Lantus along with a fast acting insulin long before the Rand Tilly protocol. Cats are mammals with an endocrine system similar to ours, which is why Lantus works so well for them.
Click to expand...
no kidding. :roll:

cjleo said:
I wish that you would learn to listen to other opinions in this forum. It would help many of your cats and their owners if people like me didn't get shut down. I have fostered approximately 20 diabetic cat in 9 years. Many of them went into remission. Others have gone on to other homes and lived long lives.
Click to expand...
please don't insult me claudia. there's good reason to shut you/anyone down if they're putting kitty in danger. tonight, you're putting charlie in a potentially dangerous situation by suggesting a super aggressive technique (usually performed in a clinic/vet office only) on an internet message board with very little information about the cat.





~ edited last paragraph to clarify.
 
Re: On the brink of DKA 3rd time in 3 months 2 year old Char

I am sorry that we caused an issue. I just want to do the right thing by my cat. I don't want anybody to get in trouble I know everyone is only trying to help. I honestly don't feel comfortable giving more humulin tonight firstly because his number right now is pleasing to me. It's below 300 and that's pretty huge for us. He seems to be improving and happy and in all honesty I don't know how much longer I will ve able to keep my eyes open. Very emotional day. We had to send our 20 year old kitty to the bridge today plus the Charlie roller coaster, I'm a wreck and my body is demanding some shut eye. I have Charlie curled up with me and will continue to keep a sleepy eye on him. Thank you all for your help tonight it means the world to us
 
Re: On the brink of DKA 3rd time in 3 months 2 year old Char

I'm so sorry to hear of your other kitty passing. What a rough day.

You haven't caused anything, so don't worry.

Sleep well and see you in the morning. :YMHUG:
 
Re: On the brink of DKA 3rd time in 3 months 2 year old Char

((((Ellie))))

I am so sorry about your kitty that crossed today. You've been through a lot since Charlie's first bout with DKA. As much as we love our babies and want them to be well, it's important to take care of yourself, too. You can't take care of him if you are emotionally and physically exhausted.

I'm glad he seems better. I hope you all get some rest and his numbers continue to improve.
 
Re: On the brink of DKA 3rd time in 3 months 2 year old Char

I'm so sorry for your loss. We never seem to have enough time with our precious little ones. I'm still reeling from losing one of my own this week.

Hope you can get some rest tonight...
 
Re: On the brink of DKA 3rd time in 3 months 2 year old Char

299 is current reading (263 an hour ago) which looks like he's going back up or at least the humulin has worn off. Thanks for all your kind words about my other kitty. Talk in the am I'm beyond spent. Goodnight thanks again
 
Re: On the brink of DKA 3rd time in 3 months 2 year old Char

Good morning friends. Hope everyone is a little more rested. Charlies AMPS today was 395 and I gave him 3.50 units of Lantus (no humulin without advice here) and he seems to be feeling a little better, he actually ran over to greet me and did his stretching himself up my leg routine that means he wants to be cuddled. I am happy he is starting to act "normal" and not hiding today! I am not leaving the house today so I can get bgs every 2 hours faithfully throughout the day. Should I start a new "topic" or stay on this one? Hope everyone has a great day with no stress or obstacles! I want to thank everyone that stayed up with us last night to get Charlie thru the night without incident. I know there was the issue with the advice that Claudia was giving. Again, I am new here and I know there is the rule that all questions must be posted on the forum which I will strictly follow. I know Claudia was trying to help, she offered to stay up with us all night too. Maybe her treatment advice was a little on the aggressive side but I think that was because I was desperately trying to keep him out of the ER and she knows Im a vet tech. I listen to all advice on here very carefully and if something seems too aggressive I wouldn't put Charlie in jeopardy. Thanks again for everything everyone on here has done for us. Please advise on treatment plan for today. :)
 
Re: On the brink of DKA 3rd time in 3 months 2 year old Char

Great job last night!

It might be helpful to start a new condo with the subject of 08/31 Charlie AMPS and his number...

You can link this condo to the one you start today.

It is nice to have the new condo each day, so people don't have to scroll through a ton of messages to get to the new info. Also, I would edit this post to remove the 911 (you can go up to your original post and edit it and select none as the icon).

Let's hope Charlie plans to keep on keepin.....

Also, so sorry to hear of the loss of your other cat.....never easy to let one go.....
 
Re: On the brink of DKA 3rd time in 3 months 2 year old Char

Morning Ellie,

Taking my hat in my hand, but I'm posting again. Sorry to hear you lost a kitty yesterday. Fly free on angel wings to your 20 year old. Hugs and prayers for solace and comfort for you.

Lantus increases need time to fill the shed - like a few days. So, increasing it two days in a row will not show in Charlie's bgs for a day or two. That is the value of using R IM to keep Charlie at a level that keeps ketones at bay until you increase his Lantus dose according to protocol.

At 395 on the AlphaTrak, Charlie is above what we call renal threshold. As I said last night, I would be giving him R IM. If you would like a possible dose, I would use the same dose as for the 411 bg last night. And, I would give it soon so it is waning as the Lantus kicks in.

Just my two cents for your boy Charlie.

All the best to both you and Charlie

Claudia
 
Re: On the brink of DKA 3rd time in 3 months 2 year old Char

Good morning, Ellie!

You will want to open a new condo/thread like Molly suggested. Let us know if you're not sure how to link this condo to your new one.

When you have a chance, could you please update Charlie's spreadsheet? It's difficult for me (and I'm presuming others) to have the big picture of how Charlie's been doing without the numbers.

I'm curious. Did your vet suggest giving IM shots of R? From what I can tell from the (human) research literature, giving R as an IM shot has a quicker onset. I don't believe it effects duration and I don't know what it means for nadir. In general, you need to be cognizant of how you're timing your shots of Lantus and R so that the nadirs don't overlap. I can think of only one person who gave a long acting insulin as an IM dose and her cat's situation and age were very different than Charlie's. I can't think of anyone who has given R as an IM injection. Jill has been around longer than I have so she may know of someone. We typically don't give IM injections since if numbers do plummet, it can be harder to control without benefit of IV drips, etc. that would be available if a kitty is hospitalized. Frankly, given the short duration of R, I really doubt that there's that big of a difference between giving R sub-q or IM. Given the trade off with respect to safety, I'd strongly encourage sub-q shots and lots of monitoring.

Claudia is correct in that because Lantus is a depot-type of insulin, it's best to not increase the dose with less than 2 days/4 cycles between increases. The depot needs a bit of time to stabilize after any changes otherwise, the numbers become very hard to interpret. In Charlie's case, using R within the first 2 hours after your shot or after about +8, may help to keep numbers in better ranges. Using a basal (Lantus) and bolus (R} insulin in this manner will give you a better sense of which insulin is having an effect. Lantus isn't designed to chase numbers the way shorter acting types of insulin are. If you use R in a way that it lowers the numbers, it's easier for the Lantus to "grab on" and work to lower the overall range. You want to try to avoid R tanking the numbers because then not only do you have to deal with that situation, but you end up with numbers bouncing back up into the stratosphere.
 
Re: On the brink of DKA 3rd time in 3 months 2 year old Char

Hi all,

On two different occasions when I have used R, the vet recommended giving it IM. The first was a foster I took who turned out to be an acrocat. He has since been adopted by someone who handles acros.

The second was recently after the DKA and the restart of Lantus with one of my current diabetics. So, I have had a bit of experience with R given IM. This type of dosing does impact the time of onset, peak and duration because is causes a quicker absorption of the insulin.

In humans, R onset is 20 min, peak is 2-4 and duration is 5-6 hours. In cats the timing is affected by the higher metabolism rate. What I determined with R in the 2 cats where I was using it for a period of time is that onset is closer to 10 minutes, peak 1-2.5 and duration is about 4 -4.5 hours. Given these numbers, R IM which is a little faster can be given at the time of Lantus and after +8 with little crossover of nadirs (peaks). Basically, these facts bear out Sienne's suggestions as to timing. The IM dosing is apparently a bit more stable dosing method.

Hope this is helpful.

Claudia
 
Re: On the brink of DKA 3rd time in 3 months 2 year old Char

Actually, IM dosing of R by itself it not stable -- at least that's the information in the human literature. It does become more stable in combination with a basal insulin. However, and this is a big caveat, I did not come across any references to IM injection in felines. I didn't do a comprehensive search, though.
 
Re: On the brink of DKA 3rd time in 3 months 2 year old Char

I find it helpful to see a timeline for insulin duration, so I made this chart. Perhaps it will be useful.

A visual display of 2 ways one might use a supplemental insulin such as R:
1) Basal + bolus,
and
2) chinking where the short acting insulin fills in over the tail ends of the long acting insulin.

https://docs.google.com/spreadsheet/pub?key=0AgYqouyQhh_BdE90bm1uUU8tOGZCTWxQVEswUzVwbnc&output=html

(Chinking is what they call the mud plastered into the curves between logs in a log home; it helps level out the surface and fill in the gaps.)
 
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