Re: HELP - B the C PMPS-67, +6.5-77, +11-263

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kotek

Member Since 2011
So B the Cat is holding in the 400s for 36 hours now, and this morning has a trace of ketones.

I am just about to test/shoot her AM.

I'm assuming I should hold the dose, but what do I do about the ketones????

She has been eating pretty well, but obviously in the 400s not much getting into her system...
 
Re: HELP - 1/11 B the C 400s still, trace ketones

You can raise B's dose tonight. This may be the tail end of a bounce off of the green numbers on 10/29. It can take up to 72 hours for a bounce to clear.

Are you adding water to B's food? If no, start. Water is good regardless of the ketone situation but given the trace ketones, water will help to wash the ketones out of B's system. Are you giving sub-q fluids? I would try to get another ketone test later today so you can stay on top of things.
 
Re: HELP - 1/11 B the C 400s still, trace ketones

Thanks, Sienne. I have been hesitant to add water to her food because I'm worried she'll feel "fuller" and eat less. Unfortunately, she's not at *all* food motivated -- she's a very conservative, routine-based eater -- so I worry about getting enough calories into her. I'll try a little and see how she responds.

She is getting 100mL of subQs per day, in the evening. I'm not really advised to give her more due to her heart murmur.

Will stalk her for another ketone test later. Interestingly, she seems to maybe be peeing a bit less...doesn't seem to be going in the night at all...

Up to 1 unit tonight regardless of what happens today?
 
Re: HELP - 1/11 B the C 400s still, trace ketones

Hi guys .. no dosing advice here .. mocha only had very slight trace ketones once, and we were able to give her a ton of water and within a day they were gone .. but mocha is very food driven :lol: I hope the ketones don't get any worse .. have a great day!
 
Re: HELP - 1/11 B the C 400s still, trace ketones

B is the only creature in our house that *isn't* food driven!

Hmm, now she's going down rather quickly...?

FYI, I have been alternating her injection sites. She would normally get insulin in the scruff, as she tolerates that well (not so well in the side). However, we had been trained to give subQs in her side and she hated it. So vet advised to try the scruff for that, and she tolerates this much better.But I can't give insulin and subQs in the scruff at the same time, as the subQs will interfere with the insulin. So I was advised to alternate. I have been going back and forth between scruff (am/no subQs) and flank (pm/subQs in scruff). However, yesterday it occurred to me that it might be better to be more consistent and stay in the flank, as I have sometimes read the scruff is not ideal. So both her shots yesterday were in her right flank near her hip.

This morning I went back to the scruff as I was wondering if it might make a difference. I am guessing that is just a coincidence (particularly since I understand the issue is it can absorb worse in the scruff, not better) but thought I'd throw it out there.
 
Re: HELP - 1/11 B the C 400s still, trace ketones

With numbers coming down like this, it looks like it's a bounce clearing. I would post toward the end of the cycle and ask about an increase then. You don't necessarily want to increase simultaneously with a bounce clearing.

One thought re. sub-qs and the murmur is whether you might be better off giving half the fluids twice a day. I don't know if that might help with the current ketone situation but it might be a question to raise with your vet. Water in food shouldn't be an issue. Most cats in the wild get their daily water intake through their food (i.e., prey).

Scruff shots are fine. The issue is more that if you are giving fluids, you don't want to give the fluids in the same location as you're giving your insulin shot. Some people find that their cat absorbs insulin differently in the scruff than elsewhere. At least for me, I've found that I would give more fur shots if I used the flank. I stick with areas in the vicinity of the scruff.
 
Re: HELP - 1/11 B the C 400s still, trace ketones

Sorry to hear about the ketones. Not much advice from me but it sounds like SIenne has given you some good information. I, too, wonder if dividing the subQs to 50 Ml BID might be beneficial; great question for your vet.

Have a great day.
Karen
 
Re: HELP - 1/11 B the C 400s still, trace ketones

I like the idea of going with fluids twice a day too, and you should ask the vet about it. I'd also stay with flank shots just to remove the possibility of insulin and fluids "mixing" from the equation. See if watering down the food works, and if you see any ketones higher than trace, call the vet immediately.
And when you test, add the latest numbers to your subject line and that will catch "eyes" on the forum.
Carl
 
Re: HELP - B the C +2-15.3 (275) +4-9.8 (176)

The problem with the subQs is that she hates them. She tolerates them better in the scruff but is still really unhappy/pretty much struggling to get away the whole time. (She tolerates pretty much everything else pretty well from me, but not this. Only fractionally better with warmed fluids, too). So while I appreciate that twice a day is less stress on her body, I need to balance the stress it puts on her psyche. :? If someone has a magic equation, I'm be grateful for it.

Thanks for the advice about changing the subject -- will do!
 
Re: HELP - B the C +2-15.3 (275) +4-9.8 (176)

Thanks, Carl, for posting that because I was about to. There are just some tips that might make it go faster. If you got needles from the vet, they are usually 18g "harpoons". I'd ask for something smaller like 20g but it will take longer to get the fluids in her. But not much longer. It takes me about 5-7 mins to get 150 mls of fluids into Gus with a 21g needle.
 
Re: HELP - B the C +2-15.3 (275) +4-9.8 (176)

Marje,
Don't let Ms. Gracie read what I said about Gus:-)
Carl
 
Re: HELP - B the C +2-15.3 (275) +4-9.8 (176)

I give Blackie 1/2 cup of water a day total (divided throughout the day) with her food (2 tsps. per PS, +1, +2, and 6 tsps. +3 both AM and PM). She also has 24/7 access to water (a double sided bowl... both sides filled with water) if she feels that she needs more. Adding water to B's food will not hurt at all.

Looking forward to seeing better #s for you both. Have a great day!
 
Re: HELP - B the C +2-15.3 (275) +8-4.1(74)

Thanks for the subQ and other water advice...I tried adding a little to her food and she seemed to like it; will try more.

Gus is *very* cute!

I have tried the 21g needles and they took forever. In her scruff she doesn't seem to mind the 18g harpoon stick -- she doesn't like how the liquid feels. I'll try warming again. I need one of those infrared thermometres. Also a scale...can't see how anyone measures fluids using those bag markings...we currently buy a burrette from the vet, which gets very expensive.

Fell all the way down to +8-4.1 (74) now...so Iooking an awful lot like the long swoop down we've seen before. And then I won't be able to shoot her for the PM, and then she'll go back up again.

I feel so discouraged and frustrated. I really need to be able to leave the house during the day. How do people do this and go to work??

Meanwhile, she feels crappy from all the swinging. She is mostly hanging out in one room, and haven't heard any purrs (or seen any washing) for almost two weeks, since she was in the hospital. :cry: Although I admit that is still progress from how she was when her BG was off the charts last week and she was peeing on the bed...so she is getting better, just very slowly.

I just want to do what is best for her...
 
Re: HELP - B the C AMPS-418 +2-275 +8-74

Well, I'm posting from work!

You are doing a wonderful job. The first part of this "adventure" has to be the scariest and most frustrating. The more test data you get, the more you'll begin to see B's patterns. I used to stay up all night if I saw a green number. Now, not so much!

From my perspective, some of the very high numbers you were seeing, may have been due to bounces. While the bouncing can make us nuts and cause our kitties to feel less than wonderful, they pass. They are not dangerous and it tells you that B's body's protective mechanisms are working the way they should. I would not presume that you won't be able to shoot tonight. If your PMPS is lower than what you're comfortable shooting, there are options. Take a look at Libby's post on dealing with low pre-shot numbers. It may be helpful for you to review this in anticipation of lower numbers.
 
Re: HELP - B the C AMPS-418 +2-275 +8-74

I believe that the high numbers you've been seeing for the past couple of days are due to the skipped shot on 10/30 (and yes, probably some effect from bouncing at the same time). Remember that because Lantus is a depot drug, what you do in one cycle can affect the next few days. You missed a shot, and her numbers went high for the next three cycles as she refilled her insulin depot. We are just now starting to see what the 0.75u dose can do, since this is the first time she has received that dose for several cycles in a row.

If she cruises in for a low preshot again, the options are to learn to shoot lower (see the link Sienne provided), or reduce the dose again so she will hopefully have numbers high enough that you won't have to skip shots. In the TR group we would shoot (within the guidelines in the link). I will add that based on the data you have I wouldn't shoot today if she is still dropping at shot time, the time for that will come later. See what the numbers are at +11 and +12 and that will help you decide.

Also try to get another ketone test before shot time. If she is throwing ketones, and especially if the amount of ketones has increased, then skipping tonight could be risky. A better alternative, if she is too low to shoot at +12, would be to stall a little bit until the number comes up to a range you will shoot. You'll want to get some insulin in to combat the ketones.
 
Re: HELP - B the C AMPS-418 +2-275 +11-65

Thanks so much for your wisdom...and the encouragement. It has been an exhausting couple of months, as she had two crashes in a row with only about a week of really good time in between. It feels like it has been all kitty all the time, and while I love her more than the moon, the strain is starting to show. :sad:

I've read the dealing with low numbers post a few times now (thanks Libby!). I am seeing more and more clearly that this is part of me getting into the Lantus head space, and that I have to learn to shoot her far lower than I would have previously (i.e. on caninsulin), because that is the whole point. You'll see she came in at 4.0 (72) at +10. I have been staring at the chart and if it's not too early to draw any conclusions she seems to start really rising at about +14-+15...which seems not too far off from when she is dropping from a new dose.

Spoke to my vet (I called this morning about the ketones and she asked for an update later, so sent her the BG chart) and, particularly knowing my need to get all this on a more reliable schedule, she suggests that if B is still low at shot time I reduce to 0.5, still shoot her on time, and keep a close eye on her. This seems pretty much aligned with what Libby is suggesting, so seems like a good plan.

I was going to write "if she is still dropping I will reconsider", but just did my +11 test and of -- of course! -- she is a little lower at 65! Well, I will cross my fingers that she will come back up for +12...or at least stay steady? Will report back. But if this happens I will stall just until she starts to rise...that seems like a good compromise.

Incidentally, where does the wisdom lie on the test-over-test consistency of glucometers? I have done two tests about 2 minutes apart and gotten different readings...so how do we reliably know if going down is really going down, or if it could actually be going up, when the difference is small like in this case -- between 72 and 65?

I haven't been able to get another ketone test, because apparently she hasn't had to urinate since this morning...? I have been noticing this over the past few days...makes me wonder if the Lantus is working on some levels already. In any case, I absolutely agree that having had a trace ketones reading I am strongly disinclined to skip the shot.
 
Re: HELP - B the C AMPS-418 +2-275 +11-65

Incidentally, where does the wisdom lie on the test-over-test consistency of glucometers? I have done two tests about 2 minutes apart and gotten different readings...so how do we reliably know if going down is really going down, or if it could actually be going up, when the difference is small like in this case -- between 72 and 65?
Click to expand...
You anticipated what I was going to post! There is roughly a 20% variance in the numbers that's due to the meter. So, a 72 is really between 58 - 86 and the 65 is between 52 and 78. In other words, the two numbers are pretty much the same.

I think everyone here would encourage you to get at least a reduced dose into B due to the ketone reading. Skipping a shot with ketones poking their noses up is not a good idea. One other thing to keep in mind is that you can always feed high carb food to offset the insulin when it's necessary to use insulin to combat ketones. I had told another member whose cat was going through episodes of DKA that I didn't care if she had to feed her cat a hot fudge sundae (minus the fudge) if that's what it took to get insulin into her cat.
 
Re: HELP - B the C AMPS-418 +2-275 +11-65

I have high carb food, canned and dry, I'm just worried she won't eat it in a crisis! She's so crazy conservative when it comes to eating. But I guess, if it comes to that, I can syringe some into her...one of my many new skills. :smile: I'd probably rather not learn to insert into her rectum, but have corn syrup on hand as well. :shock:

(I guess I should have those powered sugar cake doughnuts on hand for this circumstance...she's famous for stealing them if you turn your back. Never thought that would come in handy!)

So, looks like we agree she has plateaued more than is dropping. So maybe okay to stick to the original plan and shoot a 0.5?

I take the point about stalling and gathering data very seriously, but I guess I kind of did that the other day when I skipped...one giant stall.

Almost time...eeeeeeeeee...
 
Re: HELP - B the C PMPS-67

I have given myself a half-hour stall to freak out (thank you Daylight Savings Time, for affording some flexibility). nailbite_smile

Then I am going to surrender to all of your expertise, which also corresponds with my vet's advice. :smile:

I will report back soon.
 
Re: HELP - B the C PMPS-70

Okay, done...although now I am paranoid about fur shots -- I would hate for all this gear-up to be for nought...also, those pesky ketones...

I actually tested her with 0.5 units of water on her fur and I'm pretty sure I'd be able to tell. Yup, I'm that kind of crazy. ;-)

Anyway, will be testing for the first couple of hours...and keeping you posted.

Thanks again for all your help and support!
 
Re: HELP - B the C PMPS-67

You shot .5u, correct?

I'll be back on in a couple of hours to check in.

Carl
 
Re: HELP - B the C PMPS-67

Please get a +1 and a +2 test. Whenever you are shooting low, you want to get early tests so there are no ugly surprises later in the cycle.
 
Re: HELP - B the C PMPS-67

you shot at +12.5~70, is that correct?

Please get a +1 and post it. That's pretty low to give a shot without data - I would have probably had you stall longer until there was a rise.

You have high carb wet food if needed, right? You might need to steer the first part of this cycle a bit, but let's see what the numbers are.
 
Re: HELP - B the C PMPS-67

Yes, I shot 0.5 -- sorry, have updated spreadsheet now.

Will definitely get +1, +2, and more often if she seems to going pretty low, and through the night.

I have high carb wet and dry food and corn syrup. Whether she will eat on command is very much in question. Just getting my feeding syringes ready with the high carb food if necessary.
 
Re: HELP - B the C PMPS-67, +1-52

+1 was 52...down a little faster than I'd like, to be frank.

Advice welcome -- including if now would be a good time to feed anything in particular. For now, I am putting her regular food next to her so it's handy.

I will check again at +1.5.
 
Re: HELP - B the C PMPS-67

Hi Kotek, Nice BOS shooting! I hope B stays steady for you. :mrgreen: You are doing great adapting to the LL lifestyle, a level of cat servitude that is really hard at first. Hang in there, it gets easier as you figure out ways to make it work for you and your cat, and eventually it really does become routine. cat_pet_icon Along the way your bond with your cat grows even stronger and deeper. The wonderful folks here are always available for advice, support, suggestions, laughs and venting when you need it, we have all been there and we get it. Before you know it you will be reading a newbie's post and thinking wow, I rememebr feeling exactly like that...
 
Re: HELP - B the C PMPS-67, +1-52

it's so early in the cycle that I would give her 2 tsp of gravy from the high carb food. Test again in 20 minutes.
 
Re: HELP - B the C PMPS-67, +1-52

Sorry, missed the moment...she ate a decent amount of her regular food, but isn't really interested in the hi-carb. As I mentioned earlier, she's a pretty picky eater.

i can syringe feed some high-carb to her if you think that's best. I'll put some of the high-carb dry next to her, too.

I will be testing again in 5min.
 
Re: HELP - B the C PMPS-67, +1-52

How about trying to rub a bit of syrup, like a drop on B's gums? Will she put up with your doing that?
 
Re: HELP - B the C PMPS-67, +1-52, +1.5-40

Yup, I can do that.

+1.5 = 40

UPDATE - bit of syrup rubbed in. I think she'd eat it actually. Diabetic cat with a sweet tooth.

Will test again at +2 unless you think it should be sooner. Keeping a close eye on her -- in very high spirits at the moment. More active than in days.
 
Re: HELP - B the C PMPS-67, +1-52, +1.5-40

yeah, some syrup. Rub a little on her gums if you can.

How far away is the ER vet, in case you need it? I ask because it looks like B has a late nadir when she isn't bouncing, even as late as +10. If she won't eat reliably, the vet might be your best bet. This could take a while, if she doesn't start to bounce.
 
Re: HELP - B the C PMPS-67, +1-52, +1.5-40

10 minute ride in the taxi to emerg vet once it comes, so probably 20 minutes in total, give or take -- not too far. They know us a bit...that's where she was for her DKA.

My regular vet also want me to call her at 10pm, which I was planning to do after B's 10pm test.

Can you help me understand? Looking at her chart, I am assuming she plateaued for the previous dose. So right now she is going up a tiny bit from that dose while simultaneously down from her new dose. She seems to start to climb a bit at +13 (now-ish?) then pretty dramatically between +14-+15. At the same time, she seems to go down a bit at the beginning then kind of slowly until about +3. So the idea is that her dropping and her climbing would balance out...no? I could be way off.

Don't think I'm not panicking a little here -- just trying not to. All supplies at fingertips.

At what point should we be thinking in the vet direction?

I only rubbed a little...would more be better? And like I said, I can syringe feed her if need be.

She is very responsive still, BTW.
 
Re: HELP - B the C PMPS-67, +1-52, +1.5-40

Libby - you think I should go now? I'm going to test again and call my vet. BRB.
 
Re: HELP - B the C PMPS-67, +1-52, +1.5-40

yes, test now and see if the syrup worked.

Some cats drop early and then bounce up quickly, but we don't have much info on B. She has never really had a full insulin depot before, but it looks like she might have a late nadir. ER - it's your call, but you might be looking at 6-7 hours of feed/test/feed/test and if she's not eating reliably that will be very difficult. Basically we have to keep feeding and testing until she starts to bounce (whenever that might be) or gets past nadir.
 
Re: HELP - B the C PMPS-67, +1-52, +2-34

She's at 34, which is pretty close to last, so that seems promising...

I pretty much figured I'd be up all night with her. Just to be clear, she'll eat, just not the hi-carb stuff.

Just calling my vet....

More syrup?
 
Re: HELP - B the C PMPS-67, +1-52, +1.5-40

Yes, more syrup, please. Will she eat the syrup if you put it on a tiny bit of low carb food? Or better yet, if you put 2 - 3 drops in her bowl
 
Re: HELP - B the C PMPS-67, +1-52, +1.5-40

You can't really go by most of her cycles, because most of them either came directly after a missed shot or included some sort of bounce or bounce clearing. It's hard to really say when her nadir is. 10/29 looks somewhat like a bounce was clearing (like today), and her nadir then was around +9. Otherwise there's not much to go by.

Today she was clearing a bounce, so her numbers already had some downward momentum when you shot. That momentum has continued after the shot. And there is also lots of effect from the 0.75u shot this morning thanks to the depot. That can take a few cycles to clear out. Often when someone takes a dose reduction, they still have a bit of a fight to keep the numbers up the next cycle or two. It doesn't mean that the 0.5u dose is too much, it just means that the 0.75u dose hasn't left the system yet.
 
Re: HELP - B the C PMPS-67, +1-52, +1.5-40

I would rub some more on her gums and maybe syringe some into her (or if she'll lick it up, do that instead of syringe, it's less messy!).
 
Re: HELP - B the C PMPS-67, +1-52, +1.5-40

Test in 15 and if she's not rising, hit the road. Not trying to scare you, but better safe than sorry.

If you go, take your meter and syrup in case you need it on the way.
 
Re: HELP - B the C PMPS-67, +1-52, +1.5-40

Okay, more syrup on the gums, and she licked some, and is eating her regular food. I'm sure she will eat more syrup if required.

Vet agreed with giving her syrup, and said go to emerg if she gets down to 18. That freaks me out less knowing the human meters read high. The very first reading I ever did on her was 0.9 at 11pm.

Again, still perky. Will test again at +2.5.
 
Re: HELP - B the C PMPS-67, +1-52, +1.5-40

most meters don't read down to 18 in US numbers. You're in Canada, right? So that would be 1, I think. I would not let my cat get anywhere near 18.

Human meters don't read high all the time. The lower the numbers, the closer they are to the animal meters. We have had several people run comparisons, but I don't want to take the time to look for them now. Don't trust that it will be higher.
 
Re: HELP - B the C PMPS-67, +1-52, +2.5-85

Good news! Jump up -- we're at 85 (4.7).

Going to post this and edit with more, so you're not wondering.

---
I am crossing my fingers that she will balance out there and the early trend data isn't as iffy as it might be...although, Libby, I definitely take your point that it isn't as reliable as if we had built up a good set of information.

Testing again at +3. Hmmm, I started the night with ~50 test strips...I have around 30ish now (and more waiting for me at the post office I didn't get to pick up today because I was at home monitoring). I think that should get me through til morning, yes? That gives me 3 an hour? If she keeps stable how often do I test her -- hourly?

If you think I don't have enough I will get my partner to run to the drugstore...I will need to use a lot of relationship points!
 
Re: HELP - B the C PMPS-67, +1-52, +2-34

That's a relief. Libby had to take care of her kitties. She'll be back in a bit.

Please re-test in 20 - 30 min. The syrup bumps up the numbers but as it wears off, numbers could drop back down.

FWIW, I think your vet's tolerance for low numbers exceeds mine. I would not be comfortable having my cat in numbers that low.
 
Re: HELP - B the C PMPS-67, +1-52, +2.5-85

PMPS (+12.5) ~ 70
+1 ~ 52 fed LC
+1.5 ~ 40 syrup
+2 ~ 34 syrup
+2.5 ~ 85

Does this look right?

Good, the syrup is kicking in. This is about the time the insulin starts to onset, so I would expect the numbers to come down again, unless she starts her bounce.
 
Re: HELP - B the C PMPS-67, +1-52, +2.5-85

Yes, that's right.

Good to know she responds well to the syrup, at least...do you have a sense of how long it tends to last?
 
Re: HELP - B the C PMPS-67, +1-52, +2.5-85

it will be good to remember in the future that she did respond to the syrup, but not very quickly. That means that you might need to give it earlier in the game than many of us would.

Each cat is different as far as how long it lasts. The one time I gave it to Jazzy, she bumped up over 50 points but 2 hours later she was back down to where we started. For Lucy I never used syrup, just high carb wet food.
 
Re: HELP - B the C PMPS-67, +1-52, +2.5-85, +3-142

Still going up - at 142 (7.9...these different number systems will be the death of me).

Now, I would be hoping (?) that this= syrup + 0.75AM shot wearing off + 0.5PM shot not bringing her down as fast as she's going up. Crazy?

Monitoring every 1/2 hour. Also she is getting annoyed with my poking her when she wants to sleep....
 
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