? Sebastian PMPS 42 +1 87 +2 123 +4 57 +5 135 +7 94 +8 78 +9 60 +10 68 +11 69 Ketones +9 0.8. 7u

Justin & Sebastian said:
+9 is 65. So what's my gameplan here over the next few hours? How frequently should I test? We're waiting for his numbers to start rising again, correct? And I'll want to stall dinner by up to 1/2 hour if they haven't yet? Will I be reducing the dosage? If I do stall and they haven't started to rise after 1/2 hour, I'll be giving HC Gravy, right? And then continuing to monitor for a few hours until that wears off and we see it rising, similar to what I did this morning?
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I would try a bit more of LC food as long as it within two hours of his PMPS. You want to be comfortable shooting a lower number again. Those of us with plenty of data shoot anything over 50. You won't have to stall dinner unless he's lower than 50 and /or he's not eating again for you.

ETA: that is over 50 on a human meter which you have switched to.
 
As per Sienne in post +7, you don't want him earning reductions right now. Can you be off with your schedule again tomorrow? If so, feed a little bit of LC food and get him up over 50. Then after 2 tests 30 minutes apart with out any more food and if he is holding over 50 shoot. Of course if he continues to drop or not come up, give a little more food. Then tomorrow's shot time will be 12 hours later.

I will try and check in on you soon. I take care of my 91 year old mom so, I just don't know how soon I can get back on.

If you need help, change your title to indicate help ASAP.
 
Not sure I understand. We're already about 2 hours off schedule and I'm not real clear on why we would stall even further instead of just feeding him a full meal. Technically yes I can stall if absolutely necessary but I'm already running way past my normal bedtime and on very little sleep and I can't continue to do this for days on end.
 
We have a saying to feed the forties. You can test again first, in 10 minutes, and let us know what his number is before you feed him. If he is lower than 40, then feed HC. Hopefully, he has risen by then.
 
I've been wondering about the volume of food he's eating. I'm used to him eating a lot, but he's also always been in the 300s. From what I understand, the higher BG makes them need more food. Now that he's low, he's barely eating, he'll eat a few pieces of kibble and a couple bites of wet food and that's it. It feels like it's barely anything, however my other cat who's not diabetic barely eats anything also and she maintains weight just fine. Like I'll put out 1/8 of a cup of kibble for her meal and she won't even eat all of it. So should I be expecting him to eat a lot less now that his BG is lower?
 
I know, normally we don't feed for the last 2 hours before the shot, but the 40s are getting on the edge of when it's not safe. He doesn't have much wiggle room before he goes too low, if you know what I mean.
Unfortunately, it looks like, in this case because he is so low that you will need to feed him just a little (LC or MC) to get him above 50. If you had lots more data in these (low) numbers, once he was above 50, you could shoot, but I'm afraid you do not. I'm thinking, it may be another night of not much sleep for you. I remember the nights, and if I could bring J.D. back, I would do them again. I know TMI. I'm thinking your shot schedule may be even more off than it already was. I'm thinking, you'll need to get him above 50 and hopefully, he'll either start to rise or surf (stay flat) and we can then decide on what (BCS if necessary) dose to give tonight.

Yes, they eat ravenously when they don't have enough insulin to get the food into their cells, and eat a lot less when they have enough insulin.
Have you gotten another blood ketone test lately, I didn't see if you got one this afternoon. I was away and may have missed it. Sorry.
 
I've already dosed him. I'll put out HC if I need to.

I really need to get some consistent info on how I should be treating him. I was told earlier that we never want to hold his shot because of his DKA history. I was also told not to feed him after +10. And now I've heard contradictions to both of those things in the past hour while I'm trying to scramble and figure out what to do. This is already stressful enough without all the questions and misunderstandings.
 
Justin, I'm sorry it seems confusing right now and I know you are stressed. I would be too.
Did you give him 7 units? I would syringe feed him some HC now, with a couple of drops of honey or syrup mixed in if you can.
 
Dyana said:
Justin, I'm sorry it seems confusing right now and I know you are stressed. I would be too.
Did you give him 7 units? I would syringe feed him some HC now, with a couple of drops of honey or syrup mixed in if you can.
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Yes I gave him 7 units. I put out some DM Dry and he ate a little bit of that but I'll give him some more HC stuff too.
I tried to test him for ketones but when I flipped him over to get the reading he started to lick his lips and then went and threw up what little he had eaten.
 
Justin & Sebastian said:
Yes I gave him 7 units. I put out some DM Dry and he ate a little bit of that but I'll give him some more HC stuff too.
I tried to test him for ketones but when I flipped him over to get the reading he started to lick his lips and then went and threw up what little he had eaten.
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So...mayday mayday on getting his numbers up. #911
 
Please change your Subject Line to reflect the latest test and that you shot. I'm trying to get more eyes here.
Let us know what the test number is after 30 minutes.
I really hate to alarm you, but how far away is the nearest ER? You may want to call them to let them know you may be bringing in a cat with low blood sugar and is vomiting. They will have dextrose that they can give to him.
 
I don't think it's that bad. He's stomach has already been iffy the past few days and flipping him over immediately after he ate just upset it. He ate a bit of the DM dry after the vomit, which was all LC, and I put out a can of FF Gravy and he's eating that right now.
 
I agree with Dyana, another test in 30 minutes. Do you think you could get a couple of drops of honey or karo in him? You can add it to a tiny bit of baby food or LC if you think he'll eat. Or even add it to the HC gravy.
 
Justin & Sebastian said:
I don't think it's that bad. He's stomach has already been iffy the past few days and flipping him over immediately after he ate just upset it. He ate a bit of the DM dry after the vomit, which was all LC, and I put out a can of FF Gravy and he's eating that right now.
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I think you're doing a good job with Sebastian tonight as far as watching, monitoring and feeding. I know it's crazy stressful when their bodies go extreme like this. I don't think it would hurt to give him a little corn syrup or honey, but I'm not the expert here.
 
Justin, the problem is when he gets to 40, you only have a teeny tiny bit of wiggle room before it becomes an emergency hypo situation.
 
He's eating the HC fine, no more throwing up. Just trying to syringe feed him some more now and let that settle for a bit and I'll get another reading.
 
It's been over 1/2 hour since that last test. Also over 1/2 hour since he ate some kibble after the tummy upset. Time for that next test.
 
I'm going to put him back on a mix of mostly DM Dry with a little Dr Elsey until the vomiting episodes are over. I don't like this sudden and rapid drop in numbers and how this is turning into an emergency every night while I don't have reliable and consistent info on how I should be managing him at these low levels.

I'm going to watch him for another hour to make sure he doesn't vomit and check his BG and I've put out an array of foods for him to eat overnight. He ate a bit of the DM wet that I put out in addition to what he already ate of the HC gravy and what I syringe fed him.
 
Whew! Looks like it's gonna be a long night for you though. Do you have to be up tomorrow?
 
Please know that the HC will wear off quickly (like in about 2 hours or less), and the latest dose of insulin will not usually onset (start to work) until about 2 hours after the shot, so you may be up for a while.
I would give him a little bit more HC (just a tablespoon or so, as you don't want him to get too full so he won't eat later when you might need him to) HC with a couple of drops of some honey or syrup to boost him up before the onset, and put a call into the ER for just in case.
Did you get the Ondansetron today?
 
Dyana said:
Please know that the HC will wear off quickly (like in about 2 hours or less), and the latest dose of insulin will not usually onset (start to work) until about 2 hours after the shot, so you may be up for a while.
I would give him a little bit more HC (just a tablespoon or so, as you don't want him to get too full so he won't eat later when you might need him to) HC with a couple of drops of some honey or syrup to boost him up before the onset, and put a call into the ER for just in case.
Did you get the Ondansetron today?
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No, I won't be getting that until tomorrow. I'm leaving HC out for him to eat. I'm not okay with running him borderline like this. We can't be having these emergencies every night so until I can get some consistent info on how we can safely manage him I'm going to back to his normal diet.
 
I would get at least a +2 and then a +3 and probably a +4 tonight, under this situation. I hope you can stay up more tonight, and catch up on sleep tomorrow.
 
Another thing I want to re-evalute is his dosage. If you look at the tab for 2018, we have a curves from being on 3u for a month, 4u for a month, and 5u for a month. In May we dropped from 7u to 3u per the vet's recommendation and had no issues with ketones or anything else. If having him at 7u is causing us to have so little margin for error at the low numbers, and we can safely reduce the dosage without going DKA, I think it's worth looking at.
 
Dyana said:
I hope you can stay up more tonight, and catch up on sleep tomorrow.
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Boy do I wish that were the case. My body is very fixed in its sleep schedule and is very sensitive to extended periods of little sleep. I wake up at 3-5am regardless of when I go to bed, that's why I can get a PM +9 but even a pm +1 is pushing it. I rarely am able to catch up on sleep during the day and with the past three nights of staying up late for tests, today was already pretty rough and I'm running pretty ragged right now.

I'll grab a +2 and then I'm going to sleep for a few hours but I'll set an alarm so I can get a +4 or +5. Based on today's numbers it looks like that's about the time he started to come down.
 
I know. I never knew how to nap until I had a diabetic cat. Please let us know what his +2 is. That's coming up soon, right?
Just to let you know, when I had to test at night, I would actually take 45 minute naps on the couch and set my cell phone alarm and put it on the coffee table. I found that setting it and going to bed would put me in too deep of a sleep and I would sometimes turn off the alarm in my drowsy state. Hopefully, Sebatian's liver will kick in soon.
 
I just wanted to clarify for you, Justin. That not feeding after +10 is in preparation for taking a PS number. We want to know if kitty's PS number is safe to give a dose and if it's influenced by food being fed close to it, then it can misinform what you should be dosing.

BUT, if at anytime in a cycle, you see low numbers under 50, then it is USUALLY time to intervene with food. The only time you may not feed right away is during shot time granted the number isn't insanely low like under 40. So the FIRST time you test and get a low number, you don't feed just to see if kitty's body is NATURALLY heading up WITHOUT food. If kitty is doing that, then it means they will be higher once the insulin kicks in 2 hours later (lantus typically takes 2 hours after it's injected to start working for the next cycle).

The advice to not feed after +10 is to help determine dosage and prepare us to figure out if a dose is safe to give. The advice to not feed and stall during shot time is to determine if kitty's BSL are naturally headed up without food and to inform us, again, if it is safe to shoot. The advice to feed when kitty reaches a low is to keep kitty SAFE and becomes priority.

Every cat is different though. And you will get different advice and suggestions. It's up to you what you do and up to Sebastian how he responds. So take note of what you do so if in the future this happens again, you have something to refer to.
 
+4 is 57. I'm going to pump the numbers up. I'm definitely decreasing his dosage in the morning also. Given his past history of going to a lower dosage with no issue I don't think it'll be a problem.
 
He has a couple of hours to go until nadir (peak of insulin). Feed some HC, and set an alarm and test again in 1 hour.
I'll keep setting an alarm and checking on you and Sebastien.
 
Dyana said:
He has a couple of hours to go until nadir (peak of insulin). Feed some HC, and set an alarm and test again in 1 hour.
I'll keep setting an alarm and checking on you and Sebastien.
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Will do. He's been eating the HC Gravy on his own while I've been out here. I syringe fed him some of the LC but he didn't really want to sit through it so I only got a few tsp in. I syringe fed him a couple ml of honey also.
 
Good.
I would test again at +10 or +11, and then you can compare that to your PS test and see if he's rising or dropping or staying the same at shot time.

I'm going to bed now. You did good with the testing and feeding tonight.
 
I'm glad his numbers are still up.
I might suggest testing a little before +10, if his numbers are down at that point you can feed him some, before that 2hr window, hopefully that would keep his head above the water till shot time and you will know the number is not food influenced.

It does look like the change to a LC diet has significantly changed the insulin requirement. We need to try and find a dose that is enough insulin to keep the DKA at bay, (especially in light of the pancreatitis flare he has at the moment) and a dose that isn't going to drop him too low.

I'll post some more on the considerations for the dose reduction in a bit.

I'm sorry it's been such a tough night.
 
I fed him a couple tsp of LC to try and get him to level off. I'll do a +10 and see where we're at. It's past 4am so I'm basically "up" at this point so I might do a +8 and/or +9 also.

Gill & George said:
I'll post some more on the considerations for the dose reduction in a bit.
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Please, let me know your thoughts. Honestly my gut tells me 3 would probably be okay given his history. It seems that for whatever reason he was resistant to the Lantus while on HC and 3 has proven enough to keep him out of DKA. I want to say split the difference and do 5 but I feel like that might be too much also. So maybe, in light of the pancreatitis, 4?

My overall thoughts on the dosage are this:
  • We started from a)an improper diet and b)a really high dose. Ideally we'd have started on LC from 3 and walked up, not the other way around.
  • We altered his diet but didn't alter his dosage.
  • History has shown that 3u was enough to keep him from DKA.
  • I'm far less concerned about DKA than hypo. Yes, both are serious and deadly but his history has shown me that his DKA gives us at least a day to react to ketones starting to build up, whereas hypo is immediate. Plus, the DKA monitoring used to be done with urine strips but now I'm doing it with blood, meaning I can have even more time to react.
 
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