Skinky insulin - PLEASE help

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skinky44

skinky44

Member Since 2014
Hi, please if anyone that 's been following my sick girl could help/comment...
she's got a long background

she is now on dexa something steroid. sorry typing fast and watching her.
new to administering insulin
she is 5.5 - 6 lbs
really haven't been injecting insulin for reasons many know of.
last night first night injected steroid. took her BG this morning. numbers are as follows:
497 9:50 am
(administerd what I think is .25 or .5 insulin)
380 1014 am
286 1:04 pm
321 8:00 pm
ADMINISTERED STEROID AT 10:00 PM
10:30 "hi" on relion
(gave insulin, small amount, I think .5?)
11:00 pm "hi"
11:36 pm 561
(gave more insulin, .5 I believe)
12:05 am 589

Shouldn't this be going down?? should I give more insulin? It's been a while since i've given insulin to her and i completely forget the "marks" on the needle. filling needle up to the first or second little line. Using U-100 needles

She is a cat that does not eat. very difficult to get food into her. I did get some light food into her before insulin injections. most of the food is catsure, which might be high in carbs (has cream in it...)

sorry if i sound so ignorant on this - i am! just nervous because of the steroid. her legs are very weak....although she has gotten up to drink water - which is a victory..

what to do?????
 
1) Insulin gets given every 12 hours when it is Lantus, Levemir, Prozinc, or BCP PZI. These take a while to work and in some cases, several days to see the full effects by testing at the nadir (lowest glucose post shot)
2) the dose you gave was very small; that was a good, safe place to start.
3) Steroids increase glucose levels; using your insulin protocol, you may adjust according to the rules.

What insulin are you using? Could you add it to your signature, please?
 
Yes, lantus. I know all of the above...but I guess I'm reacting to the "high" numbers the same as the "low" numbers. Is this incorrect?
Can I rest easy if I test again in 30 minutes or an hour and it still says high 500's or "hi"? If that happens do I need to inject another small amount or just chill out? I know when kitty gets the "lo" numbers, this is hypo and an emergency. Same for the "hi"???
 
skinky44 said:
10:30 "hi" on relion
(gave insulin, small amount, I think .5?)
11:00 pm "hi"
11:36 pm 561
(gave more insulin, .5 I believe)
Click to expand...

Was this one shot of 0.5u at approximately 10:30 PM, and a second shot an hour later of 0.5u at approximately 11:30 PM?
 
Jen&Eddie said:
Was this one shot of 0.5u at approximately 10:30 PM, and a second shot an hour later of 0.5u at approximately 11:30 PM?
Click to expand...

yes 10:30 EST first application
And then another small application either 30minutes or one hour afterwards
 
Never do that with Lantus; it doesn't work that way.
IF it becomes necessary, there is a way to use a short-acting insulin to bring numbers down quickly so the long-acting insulin can work better.
 
if it matters...i have to try to constantly feed her. I give her small amounts of syringe food all day long, including after giving the insulin. and the food - it's whatever she will eat...usually Hills AD or max cat or catsure...
 
Do the HIGH numbers need to be monitored the same as the LOW this is what i need to know please.
 
It is normally a few hours before Lantus "onsets" or starts working on those numbers, so normally you can't see what the dose is going to do for at least a couple hours after the shot. Unfortunately, Lantus can't be used that way to "beat down" those high numbers. Since you've given a basically a double dose tonight, you may need to monitor her BG for several hours tonight if that double dose takes her down too low.
 
Next shot should be around 11 am tomorrow (splitting the difference between the 10:30 and the 11:30)
Hold with 1 unit; it takes Lantus 5-7 days to stabilize its effects based on a given dose.
 
There's been a lot of variation of opinion from vets about how much to give her, including up to one unit, so I don't know that i would say I necessarily gave her a double dose. I"m trying to be super conservative because of her frailty and my understanding is that the steroids make their numbers go all over the place.
 
If you test around +5 hours after the 1st shot to +7 hours after the 2nd shot, you'll see how low the glucose goes, if at all. The steroids on board are a game changer when it comes to insulin doses: 1 unit may not be enough. You have to use a protocol for dose adjustments so you do them safely.
 
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There's a lot to take in learning how to use Lantus, especially with a sick kitty. Don't fret - there's lots of folks around with lots of Lantus experience to help you learn the ropes. The "+" simply indicates how many hours after the shot. That's easier for folks following along than trying to figure out how long ago you shot, etc., when we're across different time zones. The nadir - or lowest point - in a Lantus cycle is often 5-7 hours after the shot (between +5 and +7) - but that's an "every cat is different" thing. My guy Eddie usually hits nadir or his low point about 3-4 hours after his shot. Some kitties wait until +10. Since there were two shots, it makes it a little more complicated because you basically have two overlapping clocks - one running from the first shot, and the second clock running from the second shot. If a kitty's going to really drop fast (or possibly dangerously low), often a BG test 2 hours (+2) after the shot will be much lower than the pre-shot number. To get some idea of what this dose may do, you may want to get a test 2 hours from the first shot tonight. Since Lantus can take several cycles to build up, you may or may not see a whole lot of movement tonight.
 
On that, I don't know. If I had to guess, to try to bring down Skinky's BG some and to counteract the rise in BG due to the steroids, I'd guess that any kind of insulin is better than none. In some circumstances, caregivers do use a fast-acting insulin in conjunction with Lantus or Levemir to push down those higher numbers. Kitties that are experiencing ketones sometimes use this method. I personally have no experience with that, but there are a handful of experienced members that might possibly be able to instruct you on that. For now, what I'd suggest, is keep the Lantus so you're getting some insulin in...but you really do need to be cautious about gradually increasing the dose, and shooting 12 hours apart. But if you're not already, start religiously testing for urine ketones. I think someone suggested that since she's urinating on the floor right now, you should be able to dip the little test strip in a fresh urine puddle to check for ketones. If ketones are positive, you may have to take a different approach, but definitely report here if you get a positive ketone test. Positive ketones can become an emergency situation - DKA - fast.
 
phlika29 said:
With a higher reading the real worry is ketones and so testing the urine with the ketone testing strips is important. A lower reading the concern is that a cat will go too low and so blood glucose testing is very important.
Click to expand...

Thank you! ive tested her ketones probably every 7 - 10 days. but her bg w/o insulin was usually between 265 - 310. now w/ the steroid, different ballgame. what do i do if she does test positive for ketones?
 
I have zero personal experience with ketones or DKA; however, it is my understanding that under the right circumstances ketones can develop rapidly. In a kitty that's prone to them, running in really high numbers, or dealing with a possible infection, and with everything else Skinky's dealing with, I'd suggest trying to test for ketones at least a few times a day, if at all possible. If you were to get a positive ketone test, I'd suggest immediately posting here, and changing your subject line or starting a new post that says something like "positive ketones - Help!." The general recommendation here is that if ketones show up as anything more than "trace," kitty needs to be at the vet to deal with the situation. Trace ketones can sometimes be treated at home. However, with all of Skinky's other issues, attempting to treat even trace ketones at home may or may not be advisable. That's something that I personally would defer to members that have experience with treating ketones.
 
Don't lose heart. You have managed so well so far. Keep up her water intake and her food as much as possible.

Personally I would test for ketones at least daily whilst she her blood glucose is high. even if was over 120 I believe you are ideally meant to test daily.

I don't think you should worry about a positive result unless it happens.

Hopefully someone can give advice on the Lantus/insulin issue.
 
(((Laura))),

It's OK, sweetie. Please be kind to yourself.
You're doing an amazing job with Skinky. But it's only natural that you feel stressed by this situation.

Sit yourself somewhere comfortable.
Take a very deep breath.
Take another deep breath.
And another one.

Folks have posted a lot of info here about diabetes. And all that information is good. But you don't have to take it in all at once.
Take it at your own pace. And it's OK to take things very slowly.

We are all here for you.

Huge hug to you,

Eliz
 
((((Laura)))),
This all sounds very complicated, and it is, but for now just concentrate on the basics. 1) Skinky needs insulin. 2) Lantus is the insulin you have. 3) You have the proper U100 syringes.

Start Lantus at a conservative dose, maybe 1/2 unit. Inject every 12 hours (do not give a second dose until the 12 hours are up). Lantus is what we call a "depot" insulin: it builds up a reserve under the skin to draw upon in order to keep the cat on an even keel. Another name for the depot is the "shed". During the first week of giving Lantus, the shed is built. Therefore some of the insulin you are injecting goes into building the shed and is not immediately available to work on bringing down the blood-glucose levels. Every time you change the dose, the shed needs to readjust itself. This is one of the reasons why we keep the same dose for 6 12-hour cycles (3 days) before raising it.

Later you can read all of the details about how to proceed with Lantus in the "stickies" (informational posts) at the head of the Lantus/Levemir Forum. But for now, just concentrate on being consistent. And do check for ketones frequently. If ketones are present in anything other than "trace", Skinky will need to go immediately to the vet (or the ER) to be stabilized (it is not something that can be done at home). Ketones can rise and get out of hand very quickly. They are life-threatening. The three things that need to be present for ketones to develop are: 1) infection, 2) not enough food, 3) high blood-glucose numbers. Skinky has all three, so keep testing for ketones.

I so wish I could be there with you to help you with Lantus (which is the one thing of all that you are dealing with that I know something about!). As Elizabeth says: BREATHE!

:bighug::bighug::bighug:

Ella
 
I didn't catch an answer to your earlier question.
You do not need to panic at the high numbers. They do not need to be monitored the same as low numbers.
Nobody likes them.
They are probably partially a reaction to the steroid.... and possibly also her liver panicked at getting two doses ...

stick with the lower dose.... try to keep giving it every 12 hours if possible.... it has to accumulate.

and keep checking those ketones....
You were giving fluids, weren't you? Those help flush ketones out.... but keep watching for them.
 
Folks, because of the steroids, I really think she should stick with 1 unit and also follow the fast track part of the Tight Regulation protocol.
 
Laura - first....BREATHE! You're OK! So is sweet Skinks!

No you don't have to panic with HI like you do with LO. You've been doing fine with everything else - you will do fine with this too. You do need to test for ketones as often as you get a pee sample but that's just dipping that strip in fresh pee and reading it after 15 seconds. Ketones is something that could have happened before this and it hasn't happened. Ketones are DIABETIC thing, not an insulin thing. If you do see anything when you compare the colors, just post...don't panic....

Lantus - I agree with your .5 unit 12 hours apart but I'll defer to Marje/others if she says differently. If you have 'half unit marks' on your syringe, that's the first little mark on the LEFT side.

Remember - insulin is a hormone, not a chemical medicine. Lantus takes a bit to start working on those numbers, don't expect it to react like an (example) aspirin and immediately reduce a fever.

BREATHE Sunshine - you're OK! Relax - you don't have to learn this all at once, just keep posting - everyone here will help.

HUGS and HEADBUTTS for sweet baby...
 
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Ok, well an update.
She is doing a lot better. By far not out of the woods, and maybe this is just a temporary reprieve if it is in fact cancer...but she's starting to look and behave more like a kitty. !!!!!
she's gained a little weight. SHE IS DRINKING WATER! she is sticking her tongue out a little, in a good way. for whatever reason, and I think it has something to do with this swelling in her face, and maybe pain in her mouth, but when she would drink water, she would pretty much dunk her lower face in the water. she's still doing that a bit, but is also using her tongue more. she drank A LOT of water yesterday. I know this might have to do with the steroid increasing her sugar, but i was so happy to see her regularly drink water.

she is still very weak w/ her hind legs - although she jumped over the tub and up on the loveseat today. she is easier to syringe feed. Still a HUGE pain to get blood from her ear, and if i don't get right away on the first stab or so, she is just a stressed out little terror. checked for ketones earlier, negative.

I think her eye is gone, but not sure. it's taken a back seat. Is anyone familiar with something called remend corneal repair?

I am overwhelmed with the insulin. everythign keeps changing with her and for the most part, although I got MUCH better help from the last vet, the MO is still to keep her in comfort, while she presumably dies. i LOVED the vet, but I do think that was what she was thinking. But I don't even think I have to administer the pain med today, she is doing pretty darn well. and been pooping!

I am going to call the vet tomorrow, she asked me to check in with her tomorrow. She and I hadn't discussed amounts of insulin when I saw her earlier this week, she knew I had some lantus at home and really, we just wanted to see if the steroid, as a last shot effort, would help at all with her condition. Not sure if it is the roid or the combo of steroid and insulin, but i want to emphasize she is really doing much better.

One thing that concerns me is that every twelve hours will be difficult for me with her...I have a lot of doctor appointments, many of which I postponed (for my rehab after surgery) and i take the appointments whenever I can get them (physical therapy, physiatrist, chiros, all weekly, and then random ortho appts.). I also sometimes travel out of state which is where two of my surgeons are. This Wednesday I'll be in Philadelphia for another preop visit, i'll be gone for several hours.

How is this going to impact her/us with the insulin??

I don't know how to incorporate
 
If you have to shoot late, you work back to your regular time either 15 minutes per shot or 30 minutes per day.

You do the best you can.
 
what does 15 minutes per shot or30 minutes per day mean?
right now i'm trying for 10 am and 10 pm. but on wednesday, i'll be leaving at 7 am and won't be back till around 430 pm...and things like this will be happening randomly...
 
You try to move the shot time by 1) 15 minutes per shot OR 2) a total of 30 minutes per day.

Since you know Wednesday is coming, move the shot time earlier, so you can do it safely.
- Saturday night, shoot at 9:30 pm.
- Sunday am, shoot at 9:15 am
- Sunday pm, shoot at 9:00 pm
- Monday morning, shoot at 8:15 am
- Monday evening, shoot at 8:00 pm
- Tuesday morning , shoot at 7:45 am
- Tuesday evening, shoot at 7:30 pm
- Wednesday morning, shoot at 7:00 am


And now, when making appointments, try to schedule them so you can do a consistent shot time.
Or find someone locally you can trust to give the insulin.
 
So glad to hear that Skinky's brighter today, drinking, pooping and getting on a bit better with the syringe feeding. Also good to hear that the steroid seems to be helping the swelling go down and that your precious girl is gaining a little weight! :)

I know you're nervous about the insulin, Laura, but keep posting here with questions and requests for advice and lots of experienced people will help you.

Keeping you both in my thoughts and my prayers.

((((Laura and Skinky))))
.
 
Laura,
I saw you mention a question about the amount of the dose you are giving...
it's been a while since i've given insulin to her and i completely forget the "marks" on the needle. filling needle up to the first or second little line. Using U-100 needles

Here is a pic of .25u in a u100 syringe with 1/2 unit markings. I think the first line would be .5u?
025unit-1.jpg


I liked what Marje said earlier:
Skinky should not be on the TR protocol. This is an instance where we will have to wing it and dose according to Skinky's special needs.

I think you're going to have to approach this on a day to day, or even a cycle by cycle basis. Perhaps Lantus isn't the best choice for "winging it", but it's what you have on hand.

Sometimes we can adjust our lives around diabetes. But sometimes we have to adjust diabetes around our lives. If that means doing things completely outside the box, then it is what it is. I'm sure you're not the first person who has had to go off of a 12/12 schedule with Lantus. We need to find a few people who have had to do so and catch their attention. You're dealing with so many issues at the same time and doing a remarkable job, Laura. Scheduling insulin shots shouldn't be the #1 issue you have to deal with.
 
Guys - thanks so much! i see what happened here...the needles the vet gave me for the pain meds are u100, but they don't have the little marks. just the single unit marks. I can either re-use one of the older needles or the pre-filled needles which are filled with the dexamethasone.

i'm in process of trying to work some food into her before ten-ish to inject her. seeing that she tested mid 500's before the steroid shot, i'm concerned about what her pre-insulin level will be.

Yes, I don't see how i can stick to a rigid 12 hour schedule with her. I don't know what to do! it takes a little while right now just to get enough food into her..and i have to grab my doctor appointments when i can. I'll try to discuss a little more with the vet tomorrow and see if i can pick up different needles from her tomorrow. we weren't really focusing very much on her insulin issues when I saw her earlier this week...

Thanks Carl for that picture. and for your support. MUCH appreciated..!!!!!
 
I think discussing with the vet the dose, the frequency, what number to shoot and what to not shoot, etc is a good idea. With all that Skinky has going on, you should really have the vet involved in the dosing.

I agree with Carl, though, that sticking to a 12 hour schedule is the least of the concerns.
 
She's just the little kitty that won't stop ticking. Thank God! The vet really just wanted to help keep Skinky comfortable. When I saw the vet, again, a CT scan was emphasized. WE didn't discuss insulin amounts. I think the vet really thought that Skinky wouldn't make it for the next few days, so discussing targets, etc., was sort of a non issue. And I understand where she was coming from.

Tomorrow I might try an appetite stim for her. Her gurgling noises are gone. ! I have to decide what the best next step is...to bring her to dentist or to try to do CT scan or to continue to try to get her "strong" to sustain anesthesia for one of those procedures.

But I do continue to have the WORST time getting blood from her ear. One hour after insulin injection, her BG is still over 500.
 
Good Morning, Laura,

Skinky sure is a fighter! And you are doing a great job, juggling all of the meds, the insulin, the foods, etc.
It takes about 2 hours for Lantus to "kick in" (onset), so it is not surprising that her bg is still high after 1 hour. If you can get in a test somewhere in the middle of the cycle (+4 to + 7 or thereabouts), you will have a better idea of how she is responding to the insulin.
Insulin syringes are not expensive, but in NY State you need a prescription to buy more than 10 syringes. Tomorrow ask your vet to phone in a prescription to your local pharmacy. Ask her to specify U-100 insulin syringes, 31 gauge, 3/10 cc, 5/16'' needle length (short needle), with half-unit markings. A good brand available everywhere is BD.

Sometimes it is easier to get blood from the ear if you use the lancet device. But whatever technique you use (free-hand or device) it is important to warm the ear (I use a warm, damp baby washcloth, heated for 10 seconds in the microwave, and then put into a plastic baggie). Another tip: blood flows from the tip of the ear down. So if you put a little pressure just below where you intend to do the prick, you will form a "dam" and the blood drop will emerge above the dam. Put a little vaseline on the ear first, so that the blood will bead up.

I hope that Skinky continues to eat and that you both will have a good day.

Hugs and scritches,

Ella & Rusty
 
The only way to know is to try it. I'd use a lancet, not a needle, for alternate site testing, myself. They're 26-28gauge.
 
Here's Skinky's blood work...
concerned ab
Critter Mom said:
Hi Laura,

How are you and Skinky doing today?
.
Click to expand...

Hi Aine,

We're doing ok. She WAS doing better, now she's not as good as yesterday, but better than last week.
Her hind legs are so very weak, she wobbles quite a bit. Still not eating on her own. A lot of mixed info about the insulin. Current vet, who i spoke to today, said if i want i might not even want to give her the insulin, but I don't think that's a good idea, since w/ the steroid, sometimes her BG can be "hi", and certainly in the 500 range.

We are going to see an oncologist on Tuesday at the big medical center. I'm dreading the appointment.

She's out like a light now...i might join her soon..
 
Hi Laura,

I'm glad to hear that Skinky is better than she was last week. I wonder whether the higher blood sugar might be contributing to the weakness in her back legs (poor baby)? The B12 supplementation may help with that. Maybe more experienced members might know more.

With respect to the insulin, always ask questions here as well as discussing with your vet. There is such a wealth of experience among the members here. The more information you have, the better the decisions you can make to help Skinky.

I can understand the trepidation you're feeling about Tuesday. Know that I am keeping you both in my thoughts and my prayers.

Wishing you both a restorative and peaceful night's sleep and better things tomorrow.

((((Laura and Skinky))))
.
 
Hi Laura,

Checking in to see how you and Skinky are doing today.

Keeping up the prayers here.

((((Laura and Skinky))))
.
 
Critter Mom said:
Hi Laura,

Checking in to see how you and Skinky are doing today.

Keeping up the prayers here.

((((Laura and Skinky))))
.
Click to expand...

She's not drinking water again. and getting squirly when i'm feeding her again. gave her the odanestron and fantomine. she got b12 from the doctor, it's her third b12 shot, yes it helps, but only for a few days, doctor says it's supposed to last two weeks.

i really need her to at least be drinking the water again, she is def. dehydrated but half unit of the sub q's only goes so far in rehydrating her.

it seems like the positive effects of the cerenia/b12 and steroid are wearing off. we see an onocologist tomorrow.
 
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