? SweetPea: 03/07, post-DKA dosage advice please

[Marshmallow Cat]

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[Olive & Paula]

Are you giving Lantus? Different doses will mess with the depot and make it unstable.

 

[Olive & Paula]

Yes, we are using Lantus. The vet told us to adjust the doses based on her numbers; is that not good advice?

If using the shorter acting insulin you dose according to numbers.

Longer acting insulin like Lantus/levemir you dose based on the nadir. Here is some info that might help you understand it.

http://www.felinediabetes.com/FDMB/threads/what-is-the-insulin-depot.150/

 

[Chris & China (GA)]

Am I understanding this correctly? Because she hasn't dropped beneath 2.2 / 40, or had nadirs of 2.8-44 / 50-80 for a week with values generally around 5.6 / 100? And that even in that instance, we would only reduce the dose by 0.25U and then hold for 3-5 days?

Correct!! Except for a few details....If you're still using the AlphaTrak, if she drops below 68, it's a dose reduction of .25 (and it's below 50 on a human meter unless your cat has been diagnosed over a year)

I feel so confused because I have all these notes from when this vet was discharging SP and none of them make any sense with this new information. Hopefully it doesn't hurt SP that I only gave her 1U tonight.

Don't worry about it....any time you do something "different" it's still a learning experience. You gather data to see what happens!!

It really sounds like your vet is more used to dosing with an insulin other than Lantus though. We don't use the "sliding scale" method with Lantus because it seems to work best when given at a consistent dose so that the depot can settle down and do it's job.

If you keep changing the dose like your vet has suggested, the depot is always releasing different amounts which ends up giving you wonky results.

 

[Olive & Paula]

One more thing. When increasing or decreasing a dose it is done by 0.25 units. Do you have syringes with half unit marks?

 

[Sienne and Gabby (GA)]

Overall, the information you've gotten is correct. There is one very important caveat. Ketones/DKA trumps absolutely everything. DKA is one of the most challenging issues anyone here has to contend with. Trace ketones can develop into full blown DKA in an astonishingly short period of time. And as I'm sure you know, it's life threatening and expensive to treat. So, we want to help you avoid a repeat.

Testing regularly for ketones is essential. (You're obviously doing that.) IF trace or greater ketones show up (I'm not sure if you're testing for urinary or blood ketones -- urine strips or a meter), then following a dosing method may not apply. Ketones appear if there's not enough insulin on board, there's some source of inflammation or infection, and your cat isn't getting enough calories. Given how close the episode of DKA was for SP, I would not be looking to reduce the insulin dose too soon. (This is another reason your vet's suggesting a sliding scale dose is not a good tactic -- well, that and it will cause Lantus to give you wonky numbers.) Rather, if you see numbers are dropping, prop them up with food as best you can.

Given the recency of the DKA, if you get a low pre-shot number, I'd encourage you to post rather than skip or deduce the dose. For example, on 3/7, SP's PMPS was 103. You reduced the dose and by +2, SP was at 221. A different tactic would have been to stall without feeding your kitty. If over the next couple of tests (e.g., you want to test every 20 - 30 min) and if numbers are rising, it's likely safe to shoot. Ultimately, if you are following TR, you will get comfortable shooting progressively lower numbers.

Also, a piece of housekeeping: You might want to change the title of your spreadsheet to something like "SweetPea's Spreadsheet." The spreadsheet itself is titled "FDMB World/US 12/12 Insulin Spreadsheet Template FOR PET METERS." I'm hoping you didn't save your data to the original template!!

 

[Hogan]

Excellent, thank you, I'll make note of that. We are using the AlphaTrak until we run out of strips, then we'll be switching to the Freestyle Lite.

My tiny bit of advice is I wouldn't wait until you run out of the strips for the AT2, I would switch to the Freestyle Lite right away if you are going to follow TR.

 

[Hogan]

I used the AT2 exclusively as well and wish I had switched to the Freestyle much sooner that I did. The guidelines for dosing in the TR and SLSG protocols are designed for human-meters, so if you use an AT2 pet meter, you are going to be dosing more "aggressively" - not sure if that's the right word.

There are others with much more experience than me on this board so I'm sure they will chime in. I'm relatively new, so please take what I say with a grain of salt. I just wanted to bring it up, as I wish I had realized the significance sooner.

 

[Sienne and Gabby (GA)]

I would check the instruction manual for your ketone meter. There are some small differences between meters. This link has very useful information on ketone. Just below the picture/drawing are links to 2 articles that give parameters for blood ketone readings.