Help! PMPS 84 (last night) today AMPS 154, +1 179--Hold dose?? PMPS 75

Good morning, I was hoping maybe a couple of you would have time to look at Kekoa's chart and let me know if you have any advise? I'm getting a little nervous about his values to the point that I'm getting little sleep because I get up in the middle of the night to test him. I'm also worried about not being able to come home during the day to check on him (I work 45-60 minutes from home).

Should I keep at the same dosing? Just fyi...I do "eyeball" the .25 units of Lantus. I fill the syringe so that the top part of the black plunger is at the top of the .5 line. When he's under a 100 preshot, I will remove a drop.

Thank you in advance for your time!

 

Hi there Anela and Kekoa and welcome to the Lantus forum.

His numbers do look good, I see from your previous post that you were previously using the AT 2, with a human meter the numbers will look lower, and the tests you have got show him to be right in the zone for healthy healing numbers.

Here is your last post on health just for some history for anyone stopping by
http://www.felinediabetes.com/FDMB/threads/need-help-with-dosage.188640/

Before offering my thoughts, I have some questions, as my response will be dependent on the answers to those. (Sorry)

• Aside from the diabetes and bladder probs, any other health issues? has he ever had DKA?
• Reading through your last post, you stopped all dry back on dec 27th, is that correct?
• Did you decide on what dosing strategy you wanted to follow?? The dose advice would be dependent on this.
• When you are away at work, I see from another post that you watch your kitties, but can you elaborate on what their feeding set up is? are the free fed? Timed feedings? Does he usually eat well?
• Are you gone for 12 hours in the am cycle?
• What are your shot times? Have you got any flexibility to be able to move those so that you can grab a test say at +1 and or at +2 before you leave in the mornings?
• Is there anyone at home that could grab a test for you?

 

Gill & George, Thank you for responding... Here are the answer's to your questions.

• Aside from the diabetes and bladder probs, any other health issues? has he ever had DKA?
  • Kekoa's other health issues include Hyperthyroid (controlled and within normal range w/ 1/4 Methimezole once a day)
  • Dx with Heart Murmur Nov 2016 and possible cardiomyopathy, however since Hypertyroid has been controlled they don't hear the Heart Murmur anymore. He goes back to his cardiologist in March for a 1 year check up.
  • One prior incident of crystals in his bladder 10+ plus years ago.
  • Dx with confirm TCC (transitional cell carcinoma) in the Bladder Sept 2017, He had surgery on 10/20/17 to remove the tumor and 1/3 of his bladder.
    • On the fourth day following the surgery Kekoa was admitted to ICU. He was treated for DKA. He had not eaten since the night before his surgery and the amount I was able to syringe was too little. He did not receive insulin that entire time after his surgery as a result of bad advise from the vets office. I called them everyday letting them know he had surgery and was not eating and was concerned about his diabetes. At the time, I was so overwhelmed by the surgery and his cancer that I didn't even think of home testing. I finally brought him in on day 4 and was immediately sent to the emergency clinic where he stayed 4 days in ICU. He was severely dehydrated (although he had been drinking a ton), his glucose was over 700+ and his kidney values were also off the charts. He received a blood transfusion which in ICU which saved his life. All his values came down before they released him, however, his kidney values are now in the low-high range.
• Reading through your last post, you stopped all dry back on dec 27th, is that correct?
  • I stopped all dry when he came home from the emergency clinic on October 27, 2016. He also began his diet of strictly Fancy Feast. Prior to that he was eating Prescription CD for 10+ years.
• Did you decide on what dosing strategy you wanted to follow?? The dose advice would be dependent on this.
  • I have not, I'm still trying to wrap my head around all the information. I've been juggling allot of information about treatments for his TCC and his diabetes. I've been watching his values more closely because the change of diet make a huge impact on his BG numbers. I'm scared to death about him going Hypo or DKA. Also still trying to understand how Ketones play in all of this. I bought strips to test, but never seem to be around when he pee's.
• When you are away at work, I see from another post that you watch your kitties, but can you elaborate on what their feeding set up is? are the free fed? Timed feedings? Does he usually eat well?
  • They free feed. I mix two cans of Fancy Feast with two Primal Nuggets in the AM and PM and leave out whatever is not eaten. They will always finish everything given in the AM before I get home from work, however, they don't always finish their PM meal before I get up in the morning. In the PM I do withhold 1/2 their food until bed time to keep it fresher. I will offer to Kekoa before putting down so I know that he's eaten something more.
• Are you gone for 12 hours in the am cycle?
  • Yes, almost exactly 12, so most days I'm 30 minutes late by the time he gets his insulin.
• What are your shot times? Have you got any flexibility to be able to move those so that you can grab a test say at +1 and or at +2 before you leave in the mornings?
  • 6am/6-6:30pm
  • No, I was able to over the Holiday, but now that my work is back to "normal" schedule I leave the house by 6:15am, 15 mins after injection.
• Is there anyone at home that could grab a test for you?
  • No.

 

Kekoa has been through a lot, glad you are able to take such good care of him and he’s lucky to have you!

I’ll leave the dosing advice to @Gill & George but I did want to mention, if litterbox stalking is a problem, you can buy a glucose meter that doubles as a keytone meter and test for keytones with blood just like you do for glucose. The strips are on the pricey side, but it would give you peace of mind, especially when you can’t catch him in the litter box. Here’s an example of one:

https://www.adwdiabetes.com/product/3400/nova-max-plus-glucose-ketone-meter-kit

 

Thank you! I've been meaning to look into this, but the couple I've found the reviews weren't great. Maybe I will search the Forum to see if anyone has a particular one that they trust and works well for them.

Yes, Kekoa and his brother Kiki have my heart, I think it’s the other way around, I'm lucky to have them. Two totally different personalities. I'm watching them on the cam as I type, it gives me a sigh of relief when I see Kekoa has come into the room and is eating. Let’s me breath again for a couple hours then I start to worry when he'll come back to eat again. lol Love the cam, but it does make me a little neurotic.

Thank you for taking the time to respond.

 

I just don’t think there are a lot of options in regards to keytone meters, so I wouldn’t worry about reviews, I think there are only one or two and they get the job done with some quirky things in the mix.

That’s so neat that you have a petcam! A little neurotic you say? You’ll fit right in here (but we just call it caring for our cats)!

 

Thanks for answering all the questions.
He has got quite a lot going on.

With DKA in the picture, it is important (as you have found out) that
1) he get enough calories
2) he get enough insulin.
If you find he goes off his food, or you suspect infection, or stress that should set alarm bells ringing and you need to be vigilant for ketones.

His numbers look good, but I can understand the apprehension, the data you do have seems to show him being relatively flat, you are not seeing big drops or swings, this is good, though it does not preclude him from dropping and earning a reduction.

Do you know the carb content of these?

One way to keep him a little higher during the day when you are out is to feed slightly higher LC, it does of course depend on how carb sensitive your cat is. George wasn't hugely carb sensitive, so if I was going to be out for a number of hours during the active part of his cycle, feeding 9% -12% was usually enough to keep him up without sending him to the moon (at least that was when he was in his flat cat/ blue/green phase, similar to where Kekoa is now.
I didn't free feed, (he's a glutton) but that meant I could target exactly when I wanted him to eat, and what, I could make sure he got higher carb just before onset and in the early part of the cycle to keep him ticking over. He is also a very good eater, so I can always rely on him eating when his autofeeder spins, especially if it is nearby his bed (he's a senior and a bit on the lazy side). That made it easier to leave him for a few hours at a time.

Usually when a CG has to be away for long periods and is unable to test during the am cycle, they often choose SLGS, the reductions are taken at 90 so it's seen as a safer/less aggressive choice, so on that basis you would be looking a reduction from 0.25u to 0.1u.

But..... with DKA in his history, I'm not sure that I would want to be reducing the dose. In that situation I'd probably opt to keep the dose the same and manage the numbers with the food. But not being able to test during the day does make me rather nervous about this approach, as I was never in a position of having to be out for 12 hours.
If you were to face a lower than usual amps, as long as he was eating well, and acting normal, then you could consider, doing a reduced dose (like you did the other day), but bear in mind that even if you do that the first few hours of the cycle will often play out the same, this is due to the influence of the depot, so even if you do reduce you might want to er on the side of caution and go for the higher LC or MC if you were really concerned.



You are really caught between a rock and a hard place, but on the plus side, he is looking pretty flat, and quite well regulated.


I know you have a really early start, but do you think you could get a test at +11? and then get the amps?
A PS number that is dropping can often lead to an active cycle, so it gives you the heads up, usually that would mean monitoring more, but in your case it would influence your decision in which food to leave out.


Have you read the sticky on TR on a full time Job??http://www.felinediabetes.com/FDMB/...ion-possible-with-a-full-time-job-yes.129378/
Do you think you could look over that.



I think for the time being it makes sense to keep getting at least a couple of tests before you go to bed, like you did on January 4th, that is giving you a lot of useful data, and giving you the opportunity to see if he suddenly decides to lower the range.

Some folk have a large drink of water before bed, and when they get up for a pee in the middle of the night they do a test then as well. I resorted to letting George sleep on the bed, I'd set alarm, wake up, rattle the strips, he'd sit on my lap, I'd poke him give him his treat, and back to sleep without barely waking up. Unless the number made me jump out of my skin.

I have to pop out to a yoga class, but I will check in later.

 

What is LC and MC stand for? Sorry, I guess I have not read those acronyms yet or have forgotten.

 

MC and HC food. BCS is the one I recall looking up, thinking it was a proper scientific term, it made me laugh. Enjoy the slang dictionary:

http://www.felinediabetes.com/FDMB/threads/lantus-levemir-land-slang-dictionary.1903/

 

Ah! Got it! lol... Thank you!

 

As for the DKA, he was "treated" for it, but he had no ketones. So I'm not sure that he had an actual DKA episode (I'm not totally clear what it means to be DKA, except that I read it has to do with ketones). His BG shot up over 700 because he had not eaten post surgery for a few days and was literally in shock. This lead to extreme dehydration. Which of course caused numerous other problems.

So I took his BG at +10...(spreadsheet updated) I believe you asked to do a +11, but I didn't make that one. What does +10 and +11 tell me?

 

Good job getting the tests in +10 or +11 is fine.


Getting a +10 or +11 along with the earlier test you got tells you what direction his numbers are going in when you get the PS
Last night he dropped into the 70's and came up a bit for his +10, and ps though lower not dramatically so, Given the variance we get with glucometer he looked flat.

Let's take a couple of hypothetical scenarios

1) 123@+2. 136@+4 80@+10 96@amps
2)123@+2. 136@+4. 142@+10 96@amps

In the first scenario you can see the amps is flat/maybe even a little on the rise, so chances are you are approaching the end of the insulins action, and by the time the next shot onsets those numbers will be on the rise, so shooting and feeding normally in this case can be done fairly confidently.

In the second scenario you'll see ps is the same, but it's actually dropped 46 PTS from +10, here you have a falling amps, it's fine to shoot a dropping ps as the numbers will eventually start to rise, and to quote Libby, 'shooting a falling number is a gift', but you may need to stay on top of the numbers steering with carbs until they do start to rise.

I love Libby's explanation in this thread http://www.felinediabetes.com/FDMB/...combining-merging-protocols-good-idea.111088/

Lovely amps this morning, I'm sorry I wasn't about when you posted earlier.

 

Help...Not sure what to do... Kekoa went higher this morning than he's been in a several weeks. I gave him same 1 drop dose and checked his +1 and his still the same. Should I give him more insulin before I leave? I'm already late for work because I wanted to check the +1. Now I'm not sure what to do.

 

He may have gone low last night and is bouncing, hard to say. But you wouldn't want to give more insulin, Lantus is not a rapid insulin and doesn't bring those numbers down quickly like you'd think and you want to keep doses 12 hours apart for the depot stability.

He will get back on track, give it a little time. This is not unusual at all, look at some other SSs and you'll see what I mean.

 

The +1 is probably a food bump, the few +1 and +2 tests you have show a similar pattern of going up before coming back down. There were no overnight tests, so you don't know, but he could have gone quite low overnight and bounced, giving you the high AMPS.

 

Hi there,
As Stacy said best not to shoot a little more, other than the reasons Stacy stated above, you can end up giving more than what you intend.

It's possible that Kekoa did go low last night, did you get a before bed test last night? nothing showing on the ss.

Another possibility is that he is not holding the reduction down to one drop. Can I ask how you are measuring that drop dose??

With it being Friday, how are you fixed up for monitoring this weekend?? Getting some extra tests/curve in might help answer those questions.

 

Thank you both! I left the house this morning and did not give him anymore. Of course the one night that I decided to give him a break and not test before I went to bed is the time that now leaves questions to what his BG was. He's been pretty consistent which is why I didn't test at +3 like I normally would. He also ate really good so I wasn't worried at all about him not eating enough or needing to make sure he ate more before we went to bed. He was in our bed this morning at 3am asking for food. I'm guessing he finished his food early last night probably helping himself up from going low?

 

That's what they do

Its our experience that they can change things up at a drop of a hat, that's why we recommend always getting a test in each cycle, makes life easier not having any unknowns.

I'm glad he's eating good and feeling well.

 

Just got home, a little late due to lots of traffic (I drove in today because was late this morning). Kekoa is now 75 on Relion meter, 114 AlphaTrak. Do I hold dose for tonight or give him same dose?

 

I'm so sorry I'm not much help, but hopefully a bump will get some more eyes.

 

Can you test tonight for as long as necessary?

Got plenty of supplies?

I'd shoot the 1 drop dose as usual ....you shot an 84 several times and he did great!

 

Yes, I just stocked up on strips. I have commitment tonight with Church though that will have me gone for about 1 1/2.

 

Just an FYI......we usually start a new post each day because as these threads get too long, people tend to think that any newer comments are probably just "follow up" things.

If you hadn't posted on the Facebook group, I would have never thought to look further since this was originally dated Tuesday

 

Test right before you leave and maybe leave down some food for him (depending on where he is at that time will dictate what you should leave down)

 

Got it! Thank you Chris. I'm sorry, I thought I wasn't supposed to start a new thread and was supposed to just change the Title or add to it. Sorry about that! I'm going to test now because we have to head out.

 

He's still at 75, he did eat quite a bit of his dinner about 30 minutes ago. Hoping he holds until we get back. Gonna rush out so we can get back ASAP. Thank you again!

 

Please leave food out, higher carb food, if he didn’t come up at all after eating, he could be on his way down and then the insulin can kick in on top of that.

 

Looks like he's surfing pretty safely!!

Be a good boy Kekoa!! No funny business!!

 

I vote +1 for bouncing.

Just a data point, but if you look at Quintus's spreadsheet and numbers on the last day I gave him insulin (it was 0.1 or as close as I could get), he dived pretty low and then soared right back up. Seems like it took a couple of days to stabilise. There was still depot in play though, as I reduced the insulin dose fast, so maybe he was going low at moments when I didn't test. It is also possible it was a case of "sputtering pancreas", not quite into gear yet.

 

I wish I understood all the numbers better. I’m so tired but I don’t want to go to sleep until I know his number comes up. I just got a 61 at +4 (then tested 3 more times because I’m paranoid and now got 81, 78, and AlphaTrak 114). I’m sure he thinks I’m crazy and wants me to leave him alone. I was supposed to curve him tomorrow during the day but may have to wait till Sunday to rest his ear and so hopefully I can sleep tomorrow. I’m sure I will be perplexed on whether I keep same dosing tomorrow or not