? 03/04 Ducia AMPR 68 after 0.5 increase, no shot, 105 after 1 hour

Yesterday link
http://www.felinediabetes.com/FDMB/threads/wheezly-breathing-in-post-dka-post-hypo-cat.174102/

Hello,

Ducia's AMPR is down to BG 68 after PM dose increase to 1.5U from 1U, she ate 1/4 can, had 12 ml water and after 30 min retest BG was 88. She ate another 1/4 almost entirely, after 30 min the Bg 105. The shot is still delayed, the dose is 1U now and I am going to retest her in 30 min again.

Last night after dose increase her +3BG was 197, +6 was 205. I felt so good about it, and overslept her +9.

I can feel my own glucose plummeting right now. The Hypo event that we went thru on 2/26 is so vivid in my memory!

Is that me, or does everyone experience such emotional roller coaster?

 

I don't have much to offer in ways of advice, but I wanted to let you know... you're not alone on that roller coaster. We're all on it to and have your back.

 

+1.5 BG 124, shot delayed for another 2 hours.

 

ThankG for that!

 

If you haven't given the insulin yet, then that +1.5 is really +13.5 (we count hours from the last dose given).
Just some thoughts for you to consider: Your PM dose tonight will need to be given 12 hours after you shoot this AM. Is your shot schedule that flexible?
With ketones and recent DKA, you do not want to end up skipping the insulin, especially if he is eating and you have the feeding tube to help.
What about thinking about giving a BCS (one time reduced dose), and then you will only be 1.5? hours off schedule tonight and tomorrow, etc, rather than 4 hours or whenever you eventually shoot this dose?

 

Sorry, I misspoke. I meant test in 2 hours and skip am shot completely. Test +2.

 

Do you mean you are planning to test again in 30 minutes at +14, or wait 2 more hours and test again at +16?
I don't think it's a wise idea to skip insulin when he has ketones and a recent DKA. Did you get the ketone test strips, yet? Please buy some as soon as possible. Most pharmacies will have them. Walmart's are the least expensive. Maybe you can call the Walmarts nearest you to see if they have them while you are waiting to test again. What BG would you feel comfortable shooting?

 

I agree. But 1U after or even 0.5U at BG 124 seemed taking big risk. She is recenly post Hypo. She might be a droper. The last night +3 was 197, +6 206 and then AMPR is 68. We are recenly onFD diagnose, her responsiveness is unknown

 

Hi Tanya--

It's definitely scary to shoot when she is low after the hypo, but I agree with Dyana about skipping shots after a DKA. Let me suggest a couple of possible strategies:

1) The reduced dose (BCS-- "big chicken shot") suggested by Dyana
2) Shoot the regular dose, and give Ducia some higher-carb food to keep her numbers up-- don't wait until she starts dropping because of the insulin, just start giving her carbs now.

Remember also, it usually takes a couple of hours before Lantus "hits" and begins working, so the BG it is going to encounter isn't the 105 or the 68, it is whatever the BG is at that time. Since she is already heading upwards, you should be safe to shoot, although of course you would want to monitor today no matter what.

It is definitely a roller coaster, you are not alone!

 

I know. You are kind of between a rock and a hard place. I understand. But going back into DKA which can happen in a matter of hours is very very serious. My cat was hospitalized with DKA for 8 and 1/2 days and almost didn't make it. I prayed for him almost every minute of those 8 and 1/2 days. Even though it was 12 years ago, it's still etched in my mind, so maybe I'm particularly concerned or biased.
I'm going to try to get some more help, by reaching out to some others with experience. I know you're new to this. Sometimes with my cat, I felt all alone in this, and didn't know what to do and was scared. I would just think about what BG you would be willing to give her a small dose (maybe 0.5 unit) at. Is your shot schedule flexible to be off by 3 hours or whatever it turns out to be, from what you would prefer? You can work your shot schedule back in 15 minutes increments per cycle or 30 minutes per day. And get some ketone test strips.

 

we that the thing - I don't.

 

Hi Tanya, I'm too new and can't give any dosing advice, I just wanted to reassure you that we've all been on the roller coaster (there may be another ride for me right around the corner!?)
Besides all of the incredible information that is available here and the wealth of peer knowledge, the emotional support remains equally important for me.
I hope you will continue to reach out for that whenever you need it.

 

These are the good strategies. But it is also important for us to keep current schedule due to work hours.

 

For future consideration: with the U100s that have half unit marks you can eyeball 1.25 u.

 

Has it been an hour since you tested last? If so, how about another test? Can your husband go get the ketone test strips?

 

Thank you for the support and advice. We skip the am shot, pray and monitor thru the day. I have recently seen her in at BG 22 with convulsions, violent spasms, screaming and the rest of the bloody Hypo nightmare. I can't risk it again a few days later. Feels wrong. The highs wont kill in hours but the lows can. I supposed to receive her urine ketone test later on and going to get the testing strips right now at wallmart.
I have an hour and a half before next test to run errands and going out. Please keep posting.

 

That was the goal but the old eyes let us down. We felt not confident and increased by 0.5. None of us here have good vision even with the glasses.

 

Some people find that a cheap pair of reading glasses in a higher magnification helps with this.

 

Hi Tanya,

I do think that taking the dose up to 1.5u, from the 1u, is too big of a jump for Ducia, especially with that 168 in there on 3/1, additionally I think Ducia may have well been bouncing of the 168, giving you those pinks that were so disconcerting.

You are caught between a rock and a hard place with DKA and the anxiety from that recent Hypo.

Personally DKA worries me more than low BG, with the BG and insulin, remember you have a feeding tube so you are able to get food into Ducia if needed.

What are you feeding her at the moment?
You may need to consider feeding her some higher calorie higher carb food (I think I remember you saying she had lost some weight), that should help keep her BG's bolstered too.

With DKA in the mix, skipping and not giving any insulin is really not a good idea, shooting a reduced dose would be a better option, and if you are worried about dropping BG then you can counter that by feeding high carb food as needed, that would be preferable to giving no insulin at all.

I think you need to try and find a way of shooting those .25u doses, cheap ready made readers over the top of your current glasses could well work as enough of a magnifier to give you the magnification to see the dose, though you will probably have to hold the syringe pretty close, take a syringe to the shop and test out the ready mades to see which strength works best, the other thing is to get a good light on the syringe, something directional, like a desk lamp, works best, a bright ceiling lamp can sometimes be counter productive in these sort of situations.
I don't think you should shoot the 1.5u again, in your situation, I would probably take her back to 1.25u, knowing that I might need to feed higher carb food to keep her in a range that is safe from a BG level and a ketone level point of view.


ETA
It is really very very important for you to get those ketostix so you can monitor her ketone levels in her urine at home. As Dyana has already said DKA can develop very quickly and the ketostix are going to be your early warning.

 

Hi Tanya.

Keep in mind, in measuring the 1.25, it doesn't have to be exactly right. Just pick a spot that looks good and then remember to use that same amount each time - consistency is more important than accuracy.

DKA is not only dangerous (although you're right, it isn't immediate like a hypo), but it is very expensive to treat. I know you aren't in a position to go through that again, financially or emotionally. Skipping shots with ketone lurking is not a good idea.

 

Tanya,
I see that Ducia is in the pink numbers at +18. If you want, you can shoot early for tonight's dose, like at +22 (2 hours earlier than your normal time). Test first of course. Or you could shoot at a different earlier than normal time. I just know she needs the insulin.

 

Actually, since you skipped the AM shot, you can shoot the PM shot anytime you want to....you don't have to wait any certain length of time

The key is whether you can shoot 12 hours from whenever you shoot tonight and continue that schedule

I agree you should get a cheap pair of reading glasses....they can really help see those lines better (and believe it or not, there actually is space between those lines!)

 

Tanya, I read the notes on your SS that said you had a "positive/large" result when you did a ketone test last night. Did you read the instructions for the strips about how long to wait before checking the colour change?

Please let us know how Ducia is doing.

 

Hi Tanya. How is Ducia doing today?
I do see that she got her 1 unit and then she came down into the yellows last night. Is the remark about ketones from last night? If so, anything above a trace in ketones needs a vet's assistance and most probably a hospital stay at a 24 hour facility. @Chris & China
Please let us know how she is doing as we are trying to help Ducia.

 

Hi Tanya,
Hope you and Ducia are OK.