1/1 Wally AMPS 506, PMPS 486 - Ketones 2.1 - Need advice for tomorrow shot

Wally & Stefano

Wally & Stefano

Active Member
Hello,

as suggested I'm posting a new condos thread about Wally here.

Prev thread is:

http://www.felinediabetes.com/FDMB/...rom-caninsulin-to-lantus.208642/#post-2312683

Wally is on Lantus since yesterday. My doubt are in short regarding tomorrow morning shot. I'm located in Italy and want to be ready when you are all sleeping.

1) Should I keep 3U? I understand I will ask for advice if BG is below 150 (highly improbable)
2) Should i adjust the dose if tomorrow BG value is above 300 something? (highly probable value considering previous values)
3) Should i increase the dose if ketones are again above 4? I will blood test ketones before AM shot to be safe.

thank you!!!
 
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Hi from Switzerland! (same timezone :))

Given you were on up to 5ui of Caninsulin, you could have started on 5ui of Lantus directly. I agree with others that 2ui was way too low, and I think that 3ui is too.

Particularly with ketones around, I wouldn't wait to increase the dose. You seem to be monitoring closely, so I would personally head to 4ui directly (or maybe even 5ui, because that is what I would have started with directly when switching to Lantus). If you took this course, you would of course continue monitoring closely. You'll want to be ready to deal with low numbers (go through the document, print it out, go through the steps in your head so you are not "lost" if you need to take action; the "take action" number is 50). You also need to keep in mind that the depot will take a certain number of cycles to fill (ie, you need to wait a certain number of injections, usually 5-6, to see the full potential of the dose you're giving). So if you increase the dose aggressively you need to sit tight and wait through the first cycles of red and black and maybe pink that you'll pretty inevitably see. You might be tempted to increase the dose higher "outside protocol", but this could be a mistake. ("could")

If this approach seems too agressive to you, then you would follow this guideline (from the DK protocol): "However, if the cat is producing continuously high BGs (nadir always >=300 mg/dl), only hold the dose for 2-3 days before increasing it by 0.5 IU." On the DK forum they will even do increases after 2-3 cycles if the numbers are consistently high, so that's what I'd do, if you're not comfortable with hopping up to a higher dose. In your case, we know your cat was on a higher dose of Caninsulin and not responding, so we can pretty confidently increase quickly.

What's really important to understand is that by increasing the dose this fast, there will come a point where things suddenly start turning, and within a few days you might find yourself having to decrease the dose. This means you need to be on top of testing and not become complacent. So take into account how feasible this is for you -- physically, logistically, and also, see where your stress levels are at.

If you did find a PS number around 150 or even under 200, which would be quite surprising, definitely hold off for advice. This might help: http://www.felinediabetes.com/FDMB/threads/tight-regulation-shooting-handling-low-numbers.147/

I hope you manage to get those numbers down soon!
 
Wally is staying pretty flat so I'd increase the dose to 4u tomorrow morning barring any low pre-shot BG which as you noted is unlikely. The sooner you can get the BG down a bit, the better. If ketones levels have increased then definitely increase the insulin and make sure Wally is eating well and staying well hydrated.
 
I agree, I would increase to 4 units tomorrow morning, as that should have been his starting dose. After that, I would hold at least four cycles at 4.0 units, unless he goes below a reduction point. Which would be 50 if following Tight Regulation, 90 if following SLGS. Given the recent DKA. TR is probably a better at least short term dosing method for you. You do test enough. At the end of the four cycles, we can reevaluate and see if we should fast track, or do quicker increases, as Stephanie mentioned,
 
I saw you gave 4ui, good job! Don't get dispirited if this cycle is as red as the next ones. With a bit of luck, tomorrow you could start seeing better numbers. I know how frustrating this can be. Great that you're testing for ketones :bighug:
 
Hello Stephanie, thank you for your message.
I will test again Wally at +3, +6 and +9... and of course i will update the spreadsheet
The guy is eating well, I'm just a bit worried because he vomited a bit of liquid this morning at 6.00AM

We are crossing fingers :)
 
3/6/9 is fine (and honestly, if 3/6 are still super high you can skip 9). Nobody likes to see vomit! With a bit of luck it's "nothing". Also, be prepared for him to eat "less well" once his numbers start coming down. The insatiable diabetic hunger will diminish. This is why it's important to test for ketones, because an unregulated diabetic going off his food could mean "better numbers" but it could also mean "ketones"!
 
I'm glad he's eating well, and his numbers are starting to come down. Since you tested for ketones early this morning, I would test for them again later this afternoon.
 
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