11/12 Alistair PMPS 216 +5 74 Is this dose safe?

Alistair has been on 3U BID of Lantus for 3 weeks now (diagnosed at end of Sept following DKA) and his numbers keep coming down. I've been reading about the dosing protocols but I have no confidence that I will make the right call, so I just wanted to check in for advice.

Since they are continuing to come down, should I slightly reduce the dose to decrease their rate of decline? I'm especially concerned because I have to be out of town Saturday and Sunday, so I'm very worried he'll end up in hypoglycemia when I'm not there (he'll be checked on twice a day but he won't have anyone to test him between shots).

Thank you from us both!
Alexander

 

Since you are feeding kibble, your only choice for dosing method is SLGS. And SLGS says to reduce if they go below 90, which Alistair just did today. Your new dose is now 2.75 units. For the weekend, and for safety and ease of the pet sitter figuring out what to dose, you might want to lower it to 2.5 units so it’s on a line. I would also leave a sample syringe with coloured liquid, filled to the dose, so the pet sitter has an example of the dose.

Have you been testing regularly for ketones? Very important after DKA. And presence of ketones may influence dosing suggestions.

 

I don’t see it in your signature however sce dry food is in the picture I’ll refer to the SLGS guidelines which call for an immediate reduction of 0.25u if your kitty dips below 90. In light of that the dose should be reduced to 2.75u starting with the next shot.

Are you monitoring for ketones? It’s very important since he has a recent history of DKA.

 

@Sandy and Black Kitty GMTA

 

Thank you! I will do that. I forgot to mention that his vet told me not to change it when I asked a few days ago when Alistair tested at 81 (which is why I hadn't acted on the SLGS guidelines), but getting specifics out of the vet has been like pulling teeth and I have much more confidence in y'all's experience.

I've tested for ketones several times, but the last time was the beginning of the month. All negative, fortunately. The vet told me I didn't need now that his BG was lower. Was that not correct?

Alexander

 

Reducing insulin when a kitty has a recent history of DKA takes careful consideration. You want your kitty to get enough insulin to properly metabolize his food however you don’t want BG to bottom out because the dose is too high. Based on what your ss shows I think in your case it’s best to reduce to 2.75u and shoot consistently rather than start skipping shots.

Given his history, I would check for ketones at least once a day. Testing is easy and it’s your first line of defense. Forewarned is Forearmed. BG does not need to be crazy high for ketones to develop. @For_Luna is a current example.
.

 

True story >> http://www.felinediabetes.com/FDMB/...-00-pm-et-luna-bouncing-back-from-dka.220920/

 

I agree that you should reduce the dose for the days that you're gone. However, I'd wait a few more days before deciding on what the dose should be. As you noted, Alistair's numbers have been coming down. You want to make sure you've got a good margin for safety if you're not going to be there.

Once you're back, you may want to reconsider the dry food. It's very high in carbohydrates!

 

Wow, that's scary! I'm so glad @For_Luna is feeling better!

I'd love to switch his food, but he's always very stubbornly refused wet food from the time he was a kitten to last week. At this point, he has a life expectancy of a few months thanks to his CHF, and stage 3 CKD which is rapidly advancing thanks to the furosemide he takes for CHF. His appetite has been a little touch and go even on the kibble, so my main priority is keeping him eating as much as he can for as long as he will :-/

Thanks for the advice everyone!

 

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