? - 181 tonight, skipped 3 doses so far-dose or no? | Feline Diabetes Message Board - FDMB

? 181 tonight, skipped 3 doses so far-dose or no?

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Heather & Hwy 99

Heather & Hwy 99

Member since 2020
Hi all, so this is sort of a continuation of previous thread/ongoing advice needed (to briefly recap I have my own health issues that leave me with great difficulty processing/understanding/retaining information so please understand if I ask the same thing over and over or just dont quite get it-thank you!) I am getting as much data as I can right now, but battling a flare up and sleeping a ton makes it difficult

So after many changes in last week (from 3 units vetsulin once a day, to 2 units Lantus twice per day-was only on that schedule for a couple days before his numbers got so low you all advised to skip some doses and reduce others) as of today I have skipped 3 consecutive doses-do I just keep doing this until his numbers go over 200? Does insulin stay in system for days and his body is maybe just utilizing residual?

*when you are looking at spreadsheet please note that I am manually writing in the hours since last insulin (today just now for example was +40)

ALSO, he went from ravenous always hungry kitty, to barely wanting to eat 1/4 cat fancy feast 3-4 times a day-do you think this is a good or bad sign? He does get a little dry hills w/d at 6am each day for his IBS but is strictly ff pate rest of day.
Thank you so much as always!!
 
Hmmmm... So, this is tricky! As long as he is still eating and does not appear to be lethargic or otherwise unwell, I think you are good, but it definitely bears watching.

We always want to be careful about reducting (and especially eliminating) insulin in diabetic kitties. The risk is that they develop ketones, which can lead to very serious (even life-threatening) complications. As long as he doesn't appear unwell, and keeps eating, and did not have ketones when you first brought him to the vet, he's probably fine, but it would be a good idea to add ketone testing to your regime (I will give some directions and tips about that in the next message once I dig up the links).

So, what is going on? Why might he be eating less? Is it a good thing or a bad thing? The answer is... yes, one of those (I know, so helpful :)). More details:

A good thing. It could just be that he is less hungry now that he is in normal numbers :). The ravenous hunger and thirst was a side effect of unregulated diabetes, and now that he's spent most of the last four days in normal or near normal numbers ( :woot: :woot: :woot: :woot: ), he doesn't have that. I think this might be what is going on, but the other possibility is...

A bad thing. (and, other than the possibility of ketones, it's not terribly bad) Because he's been in high numbers for a while, his body might have gotten used to them enough that, now that he's in lower numbers, it feels "weird", and he doesn't feel like eating as much o_O. If that's what's going on, he should get over it quickly, though, and like I said, I think it's less likely than the first possibility.

OK, more on ketones in the next post (unless someone else is typing now and beats me to it, which happens a lot around here!)! Stay tuned!
 
OK, testing for ketones!

What you are going to do:

1. get some urine dipsticks they use for ketone testing in humans (found in human pharmacies with other diabetic supplies, usually). Name will be something like "ketostix" or "ketodiastix".

2. test Hwy 99's urine with a dipstick regularly (not as often as blood glucose testing; just daily for the next few days until we're sure the appetite decrease is not due to ketones, then weekly is fine).

[record scratch] Wait, what? How am I going to test a cat's urine with a dipstick????? Good question!

There are various techniques, which one works for you depends on your cat's litter box habits and tolerance of weird behavior by you. Some cats pee on a regular schedule and will let you just stick a long-handled spoon under their butt-- they're the easiest! Others, you have to go more stealth and do things like put some plastic in the litterbox to catch some drops (you don't need much), or replace litter temporarily with something non-absorbent like aquarium gravel to do the same thing. Several strategies are described here: Tips to catch and test a urine sample

Once you get up and running on this exciting new activity :woot:, the main thing to remember about ketone dipsticks is that they are designed to be "read" after a very specific amount of time-- usually 15 seconds, should say on the bottle. Since the readings will darken over time and make things look worse than they are, it's important to read at the correct time so you don't worry!

Others may chime in with their own favorite tricks. Again, I'm betting that what we're seeing is just Hwy 99 feeling better, but we do want to double-check this.

Side note: if it weren't for the possibility of something like ketones, I would be jumping for joy at Hwy 99's numbers! He's looking great!
 
Just hitting some details here:

Heather Bentley said:
as of today I have skipped 3 consecutive doses-do I just keep doing this until his numbers go over 200? Does insulin stay in system for days and his body is maybe just utilizing residual?
Click to expand...

Excellent questions!

To answer the second one first, yes there is some residual action with Lantus (we call it the "depot"). One way to think of it is that a little bit of each shot is saved for later, and released when there isn't as much free insulin around.

So, some of the low numbers you've been seeing, even after skipping shots, are probably due to the depot of the shots you gave before. It will be less and less of a factor as time goes on (if you skip any more shots).

As for the first question, let's see where we are at PMPS and see how you're feeling. As I said above, there is a ketone risk when skipping shots, but I'm not sure Hwy 99 is going to be above 200 at the next shot time the way he is going. So we may have to choose between taking the ketone risk and relaxing the no-shoot number to, say 175 [edit: or even 150].

A lot will depend on how he's feeling as well as how you are feeling. Right now, my ketone worry with Hwy 99 is mild but present (due to the decreased appetite, mostly), and I'm more worried about him going low if you shoot, and you having to stay up late to monitor him and sparking/worsening another flare (which doesn't help either of you!).

So if he's under 200, I'd still lean towards skipping or perhaps giving a token dose (say 0.5U) if he's over 150.

If he starts showing any signs of feeling unwell, even if you can't test for ketones yet, we will change strategy. But don't worry about that unless it happens-- keep fingers crossed that this is all just Hwy 99 re-adjusting to normal BG numbers!!!!!
 
Nan & Amber (GA) said:
OK, testing for ketones!

What you are going to do:

1. get some urine dipsticks they use for ketone testing in humans (found in human pharmacies with other diabetic supplies, usually). Name will be something like "ketostix" or "ketodiastix".

2. test Hwy 99's urine with a dipstick regularly (not as often as blood glucose testing; just daily for the next few days until we're sure the appetite decrease is not due to ketones, then weekly is fine).

[record scratch] Wait, what? How am I going to test a cat's urine with a dipstick????? Good question!

There are various techniques, which one works for you depends on your cat's litter box habits and tolerance of weird behavior by you. Some cats pee on a regular schedule and will let you just stick a long-handled spoon under their butt-- they're the easiest! Others, you have to go more stealth and do things like put some plastic in the litterbox to catch some drops (you don't need much), or replace litter temporarily with something non-absorbent like aquarium gravel to do the same thing. Several strategies are described here: Tips to catch and test a urine sample

Once you get up and running on this exciting new activity :woot:, the main thing to remember about ketone dipsticks is that they are designed to be "read" after a very specific amount of time-- usually 15 seconds, should say on the bottle. Since the readings will darken over time and make things look worse than they are, it's important to read at the correct time so you don't worry!

Others may chime in with their own favorite tricks. Again, I'm betting that what we're seeing is just Hwy 99 feeling better, but we do want to double-check this.

Side note: if it weren't for the possibility of something like ketones, I would be jumping for joy at Hwy 99's numbers! He's looking great!
Click to expand...
Thank you so much-this is verry helpful! It will be a bit tricky because I have 3 litterboxes and 2 cats but I will figure it out, I have some of the plastic beads from doing my other cat's UTI testing-do you know how long the sample would be good for? For example if he peed in box in middle of night, and I dipped the ketone stick in the morning would that be accurate or does it need to be immediate?
 
Heather Bentley said:
do you know how long the sample would be good for? For example if he peed in box in middle of night, and I dipped the ketone stick in the morning would that be accurate or does it need to be immediate?
Click to expand...

That's a good question, and I don't know the answer. I'm certain that it does not have to be immediate, but I don't know exactly how long the sample is good for. Hopefully someone else knows!
 
I probably won't be around at your shot time tonight, either. Hopefully others will be here to offer thoughts about PMPS and what you should do.

If you aren't getting replies in time on Feline Health, you can try posting in the Lantus forum again. Include the link to this thread by copy-pasting this URL into your message:

http://www.felinediabetes.com/FDMB/...es-so-far-and-decreased-hunger-advice.230411/

That way, the Lantus folks can get the history of this discussion, and if they disagree with anything I said, they will be able to frame it in context.

Side note explaining the last sentence, skip if not interested :): we operate by "peer-review" here, so it's not unusual for people to offer different advice; it's only confusing when the person reading is getting lots of advice-- multiple, contradictory, but all seemingly authoritative takes-- and has no idea which one to follow. It's much more likely to happen that way when Person #2 doesn't know what Person #1 has said. Lots of times I'll read something someone has said and it's a bit different than I would have said in that situation, but not something I think is actively wrong or needing correction in any way, just a slightly different approach. Then, I know not to offer my own approach if I think it will be more confusing than helpful. So that's one reason we try to include the links to previous discussions in new posts, so everyone knows what has already been said. Also, so you don't have to keep typing the same information over and over to get everyone up to speed. And of course, just so everyone has as full a picture as possible of the situation!
 
thank you all soo much-sorry I fell asleep and left out a whole can of food for him 5 hours ago, I intended to remove it to get an accurate reading 2 hours ago but fell asleep, GOOD NEWS is he ate it all!!!! Bad news is, I am not sure over what period of time, and I just woke up (and can tell I cant stay awake too much longer given my own medication currently) so I got his reading just now of 181 (+47 hours since last shot) I am not sure if/how much food is a factor in that so I am really hoping you all can make a suggestion on giving his dose tonight or not...Im leaning towards very small dose, like .5 if nobody suggests otherwise...?thanks!!
 
Hi Heather,
Because you have had to skip so many shots, because of lower BGs, I think the best idea would be to give a smaller dose and try and see if you can give it each cycle. So in the last 8 cycles you have given 1.5 dose twice. I would try 0.5 units and see if that works if the BG is high enough to shoot.
Are you able to test during the cycle?
 
thank you, Im managing a flare up and needing to sleep way to much so Im not able to get as much data as I hope, Im going to try my hardest to get up in a couple hours again but I can barely stay awake now so I think im going to do as you all suggest and do .5 for tonight and check in in the morning again-thank you all soooo much:cat:
 
Nan & Amber (GA) said:
@Heather Bentley , please check in when you get a chance-- we worry when we haven't heard from someone for a while! Hope all is well with you guys.
Click to expand...
Thank you so much-I have been really sick and am currently updating the SS with very limited data I was able to gather these past few days-I wasnt able to get downstairs (where he is spending much of his day avoiding me anticipating the ear pokes) I feed/medicate him upstairs in my room so he atleast was coming to get food and has had decent appetite and energy, Im going to post new thread asking for more advice on dosing/schedule and would love your input if your around, thank you again for checking in!!:bighug:
 
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