3/3 Maggie AMPS 155 after feed & wait, +2 283, +4 343, +5 336, +6 282, +8 176

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Kelly Howard

Kelly Howard

Member Since 2016
Good morning!

Yesterday's thread: http://www.felinediabetes.com/FDMB/...e-ketones-give-fluids-see-later-posts.174117/

Maggie is recovering from DKA and has just started on Lantus after 6 months on Prozinc. Her AMPS yesterday was 104, today it is 76. I think that her starting dose of 1.5u is too high.

I am home today so I could monitor -- should I give a small dose? I did give her food because she was screaming for it, and I know it's important for her to eat right now.
 
If you are using an Alphatrak, 72 is uncomfortably close to the "hypo danger" cutoff of 68. Hold off a bit on a shot, wait for some experts to weigh in on this. One idea I'll throw out (again, wait for experts!) is to feed a higher-carb food, retest, then if she's high enough give a smaller dose, just because with recent DKA you generally don't want to skip shots. But for right now, please hold off on shooting!
 
Tagging @Meya14 , who knows a ton about dealing with DKA-- she might be able to give a specific recommendation for a course of action today. We really don't want to skip another shot and have a repeat of yesterday's shooting up to reds, but 72 is not a safe number to shoot without other support.
 
She ate her wet food but didn't want all of it; I got her to eat some dry also. This is the DM stuff that they sent home from the vet, I don't think the dry is particularly low carb, so that might bring her up? I had to skip yesterday so I really don't want to do it again, I just wish I had more data on her with this insulin. With the prozinc, she would have green numbers occasionally that never seemed to phase her and she'd come up quickly with kibble. I think I also read that they are more sensitive to insulin after DKA, is that right?
 
Question: I know you said you can be home to monitor today, but what about tonight/next couple of days? The reason I ask is because the more we stall this shot, the more off-schedule you will get. Not the biggest concern right now, but something to put in the mix.
 
Luckily since it's the weekend I will be home tonight, tomorrow, and most of Sunday (gone for a few hours in the afternoon and evening). My target shot time is 7, it's 7:50 now, so we aren't too far off yet.
 
I'm going to tag @Doodles & Karen and @Judy and Boomer on this as well-- I'd really like to get some experienced eyes on this question so we can figure out what if anything to shoot this morning. I'm a bit worried she didn't want all of her food-- does she have anything (even, or especially, higher-carb) that you know she especially likes?
 
Oops, I just tagged as well :) She really likes the DM wet but I was at the end of the can so decided to mix in some Nutro that she used to eat -- I don't think she appreciated that. She ate about half what I gave her, and then she ate some DM kibble after that. So a full meal between the two.
 
How far off schedule can you be? Lantus is not as flexible as Prozinc and should not be dosed less then 11.5 hours apart....12 is preferred.
 
I guess that depends how much you can adjust each time? I can be flexible until Monday morning. We are 1 hour off right now.
 
Kelly Howard said:
I guess that depends how much you can adjust each time? I can be flexible until Monday morning. We are 1 hour off right now.
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You can shoot 30 min early once a day or 15 min early twice a day to get back on schedule. Since you are feeding dry she absolutely earned a reduction and I might bring her dose down to 1 unit tonight. Since you fed her this morning I would skip the shot. Shooting this low and a food influenced number with no data on how she responds to Lantus (except currently her dose is to high) is not advisable.
 
If you are feeding mostly low-carb, you can increase the carbs in order to raise the BS and allow you to give the dose. The target BS right now recovering from DKA is higher than healthy cats to allow you room to give insulin - aim for 150-220mg/dl on a human meter (I'm not sure what this converts to on alphatrack). It's very important that she's able to get insulin every 12 hours and that insulin is not skipped completely.

Also, are you testing for ketones at home? This will provide a better guide than blood sugar to tell you if she's getting enough food and enough insulin.

Edit: Post DKA - cats can have normal-low blood sugars and still not enough insulin to prevent DKA. It's all about increasing food rather than decreasing insulin, if you can swing it.
 
Here is some info on what she eats:

- Before DKA, ate Nutro wet twice a day. Young Again kibble was available but she did not like it and I believe she stopped eating it around the beginning of the year.

- During DKA onset, was refusing the Nutro. I think she may have developed an aversion to it. She would eat Nature's Variety kibble which she has always loved. Eventually she stopped eating at all and that's when we went to the ER.

- Now, she's been having DM wet food at the ER and at home. She has been eating that since Tuesday. She's been enthusiastic about the DM since she has been home. This morning, I tried to mix it with the Nutro and she was not a fan of that. Only ate half what I gave her, so I offered some DM dry as well and she ate that happily.


2 hours after eating would be in roughly 30 minutes. That means 9am shot today, we could do 8:45pm tonight, 8:30am Saturday (hey, I get to sleep in! oh wait, I have a toddler...), 8:15pm Saturday, 8:00am Sunday, 7:45pm Sunday, 7:30am Monday. That's really tight, but I could make that work. 7:30 is about the latest I can shoot on a weekday morning.
 
Meya14 said:
Also, are you testing for ketones at home? This will provide a better guide than blood sugar to tell you if she's getting enough food and enough insulin.
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Yes, I am planning to test every night for a while. Last night, after having to skip the AM shot, she was 3.0 on the ketone meter which is like .6 or .5 above when ketones supposedly start to show on it for cats. So I'm thinking that is about Trace level. There doesn't seem to be a ton of data on the blood ketone meters for cats. I will keep trying to catch her for a urine test.

Meya14 said:
Edit: Post DKA - cats can have normal-low blood sugars and still not enough insulin to prevent DKA. It's all about increasing food rather than decreasing insulin, if you can swing it.
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Should I go as far as giving gravy food? I do have some in my hypo kit. We also have several varieties of kibble that always spike her!
 
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2h after last food, she's 155, I am going to give the full dose. I will be watching her closely throughout the day.
 
Doodles & Karen said:
The earliest you could shoot would be 2 hours after she last ate so that would put you off schedule for 2 hours.
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Not true - you don't have to wait that long. You can shoot if you start to see the numbers rising above the food bump and she is in a safe number range to shoot.

I'm glad you shot Kelly. I would get a test in two hours. The +2 test on Lantus is a good one to give you a heads up how the cycle is going to go. Do you have plenty of test strips and high carb food around - just in case?
 
Yup, I have gravy food, a few different kibble types, and Karo. I just opened this strip vial and there are probably 40 left. Going to reorder some now too.
 
Sounds like you are good for today. Best of luck.

In between chasing after a toddler, I hope she let's you get a ketone test in today.
 
Thanks everyone! I have so much to re-learn now. I'm feeling really optimistic about the Lantus though. I think it will be a good fit!
 
Dry food and is likely bouncing. Bouncing can happen from big drops like last night, going too low, or if a cats bg goes lower than they are use to.

Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).
 
So much excitement in your early days on Lantus! There's a ton of help here from very knowledgeable people. :)​

Re food: it's good that she likes the DM pate. The "Savory Selects" chunky version is almost double in carbs. Maybe she'd like that if you need higher carb food for now. I feed Teasel Fancy Feast and Friskies along with the DM pate but not everyone wants to feed those.
 
Sorry I was away from home after I posted. I'm glad you were able to shoot the full dose, if she does start to drop mid-cycle, steer the blood sugars with higher carb food. I would personally only take a reduction in the overall dose if urine ketones were negative (not too familiar with blood ketone readings). If she is very skinny, even with negative ketones, you might consider continuing to hold the dose and feed higher carb for a couple weeks, as this promotes weight gain and can help keep her stable. Of course, if you are unable to monitor during the day, you gotta do what you need to do to avoid hypos as well, so it's always a consideration.
 
Kelly Howard said:
Kris, do you actually mix them or you just alternate what you give him?
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I mix them together for his main meals, about 2/3 DM and 1/3 FF or Fr. For his small lunch it's usually just FF or Fr. His before bed snack is a small amount of each most of the time. There's no particular logic, just using DM as a known LC base but jazzing up the taste with FF or Fr. I also give him a bit of fish type FF or Fr on Fridays just because ... :)
 
Meya14 said:
If she is very skinny, even with negative ketones, you might consider continuing to hold the dose and feed higher carb for a couple weeks, as this promotes weight gain and can help keep her stable.
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She is quite skinny, she started losing weight again at the beginning of the year. She's just under 8lbs now. She was 10lbs when she was diagnosed 6 months ago, and closer to 13 pre-diabetes. I was thinking of actually finding some kitten food to give her. I know she wouldn't turn that down!
 
I cancelled our 2pm vet appt and will go in tomorrow morning -- turns out our vet is on walk-in duty tomorrow, even though she normally doesn't work Saturdays. Hopefully tomorrow will be a more normal day. The last thing I want them to do is tell me to increase her dose because she's in the 300s when she should be at nadir!
 
336 @ +5. Hope we are past the peak. Out of curiosity I tested with the glucose strips in my (human) ketone meter, 263. Wow! That's a big difference.

Also she's meowing at me which she only does when she's hungry. Should I give her some LC wet?

Looking back now, do you guys think it would have been safe to shoot both AM shots? The 104 yesterday and 76 today. Just trying to figure out for the future. This is a very new strategy to me. My no-shot number on PZ was 200!
 
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I think the allowable range for human meters is either +- 10% or +-15%. They changed it recently, and if you are using a pet meter, there's not really a good way to compare the two. I switched from alphatrack to a human meter because I understand the human numbers a lot better.
 
I'm really considering the switch, if I am going to be shooting so low I think I want to make sure I am using the numbers that you guys understand best.
 
For what it's worth, experienced Lantus/Levemir people will shoot anything above 50. I wouldn't put you in that category yet. ;) But it's something to anticipate. Remember we dose Lantus based on how low it takes kitty at nadir, not the preshots.

Love the blue already.:cool:
 
I do wonder if it was a bounce or just a reaction to the DM dry. She's no stranger to greens and blues, even at preshot. And I've never fed that food before, so I can't say how it affects her. She did go sky high on the Evo dry which was supposed to be low carb. The only kibble that didn't spike her was the young again zero, but she decided she didn't like that much. Fine by me! I love that she's willing to give up the kibble.

Oh well, glad to see the blue regardless of the reason! Looking forward to seeing what a typical cycle will look like for her.
 
PMPS 97, effectively the same number as +10. I can't afford to wait, she has to get her shot in 15 mins if we are going to make up for this mornings 2h wait. She is eating now. I will just plan to monitor her. We'll be up for another 2 hours, and I'll set some alarms.
 
Eeeeeek, 51 @+4. She's eating gravy food now. Will test in 10min. No hypo symptoms.

Now I don't feel like such a wimp for not shooting those two low AMPS!
 
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