? 4/14 time to shoot, new to Lantus, PMPS 165, help?

http://www.felinediabetes.com/FDMB/...nto-switch-pmps-390-2-248-5-136-6-149.213211/

Previous thread.

We are just starting her out. I think 4u sounds like a lot now and I'm worried.

 

Have you fed her yet? If you haven't, don't feed her and test again in 20 minutes

 

Nope. Waiting!

She's hungry though. :\ poor baby.

Just got a fresh pee again. She's having trouble, or not squatting properly, and starts to stand higher as she finishes.

Anyway.
Ketones?

 

I think you're OK on the ketones but the more water you can get into her, the better. Did they by any chance send you home with Sub-q fluids?

 

I had a leftover bag but it's not still good. I'll keep adding water with the food as I have been, and ask about getting some tomorrow. I've been giving her a sip by syringe here and there. I'll up it.

 

144

 

She's going down

 

@Chris & China (GA) thoughts? She's hungry and really cranky.

 

Her ears are very warm too. :\

 

OK....you're going to have to make a tough decision.

She hasn't earned a reduction yet so I'd probably shoot the 4U dose BUT you may have a long night ahead of you. I suspect at some point she'll bounce again higher, but there's no way to guarantee it.

Even if you shot a reduced dose, there's no guarantee she won't drop low on this cycle due to the depot being in play, but it may lesson the chances.

We don't want to skip due to her recent history with DKA....but you can feed her higher carb food to keep her BG up if you need to.

If she were my cat, I'd shoot the 4U dose and be prepared for a long night (but hope for the best!) making sure I had lots of high carb foods in the house.

 

I don't know what to do. now I'm 30 minutes off schedule too.

Thanks for responding!

 

What frequency of testing would be recommended at 4u at this point?

 

I'd go ahead and shoot and get a +1 and +2 to start

 

And do I need to test her one more time before shooting?

 

Yes for her "official" PMPS

On her spreadsheet, you'd put ### @ +12, ### @+12.3, ###@+12.5 all in the PMPS cell

 

How will I enter in the other two on SS? And can I go ahead and assume a little more gravy be friskies tonight then? I'll mix it with the 4% some.

Who is on here when it's night in the States? For later?

 

Edited that info above....you will have to color code it manually

I'll be on for several hours and will watch for others with experience to come on. Right off hand, I'm thinking @Wendy&Neko , @Marje and Gracie , @Bron and Sheba

 

Official PMPS 128 shot 4u

 

Fed a spoonful of 14%, then a 1/4 can (friskies) 4% with water. Is it safe to wait an hour now? Next check will be about 45 after the hour again....

 

Yes I think that's fine

 

Thank you for being here. I am terrified of tonight.

 

Can I feed as much as she wants right now?

 

She should have a fairly "normal" sized meal.....you don't want to fill her up TOO much in case you need her to eat later

 

"Normal" is tricky to determine. She is almost always so hungry. I have honey stocked and ready on her shelf too though. I'll be more liberal with the 14%.

 

Good for you shooting that blue. Lantus does a good job of keeping lower numbers flat. She shouldn’t dive like she does from higher numbers.

I will be on for a couple hours, but will be collapsing early. I was racing today and am beat. I should be up for that +2.

 

Thank you, that's a mild comfort without adding complacency. (There are waves of anxiety rolling off me.)

I guess I expected higher at PS because I am really used to seeing those numbers go back up.

Where's a good graphic again of how Lantus cycles work, and possibly comparison with NPH? I probably need to find something to study to keep me going for the night.


Alice is getting very mad about her ears. She never growls and she barely can right now and I don't like that she is hurting. I don't have the pain relief neosporin right now, just regular. I want to be able to spare those ears soon. My poor baby. Sigh.

 

Hi. I’ll try to check in on your next tests after Wendy has to leave.

 

Thank you!

 

Her current demeanor is nice. Grooming herself. Just had some petting and responsive purring. She is able to comfortably exert herself a bit more. And she's not hungry for the moment. (She would probably eat more if I put it in front of her though.)

 

There's no comparison between Novolin and Lantus, but this is what you're shooting for

+0 - PreShot number.
+1 - Usually higher than PreShot number because of the last shot wearing off. May see a food spike in this number.
+2 - Often similar to the PreShot number. Onset begins around +2 for most cats. You'll probably see an active cycle if the +2 is the same/similar OR lower than the preshot number. Continue testing!
+3 - Often lower than the PreShot number.
+4 - Lower.
+5 - Lower.
+6 - Nadir/Peak (the lowest number of cycle. NOTE: ECID. Not every cat has a mid-cycle nadir. Adjust the hours on this example to fit your cat.)
+7 - Surf (hang around the nadir number).
+8 - Slight rise.
+9 - Slight rise.
+10 - Rising.
+11 - Rising (one of the quirks of Lantus/Basaglar/Levemir: some cat's blood glucose numbers dip around +10 or +11... not to be confused with nadir).
+12 - PreShot number.

 

+1 is 140

Thoughts? Test at +2? (Sigh!)

 

Yes.....Sorry Alice but mama needs to keep you safe

 

I almost feel stupid asking this but then have to remind myself it doesn't matter.... Is she stable enough theoretically that I can stop checking on her every ten minutes or less? Turn off her light and let her nap for 30 min in between torture?

How fast can a drop happen with this? From the 100s...?

 

We all truly do understand...We've all been there. None of us likes to think we're doing anything to our babies that bothers them in any way, much less might be painful, but keeping them safe and with us as long as possible is the ultimate goal

 

If we tell you to re-test in X minutes, it's because we truly feel like it's OK to wait that long.

Most cats also will become crazy hungry if they're dropping too quickly or into lower numbers. I could always tell when China was dropping too low because of the way she acted....she demanded food, NOW

 

Oh I realized I read your comment wrong and then deleted mine. Then your next comment showed up. Sorry!
It finally occurred to me I can drink coffee at night right now. Working on getting focused.....

 

That's about how Alice was getting at PS.

Her bowels are noisy. I can hear them gurgling quite a bit. Is this particularly odd?

 

Well with China, it was demanding food at an unusual time, not the usual "pre-shot" feeding

Now this one I can't answer....if it's unusual for her, tuck it into the back of your mind in case it makes sense later (like she has a really running poop next time she goes)

 

Oh no foul foul foul bowel movement and poorer fecal score.

 

You called it in real time.

 

Oh there's more. Crap. I don't have an anti-diarrheal medicine if this gets worse.

 

have you got some plain pumpkin? It works for both diarrhea and constipation

 

Maybe. At what point and in what amount would one administer? Will she be more or less likely to enjoy it? (Read: how to give, and difficulty level.)

She just got a can of FF (2%) mixed with some water. Sometimes I think her tummy has some sensitivities I have never figured out. So maybe bringing a little more of that back in will help.

 

This is what happens when I take a break. One of them is seriously grooming the skin off my face and the other is making biscuits on me and his brother and purring. (Is off-topic briefly okay?)

 

About a teaspoon and some cats love it....others don't so can't give you a difficulty level

 

Absolutely....our kitties are more than just their numbers.

We love getting a WCR (Whole Cat Report)….are the 5 "P's" in place? Peeing, pooping, playing, purring and preening

 

I'm unsure here of the use of the word "prepared" ...... Hmm. Does it look nutritionally as it should?

 

Looks fine to me!!

One thing a lot of people do is put the pumpkin into an ice cube tray and freeze it so you have it when you need it (since she's not going to eat a whole can before it goes bad)

 

Oh good. I find paying attention to her levels of activity/exertion give me a lot of clues towards her care. And as previously mentioned somewhere or other, I have amassed a large collection of poop pics now.

Playing is a no though. She has not felt well enough to be playful at all. She was never a whole lot though. Oh but when she was a baby...! Her and her brother! <3 <3 <3

 

+2 dropped!!! down to 87 from 140.

Giving another spoon of the 14%
*eta well more than a spoon's worth

 

What else do you have available in the way of high carb food?

Any Fancy Feast Gravy Lovers?

Get another test at +2.5

 

No, just checked, but didn't know I'd need higher. What range is HC again please? I'll buy some tomorrow as soon as it's safe to leave for a bit.

 

I usually consider HC to be over 16%

I usually kept several cans of Fancy Feast Gravy Lovers beef in the house because it was the highest carb

 

Alright I'll look tomorrow.

Gave her 1/4 tsp pumpkin. She was pleased. Also more 14%, and a sliver of the 4% pate because it mixes into the soupy water thing well. Gah I hate testing her this much.

ETA I know dry is bad but I also recall reading somewhere something about it sort of possibly hanging around in the system longer. So I have Purina DM dry emergency kibbles too.

And her belly is WAY too full now. If she gets lower, a bit of honey on kibble?? :\ *nervous*

 

she did accept my invitation to sit next to me though. That's a positive sign.

 

Let's see where she's at first.....honey has it's place too

 

Testing in progress.....

 

I’m checking in. Waiting for results.

 

+2.5 is 81 !!!

 

Drop 6 points in 30 min after lots and lots of food, much of it 14%, scares the pee out of me this early.

 

That's really about the same number as the 87 so she's not really dropping.

If you have some 14%, give her another spoonful

 

No need to be scared, but we do understand how you feel...but you have me and Elise watching so we will do our best to help you out.

I know it seems scary, but 81 is a nice safe number

 

Already done.

Next test time?

 

I would feed a teaspoon of 14% and test again in 1/2 an hour. She might be leveling out. She’s in good numbers but I understand scary for you.

 

+3

 

Thank you. I just don't want a repeat of anything as terrifying as the last hospital rush. She's actually super alert. Curling her little paws in front of her. I can tell her level of alert is food related though. And her belly really shouldn't be stuffed more!!!

 

In theory so far what does this tell us about the 4u dose? Her rapid response has me confused!

 

Oh and I meant to show you this....this is what we consider the "sweet spot" on the ear....it looks like you're poking up along the top.

Might make her a little less sore if you change where you're poking a bit more

 

It's too early to know yet...….she hasn't earned a reduction in dose yet if you're doing Tight Regulation (that's the dosing method I used with my China)

You do need to decide which dosing method you want to use at some point though. You do test enough to do TR, but there's also Start Low, Go Slow

TR gives the best chance at remission because we don't hold a dose longer than 3 days if it's not getting them where we want them.

SLGS holds the dose for 7 days (unless they earn a reduction) which can leave them in higher than we'd like for several more days....but we've had cats go into remission on SLGS too

 

I want her stable first and foremost, and remission might not be a possibility if there is another underlying condition. I'm hopeful but not overly optimistic. I just want her to feel well again. As well as she can for her life to have a valuable enough quality for herself. Ideally I want this "fatty" (in comparison!) back:

 

Testing again now

 

With DKA in the picture, we need to not worry about SLGS. Once she’s more stable and at a good dose, then the method can be decided.

 

One consideration for dosing method is the recent DKA. You want to be able to get as much insulin into her as is safely possible, as you said, healthy first, then we think about next steps.

 

Steady +3 at 81, no change from +2.5

Next test time rec? Feeding rec?

Thank you again, everyone.

 

I’d feed a little 14% again and test in 45-60 minutes.

 

This is what we call "surfing"....staying pretty much stable....and she's surfing in a wonderful range too!

I agree with Elise....a little more food and test again in 45-60

 

Done.

(She doesn't usually eat from the can but it's almost all gone and it will keep her interest a little longer. It's been fed to her I think for about the past 24 hours ish minus a maybe 4 spoonfuls to the ginger boys and their begging. :b and other food of course.)

 

They often get really hungry when in green numbers which is a good thing when we need them to eat.

 

I will be BG testing again at 12:45 central US time. Got another pee to test now!

ETA: new ketone test, small-moderate??

 

But how much can her belly handle? Will she regain fat first and muscle later, after wasting?

 

Have you looked at China's Profile in my signature? She regained both as she became better controlled.

 

No but now I did. That video, omg chonky chonkers!

 

Yeah.....she went too far the other way...she was "too fluffy"

 

I guess every cat is different. Max never lost muscle but got way to fat as a diabetic. I couldn’t get him to move much.

 

omg this photo is killin me... glad she's eating

 

As my bottle baby, that paw hold brought me back. I used to wrap her in a towel and hold her near my face, she would brace one baby paw against my thumb and another on my cheek as part of my hands were holding her and the bottle. But she wanted to grab/biscuit. Baby kitty biscuits omg love <3

 

Alice was always petite and long. Most people think she is a year old even when healthy when she's over a decade. Her brother was the same build. Her wasting was a huge alarm towards her DX.

 

Hey Cassandra.....It's getting late for me since I have to be up early in the morning. Elise is experienced and I know she'll help you if you need it.

I've also asked @Bron and Sheba to keep an eye on you. She's in Australia so it's earlier in the day for her.

If I didn't know there were others I trust completely to watch for you, I'd stay online (and I'll probably still be here for your next test)

We agree not to leave anybody that shoots a lower number until they're comfortable unless we can find someone else with experience to take over

 

Alice says "Thank you!!!"


Next test will post in 15 minutes.

 

I’ll check back then.

 

+4 is 72

9 point drop in an hour at this level...

Feed and test recs?

 

Still surfing pretty!!

I'd give her another teaspoon of food and test again in an hour

 

Hi Cassandra I am online now and can be around for you. You are doing really well. Chris has been great as usual and lovely to seeElise as well!. And I think Alice is adorable. I agree with Chris, if you move down the ear a bit you should get just as much blood. When I was having to test a lot, I used both sides of both ears.

 

@Bron and Sheba thanks! tests on the +hour should be posted every 45 minute past the hour due to test/wait20/test/wait20/test/shoot earlier.... I am terrified of hypo. Soooo scared. Have not had a nap beyond maybe two hours max in days now. Thanks for being here.

 

Hi Bron. I’m going to head to bed now that you are here. Alice is surfing nicely. She’s just where you want her Casandra. As long as she’s eating you can steer her with food. Max never had a symptomatic hypo and even dropped under 50 plenty of times. I did print the yellow sticky on handling low numbers until I got used to the routine just in case nobody was around. It is scaryI know.

 

Thanks for hanging around. I appreciate it. Sleep well!!!

She is eating, but that belly is SO full. She has easily had another two oz or so of the gravy 14% since I opened a new can earlier..... I'm probably letting her eat a little too much. I don't know. Better a little high than too low.

 

You're doing great, and Alice is doing great and you have great people standing by... I'm no expert but you have all the tools you need to prevent hypo, an awesome support system, test strips, gravy food, and honey! lol ... even when my guy went down to 53 on his second day and I panicked, all it took was a little honey to quickly get him moving back up into a safer place giving him enough time for the gravy food to kick in.

I know how scary it is, but you're able to test frequently enough and you have enough tools on hand that you can handle it if she starts to go lower.

Take a deep breath , hang in there, you got this!

 

Thank you. Your anecdote is comforting to hear.

 

+5 is 102. She's up which comforts me. I am going to decrease snacks slightly and test again at +6 and +7. If she is back on the rise, I may spread things out more. Will need dose advice AM though!!!