? 4/8/17 Sprocket, AMPS 334, 3u.+2.5/283, +5.5/192, PMPS/318. Furshot. +2/489

http://www.felinediabetes.com/FDMB/...1-4-123-5-165-day1bounce.175969/#post-1935307

Previous days plus has link to day before too.

Today he is 334. Gave 3 units. Ate 2.5 oz so far. He ate alot last night.
Will test at 930am est.

I am a mess. So stressed out. Anxiety.
He is tired with sore ears.

 

So, next test at +2.5? Sounds like a good plan.

Is there a reason for the reduction to 3.0U?

Hope today is a quiet one so his ears can heal and you can both relax a bit. Do something nice for yourself-- dunno where you are, but where I am they are predicting lovely weather after SNOW yesterday, so I am hoping to get outside for a little bit. A little sunshine can do wonders, especially at the end of winter!

 

I'm sorry you're feeling anxiety. I know it's stressful and frustrating. The blues last night were from the depot of the 3.5 unit dose still in there and slowly changing to the 3.25 dose. I would not have reduced his dose again this morning, because of the recent ketones. You do not want him to go back into DKA. He needs as much insulin as he can handle right now. I hope you feel better soon and get some rest today.

 

Ok i understand what u said but i didnt know he would go low twice in 2 days. He went down 1st time from 320 to 45 in 3.5 hours.
Last night he went from 271 down to 101 with gravy 14 carb food after eating a good 4 oz or so already in 3 hrs.
That's alot of points (not sure what its called) to go down.
Its hard too. Vet said to go to 3 units right away. I didn't. I followed chris advice.
I have to be careful too cause vet won't help if i dont do anything she says at all.
Although with those large decreases i see 3 units ok as to what i have learned. Also from the hypo instructions on board. So still not understanding about why not going down to 3 units.

Hope that makes sense. So tired

 

Hi Darnell--

Gonna re-up my recommendation to get some rest today-- you must be exhausted!

As for the dose question: there are a couple things going on here. One is that we have two established protocols for systematic dose changes (Tight Regulation and Start Low, Go Slow), and under neither would Sprocket have "earned" a reduction. Although he went into blues last night, that's not actually too low-- really, it's just where we want him to be right now while recovering from DKA!

Second is the DKA itself. One of the things that is critically important when recovering from DKA is to make sure there is a sufficient amount of insulin to counteract developing ketones. There's more to insulin than just reacting to blood glucose. For this reason, with a DKA kitty, any relaxation of the usual rules of TR and SLGS will go in the other direction, keeping a dose high or increasing. At this point in time, the ketones are the main worry, not low BG.

Chris made a more aggressive recommendation on dose to start than your vet did because you are getting help here, and we know how to keep a kitty safe if they start to go low. Yes, hypos are always a worry, but if you are monitoring and steering with food/carbs, the risk is very manageable. We have more tools to keep you in control of that situation than we do with developing ketones, which almost inevitably mean another trip to the ER. After multiple DKAs in a short period of time, it's clear that Sprocket is very ketone-prone and needs a little extra oomph to get over the initial recovery period and prevent the ketones from recurring.

Totally understand wanting to stay in good graces with your vet, but please consider these other factors, too. Let's see how he does on the 3.0U today. And, again-- try to do something nice for yourself today! You're doing a great job monitoring and caring for Sprocket, give yourself a little reward (hey, why should the cats get all the treats in the FD dance???)!

 

Adding a small clarification: when he went into the 40's the day before yesterday, then he definitely earned the reduction from 3.5 to 3.25, it's just the 3.25 from 3.0 where he didn't go low enough to qualify.

 

Actually on TR as a long term diabetic, you would have held, though I know that Darnell has a preference for SLGS, but with being long term and a with Sproket having a recent history of DKA, if it were me I would probably err more to a TR type approach and would have stuck with 3.5u, though I do understand why Darnell wanted to take the reduction.

Darnell, I have been watching Sprocket over the last few days, and I can see how that nose dive he took the other day was very scary, I see you noted it as a hypo in your ss, was he exhibiting symptoms of a hypo when he was at 48? Usually when we refer to a hypo what we mean is a symptomatic hypo. At 48 he was only just below the reduction number for a human meter (50) and he came up pretty quick which was great, you acted promptly gave him carbs and handled the situation like a pro.

I have to say I agree with Dyanna and others with keeping him on 3.25u, he really wasn't that low the other day, he responded well to the carbs and his numbers came up (as I said above I might have even held the 3.5u though I understand why you wanted to reduce), and with recent ketones the more worrying issue is them developing again, and one of the ingredients for that is not enough insulin, the others being not enough food, and things like infection and stress can be factors as well, so with his health issues at the moment, he already has some of the contributing factors to ketones developing again, by the way, good job on checking those daily, it remains an important to monitor those.

If numbers demand it, instead of feed LC, you can feed MC/HC to bolster his numbers so that you can get enough insulin into to him to keep those ketones at bay.

Seeing as he took that nose dive by +3.5 the other day, I would probably suggest always getting a +2 for him, the +2 can be a good indicator of how a cycle is going to pan out, it also allows you to intervene early in the cycle should you see he is heading for low numbers at some speed. I found that very helpful with George, if he dropped significantly by +2 I would steer with food (HC, LC or MC, depending on numbers) it allowed me to stay ahead of the insulin cycle and in turn keep the BG's under better control.

 

At 9:35am est. +2.5/283.
He ate 2.5oz this morning then after test ate about 1.5oz more. Appetite stim kicking in too.
I am exhausted. He is too. I had to wake him to test.
He peed & i used 2 urine sticks and both were negative.

How long is usually recovery period from ketones. ?

Is there a guideline already ready to print as to what to feed when we start to get low?
To balance if at beginning of insulin working?
I am trying to listen but this is so stressing. I have never had anothers life in my hands. I have trouble taking care of myself. I have never had nerves like this. I can't get sick either cause I need to take care of him. I barely know what day we are on. March was a blur.

I really do appreciate all help even though some of you probably want to smack me. I am sorry.

 

Darnell,
Believe me none of us want to smack you, we have all been through this to a greater or lesser degree so we understand where you are coming from, we are here for emotional support as well us giving you the benefit of our combined experience.

There's a sticky on handling low numbers here
And here is another thread about managing the curve with food.

How much food a kitty needs for you to steer them is a matter of trial and error, eg I learned the hard way, that if George dropped hard and fast at +1/+2 then I needed to step in early with the carbs, if he dropped from high yellow at amps (eg 280) to blue (eg 130) at +1, even though 130 was still very safe, the speed of drop, would have me bring the MC out, as I still had some margin for error, but I would probably test him again at +1.5.

On the other hand if he dropped from 23o at amps to 80@+1, again 80 is still safe, but less of a margin, I would probably give him a couple of teaspoons of HC gravy and check in 30min

So in both those examples he dropped by the same number of points, but my approach to food would have been a little bit different. If in doubt and you are concerned, and are not getting a response you can always err on the side of caution and go for the HC, the worst that can happen is that his numbers will be a little high for a couple of hours.

 

Wow. Alot of info. Think I have to print more of this stuff out today to read it more clearly.
Thanks. I need emotional support. I am disaster with anxiety, emotional overload, and so tired.
Just tested at +5.5/192. Tried to do fluids 15mins later but didn't get far. Have to try again in few hours.
He is so tired too. He ate low carb all morning.

I understand what someone said above about 3.25 n maybe feeding some MC to keep level. ( I guess someone else saying it a bit differently helps) But I did 3 units this morning. So now do I just stick to that n low carb food n keep testing. He is definitely eating more now that before he got 3rd ketone visit plus he was in 300s steady with peaks in low 400s at 2.5 units.
So maybe he will be good on 3 units?
As long as low carb?

 

Think it's too early to judge the 3.0 units. Remember that with lantus, there's a lag after you change a dose and when you see the effect because of the depot. That's why Dyana said that the blues last night were from the 3.5U dose, when the last 3.5U was 24hrs previous-- there was still some of the depot hanging around. Similarly, anything you see today might still be reflecting the 3.25U doses of yesterday, not the 3.0U dose today.

This is one reason we try to keep at least a couple days between dose changes, except in special circumstances-- otherwise, it's really hard to figure out what a particular dose is doing, and it gets very confusing.

It's really good that he's eating well! It's not surprising at all that he's acting tired-- many caregivers have reported that it takes a couple weeks before a cat regains its energy after a DKA. It's very hard on their little bodies. But the fact that he's eating well shows that he's feeling pretty good other than being tired, which is great!

 

Heck no girl, we want to hug you!!! What you're feeling is totally understandable. As you know managing the diabetes is challenging enough, but with the DKA stuff things can be more complicated. That's why everyone is weighing in and trying to help as much as possible. On the board here I've noticed there can be some differences of opinion at times, but what I like about that is people always state the reasoning behind their thinking. I'm sure at times this may seem confusing but I know in the end I've learned so much from it.
I too hope you can take some time away (mentally and physically) to recharge. It's very easy to get overwhelmed and depleted. We've all been there and know how you feel.

 

Nice to see him back in blue numbers
and good to hear that he is eating well that is so important.
See where he is by pmps and take it from there depending on how you are feeling.
You could call this morning a BCS (Big Chicken Shot) and just take him up to 3.25 and see how he does with that, the numbers you are seeing this cycle are probably not reflective of the 3u, but more a result of depot readjusting from the last two dose changes in less than 4 cycles. When we take a reduction it takes a while for the depot to catch up, usually if we are within 4 cycles of the last reduction the depot of the larger dose can still be influencing the cycle. The larger the dose the longer the depot will influence the cycle.

What most of us are concerned about, and in particular because of the DKA, is that once the depot settles, you'll start to see numbers trending quickly up, and the repercussions that can have in a kitty that is DKA prone can be very worrying. At the moment it's really very important that he get enough insulin, and we are just worried that reducing the dose too quickly may have a negative effect and set him back.

I won't be around for your pmps, it will be past my bed time (I'm in Europe/Spain), but I'm sure others will be around to help you with the decision should you need it.

 

Wow! Thank you everyone!
Alot of info. I know not everyone is around when I do his PMPS and I have a short window of time to decide on dosage or what to feed that might work best. Can we all discuss what would be better to do now that I did do the 3 units this morning.?

I have used 4 urine sticks to check ketone n all negative today.
Its hard to have to watch so carefully every day. What do I do if I have an appt? I do have some this week & one on Monday late morning I have waited for 2 months. I can't imagine if I was working right now which i am not, what would I do?
When do I know he is out of woods for ketones?
When do i stop those extra sub q fluids?

Dosage and food?
What if bg is in 300s?
Or 200s?

And if he goes lower 100s at +2.5 then what food first? HC or MC since not sure how much he will eat? Or do some dry EVO? I also have zero carb but he would need the carbs then.

A plan might help my nerves to stay together.
Thank you very much.

 

How long till PMPS?

 

My anxiety shoots threw the roof in the evenings, especially when I am super tired.

You know what to do. I know what to do but it still doesn't help when you are in the middle of it. I find if I am well prepared with supplies and food at the ready and very organized it helps. At least the stress of trying get to find extra strips or another can of food doesn't add to the already stressful situation.

 

OK, lots of questions! I'll try to pick off a few that I'm comfortable answering, hopefully others will step in with more.

-- 4 ketone tests today is super-diligent, but I don't think you need to be stalking him on every litterbox trip. Not unless he starts acting "off"-- no appetite, extra-lethargic-- or there's some other reason to suspect something might be brewing. Once a day should be fine for now.

-- We don't make dose decisions based on pre-shot, so in a sense it doesn't matter whether he's in the 200's or 300's. What we care about is how low a particular dose is likely to take him, and as discussed above, we try to hold each dose for at least a few days (pending special circumstances) to let the depot stabilize and so that we know what the dose can do. I lean towards going back up to 3.25 tonight, but wait for the experts to weigh in on that, there might be some discussion.

-- It's definitely hard to manage FD and set appointments or a work schedule, but it can be done! For a one-time appointment, you just have to be prepared and monitor enough beforehand that you can get any necessary food-steering in place early and have a sense of how well it is working. If all else fails, you can always just carb him up before you go, though that's a last resort.

-- If he does a fast drop like he did last night, where he was in very safe numbers but possibly moving downwards, let's say for now that the plan is to do MC. You have some data from last night that, when you did that, it slowed him right down and leveled him off, so that's already a point in favor of that plan. As Gill said above, you kind of have to do some experimenting with the food-- maybe next time he does that kind of drop, if it's a day where you know you'll be able to monitor and there are lots of people around on the forum (i.e., not middle-of-Friday-night!), you can try low-carb food instead and see how that works. I don't think you would ever want to bring out the high carb at that point, except maybe in a case where you knew you had to leave the house for several hours or absolutely could not stay awake to test, and wanted to abort the cycle by feeding HC. Again, that would be the last resort-- pretty rare.

Keep asking questions! We are here to help!

 

610pm i get bg then give pills then food then shoot by 7pm. Right now 430pm here

 

Ok. Lots going on here but I will really try and be here. I am central time (3:30p here now). Gizmo's PMPS/shot is in an hour my time.

 

Gill,
Sprocket was very hungry that morning he went real low. He was seeking plastic to chew on. I fed him but he wanted more so I gave more food.
When I got up 3 hours later, he had vomited a little food & clear liquid, plus had soupy poopy where night before it was soft but formed. I had also gone to bed early (about1230am) so I left food but I think he ate more earlier and nothing left for later to keep his tummy full enough to keep bg level.
So that is mild symptoms but started. I don't know what time he pooped n vomited.

 

Hello,

I am new myself on the LL Forum and cannot give you dosage/feeding advise but I can share small helpful things which I wish I knew earlier in the process. I am assuming that you will need advice/consultation with the LL Forum members often in the beginning as I have (and still do!). So the first thing is to make it easier for the experts to help you:

a) update your Signature with facts such as your location, your shot time, which protocol do you follow, type of food used, current diagnose, make sure that you stated clearly Sprocket had DKA. It is best that the person who helps you can read it all in a glimpse. The space in the Signature line is limited; you MUST have working link to your SS so do make your priorities as to what is immediately available for the helper;

b) DO stock up on testing strips, lancets, MC/HC gravy containing cans. When I look at the huge pile of FF 15%-17% gravy containing cans and tell myself that those ARE my weapons against Severe Symptomatic Hypo (which my cat is a survivor of) my easy to panic mind relaxes. I printed out “Tests whenever + Gravy = I AM IN CONTROL” and look at it often. It’s silly but works like magic on me. I do panic. I haven’t slept properly in 6 weeks.

c) I feel better knowing that in addition to regular stock of supplies I have extra meter with new battery in, extra box of lancets and strips stashed in another cupboard. I keep $50 cash there too. Very calming effect on unemployed/cash limited mind.

d) update SS as often as you can. If you gave SQ fluids mention it in the remarks section of the SS including timing. SQ therapy is very helpful but too much of good thing can turn bad. Do seek advice on the Forum and/or talk to your vet if he/she makes sense (mine suffers from the Needle Stuck Syndrome and keeps saying “bring her in” or “she needs to be hospitalized” although he knows well that I cannot afford either and do not have car during the day; tiresome).

e) open a new thread every day and edit the Title topic with your concerns as they change thru the day. Again, it will help the helpers. Many don’t have time to read the entire post (a condo in the local language).

Again, these are the small things but should I known them earlier I would avoid many weeks of living in paralyzing terror which I experienced since the day of Ducia’s Dx. And as to emotional support: I am in your shoes. FWIW, both of us are dealing with the ketones threat, both are uncertain about dosages and what to do if the preshot number is totally unexpected. I wish I can make you feel that your burden of fear and anxiety is twice as lighter because we share it now.

Blessings and the best of luck to you and Sprocket!

 

312 pmps
72 points higher than last night's pmps.
Plus he is acting very hungry!! He last ate ate 3:45pm. And has had 8.25oz already today of low carb wet.
Had about 70ml fluids at 4pm.
Worried about how hungry he is.
He ate 2oz n eating more
What do I shoot?

 

Is you SS current? With all the tests today?

 

Bg tests yes

 

This Bg number is not in your SS.
Any chance you can update the SS with all the test results for today that you have?

 

Just updated

 

You hold the syringe and only you know how tired you are. I would hold the dose @ 3U but only if you have enough food and strips and if you can test (energy).

@Tanya and Ducia ??

Again, I will be here for a whole but off/on.

 

Darnell,
do you think you can stay up and test?

 

Not all night.
I am usually up till 11 or 12. 4-5hrs from now

 

Can you get another test right before you shoot?

 

He just ate. I gotta shoot within 10 mins

 

When you do please update the SS - the units you shot column and the food he ha eaten in the remark section.
I hope someone with knowledge will check in later on. I will keep checking in with you and posting to bump your post up on the Forum.

 

So how about dose?

 

That should be plenty. I would recommend going back to the 3.25U, but whatever you shoot, make sure to get at least a +2 so that you know where he is heading and have some time to steer with food if necessary.

I might be around for that +2, but probably won't be around after that, so hopefully there will be others online tonight (some West Coasters should be around).

 

I cannot advise on dose. As I mentioned before I am too new.

 

To explain my reasoning for going back up to 3.25: he didn't really earn the reduction, he's shown himself to be responsive to food steering so you have control, and we want to be super-vigilant about ketones given his history.

 

I would go back to the 3.25 units and give it a few days.

 

****! I missed!!!
I felt the fluid n smelt on my hand.
Last 2 times i did a fur shot he ended up with ketones next day.
Crap!!!!
What do I do??

 

Dag Nabbit! Don't worry fur shots happen. Do not give another shot as you do not know how much went in. Hopefully, most of it.

 

Just assume that most of it went in, and test as usual. I would start with a +2 or +3. I would write 3.25 (if that's what you intended) and FS? in the units column.

 

I'm giving you some hugs.

 

Aw, man! Fur shots are so frustrating!!!

As Dyana says, though, just proceed as if all/most of the shot went in. A good bit of it probably did, and in any case, he does have the depot to help him out.

 

How are you doing, Darnell?

 

I am quite upset with myself.
I will test in hour n then 2 hrs after that. Feeding 1 in carb ff.
Pray he doesn't develop ketones over night.
He will probably be getting a shave or trim so I can see his skin better.

 

Every single one of us has done furshot, believe me.

I don't know what was happening during the periods that he developed ketones, but I do know this: he's doing really well right now, he's eating well, he's spent a lot more time in yellow, blue, and green than in pink, red, and black this last week, he's been getting fluids to keep him hydrated. He's been negative on ketones, so it's not like he's sort of teetering on the edge of a problem. He's got the depot in his favor, and it's only 12 hrs before the next shot. And some of the insulin probably got in anyway.

Is it upsetting/disappointing that he got a furshot tonight? Of course! But I have a good feeling about how he's doing, and I think he'll be able to handle this little bump in the road. You'll get right back on track tomorrow.

That's a great idea to shave a patch of fur (if he'll let you! hee!), it would make it so much easier. I recall when I first had a cat diagnosed with FD and I was frantically searching for youtube videos on testing and shot-giving, some of the best were from someone who had a hairless cat. Well, sure, I thought, that would be easy!!!!

Do get that +2, and don't beat yourself up over this. Maybe it will give you an opportunity to get some rest tonight, which would be a great thing.

 

Thank you for your kind words.
+2/ 489.
He was 318 at pmps.
He probably got no insulin at all.
He will end up in 600s by am.
Anything I can do?

 

Unfortunately no

Just get one more test later in the cycle sometime and plan on getting some rest!! Relax and recharge your own batteries tonight....take a walk or something....go out for an ice cream cone!

Check for ketones tomorrow and try not to worry

 

Don't think twice about the furshot. It happens to everyone. Just because having a furshot before resulted in ketones does not mean that it will this time.

The one thing I could suggest is that if you happen to be up extra early in the morning, AND Sprocket is over 300 - I think any time after +10 you could shoot.

With these conditions:
If you're going to church or going to be gone more than a couple of hours in the morning, then it's probably not a good time to shoot early.
If you're gone a couple of hours or less, or you're flexible depending on his numbers, then I think shooting early could be an option.

I agree with your decision to go back to 3.25u.

Sending you a big hug. I feel your stress and know you're trying really hard for Sprocket. Try to be kind to yourself and take care of yourself as well. We have a saying here "this is a marathon, not a sprint." Sprocket didn't become diabetic instantly and it will take time to get him regulated as well. The beginning is so hard for everyone, but people end up doing this for years and it becomes as routine as brushing your teeth. It will for you, too, when you know more and are able to predict what will happen even just a little bit. Hang in there!

 

Thanks Julie. I hope so.
Just tested at +4.45/398
Better than earlier.
Gonna get some sleep. Thanks everyone!!