? **** Advice needed ASAP: Salem 1st shot post DKA ****

Hi All, this is Sandi (@Sandi & Whisper) and I am sitting here with Tina ( @Tina and Salem ). We are going to work on her signature and the spreadsheet momentarily so please excuse that for right now.

Salem is home from the hospital. He received 2 units of Lantus 11.5 hours ago at the hospital (BG was in "the 400's" but no exact number known) and is due for his shot in a half hour. However, he was tested at home 3.5 hours ago at AMPS+8 and it was 196. We tested him just now at +11.5 and he is 177. This morning's shot was only his 2nd dose of Lantus so the depot isn't even full yet.

We've already dispelled all of the usual bad information that the vet told her (which was to roll the insulin, it takes 7 days to go into effect, only feed twice a day, only give insulin if he's eaten his food...told her to forget all that). But now we are almost at shot time and his BG has gone down in the past 3-ish hours from 196 to 177. I know we shouldn't skip, but I am also very hesitant to recommend 2 units.

Thoughts? Both for this shot and in general? Do we drop back to 1 tonight and then see how it goes? Tina is already a pro at testing so that is not a concern, and I have a hypo kit ready for her, but we don't want to go straight into the deep end. Do you think 1.0 is still too much?

To recap:
AMPS (7am Eastern): 400's?
AMPS +8.5 : 196
AMPS +11.5 : 177

Insulin due in about 20 minutes. Please advise!!! Thanks! -Sandi

 

Wish I had answers for you. If your not comfortable with the 2 units, 1 is better than nothing and he does need insulin. Make sure your monitoring.

 

I really don’t think that I am comfortable with two units. I am thinking one, only because she is really good at testing otherwise I think I would probably suggest a half of the unit instead. We’re going to stall here for just a minute or two and retest and then decide what to do. Thanks much!

 

Would have been nice if the vet clinic had tested again sometime post shot and before discharge. I wonder if BG was elevated just due to the environment and Salem has now relaxed being home. I definitely agree 2u is too much tonight. I think 1u would be a good compromise. Is his appetite good should numbers start dropping?

 

He just went up to 214 and we are 30 min late, so we are going to do 1.0 Thanks! -Sandi

 

@Sandi & Whisper -- I probably would have calculated out what the weight based initial dose would have been (0.25 x ideal weight in kilograms). (Sorry -- I just got home.)

Please make sure Salem eats. You want to get at least 1.5 times more than the usual amount of calories into your kitty. Also, if Salem like his food soupy, all the better. Adding water or low sodium chicken broth to food is good -- fluids help to dilute any possible ketones.

It will be easier to get a ketone meter unless you are really good at stalking you kitty to the litter box.Until you get a blood ketone meter, please make sure you have Ketostix to test Salem's urine.

Also, I always ask my vet for a copy of my cats lab tests. Since Salem was in the hospital, you can ask for those records to see what his BG readings were.

 

Tina, I just finished reading this whole post and was so scared of the outcome as I was getting to the end.
I can’t tell you how happy I am for you that Salem is back home with you and in your care. Wishing you tons of luck and healing vines for Salem.

@Sandi & Whisper How wonderful you are to have jumped in to help Tina like you did. You are truly an Angel.

 

Thanks Sienne, I just now got home from Tina's. I should have thought of that calculation, but it's been 4 years since I had to worry about figuring out a "starting dose" with Whispy. We were already a half hour late by that time so we didn't want to wait too long. We conservatively went with 1 unit.

Salem's spreadsheet and signature are now up to date. PMPS was 214, and +2 was 229. Tina is going to stay up for a +4 tonight as well which is in about 45 minutes. He ate well, and he tolerated our poking and prodding like a champ. In the morning they are going to pick up 26 or 28 gauge lancets because they currently have 30gauge, and he has a cyproheptadine Rx that I want her to pick up so that they have an appetite stimulant on hand if needed. I did also give her a rice sock, and that helped at PMPS tonight.

Tina knows to stay on top of keeping him well hydrated and fed (low carb if possible, higher carb if not and it becomes necessary), and I got her a vial of Ketone urine test strips today (and gave her the tricks for getting urine). A blood ketone meter might be necessary if she is unsuccessful getting urine with any regularity, and there are 2 other cats in the house so she doesn't want to have to upset Salem by isolating him most of the time to get urine either. She will see how it goes, but she'll try really hard to get urine once a day, and she knows to compare the strip color EXACTLY 15 seconds after dipping it in urine.

Her shoot time will be 7:15am eastern time tomorrow -- for reference it is 10:45pm here now -- so about 8.5 hours from now, and she is going to text me at about 7am. I recommended sticking with 1.0 units in the morning, ASSUMING he doesn't go low tonight, until we see how tomorrow's readings go and how he eats his breakfast around 5am. And then Tina is going to test tomorrow at least at AMPS+3, +6 and +10.

We'd been going through things for about 3.5 hours tonight, so I didn't get to spend as much time going through creating a daily condo, linking the previous, and editing the title as I wanted to. So in the morning I am going to open the first condo for her, and take care of updating it through the day when she texts me. Then I'll see if I can get her through it remotely for the following day, and if not then I'll make another trip up to her this weekend to go through it, and I'll just help her manage it until then.

 

Yes Sandi is aGod sent ! Im lucky to have her help me this insulin is scarey to me i dnt want to send salem back to the hospital ! Im really Blessed to have all of you and your support ! To all of you i havent been able to check on your babies im sorry i been so busy with worrying abt Salem i wish all of you many blessings and good luck and good health ! This is a good place to get help ! Many thanks to all of you ! Sandis a sweet heart i really enjoyed meeting her tonight !

 

thanks !!!! Sandi really helped me alot !!! I really appreciate it ! Thanks to all of you

 

PMPS+4 was 267.

@Sienne and Gabby (GA), following up. I would say that he is actually at a good weight now at about 16 pounds (he lost some pounds during his initial diabetes diagnosis and DKA). He's a tall kitty. That would have put his starting dose at 1.81 units by that formula. So 2 units might have been alright tonight, but it was that drop, while not significant with 20% variance, between +8 and +11 that concerned me. Plus I wanted to be sure that Tina felt confident after going through everything, and she did great.

We will post and ask for help after his AMPS+10 tomorrow in advance of his evening shot to see what folks think about the dosage. I know that the depot still won't be full, but we'll see what you all think.

Good night/morning all!

 

And she gave me supplies to help me get started ! Including insulin !!!