? Advice needed on dosage while out of town, please

Advice needed on what dose of lantus to ask the vet tech to give Angel while we're out of town from 25th evening to Jan 4 (10 days). Apologies for long post.

As you'll see in Angel's SS, he was doing very well on .5 to 1 unit of lantus for a long time and eating only LC wet food, but then a month or two ago his IBD began playing up and he once again began losing weight, getting bloody stools and diarrhea, refusing to eat anything but a little dry food etc. The vet put him on the steroid budenoside (which is better for diabetic cats), but he did not do well on it (4 weeks) and continued losing weight, bloody stools etc, so we switched him to prednisolone 10 days ago + metronidazole (flagyl) + vit B shots (+ probiotics for past 3 days), which worked magic and his diarrhea disappeared almost immediately. He's been doing really well since then: eating well, has put on weight, is happy and playful etc, with the single issue that he is being very picky and refuses all wet food and will eat only dry. For now, I'm not pushing the wet food as he really, really needs to put on weight. I will begin to work on getting him back to wet food once I return from our trip and he's at least 8.5-9 lb.

As you'll see in the SS, the combination of prednisolone and dry food is causing his BG levels to go crazily high, in the 300s mostly. I know I have not been following the protocol of waiting 3 waits before increases strictly etc, because I'm a bit short on time with our leaving on the 25th; please, am only looking for advice here, not being told what I did wrong, lol. I wondered if something was wrong with the insulin, so got a new one yesterday and used it at the PM, but the results were still in the 300s when I did a curve at night.

We will be having a vet tech coming twice a day to give him the pred (1/2 tab every alternate day) and insulin. Since he is only eating dry food, it's going to have to be mainly dry food left out. My question is: please, what dose of insulin do you think she should give him while we're gone? She cannot come in more often to do curves; as of now, I was not going to ask her to test him. We have 3 elderly cats and its been very expensive with all their vet stuff, so it's already expensive having her come twice a day without testing.

I'm guessing 3 or 3.5 units of insulin to be safe? Should I be going higher?

[Note: I mostly use the human meter, but occasionally the Alphatrak if the drop of blood is smaller. In the SS it says "AT" when I used Alphatrak.]

Thank you all so very much. Here's wishing all your sugar babies and you the most beautiful holiday season, Merry Christmas, and a lovely new year!

 

I can't really advise you on the dose, but do you have anybody handy who could at least come and do a test every few days?

 

Do you mean a pre-shot test? I could ask the vet tech to do a pre-shot test every second day, if it would be useful...wasn't sure if it would be useful? Thank you for responding.

 

Bearing in mind I'm a newbie, I'd say that at least with a pre-shot test there would be a heads-up if his numbers drop dramatically. Also sounds like it could be wise to "hold the dose" before you leave so that you know you're leaving him in a reasonably stable state and won't have too many nasty surprises. You've come up from 2.5 two days ago really fast, which means you don't exactly know what a 3 or 3.25 dose is going to do to his numbers once the depot is complete. And particularly as before his illness he was on a MUCH lower dose, there is the risk that as he finishes healing he goes back to needing that lower dose. Does that make sense?

 

As I explained above, I needed to make that jump because of the circumstances. I was aware that I was not able to follow the protocol, and did hold the 2.5 for a long time so his body could get used to it.

 

Hi Shefali!!

Glad to see you back. Ok....I won’t say anything about that fast increase since you asked us not to

If he’s eating dry food, you shouldn’t be following TR anyway. I urge you to go to SLGS until you get him back on all wet food. A requisite of TR is that the kitty be fed all canned or balanced raw food and no dry.

If your vet tech is not testing eek, he’s seen blue on 3u, I’d drop his dose back a pretty good bit since he’s never had DKA. For the first few years, Sienne used to drop Gabby’s dose back by half if the petsitter wasn’t testing. Then she started dropping it back by 0.25u. Better he be high than for him to decide to churn out some lower numbers. Perhaps drop him back to 2.75u if she isn’t testing.

 

Marje, thanks so so so much...and sorry about the fast increase . Just trying to balance too many things at once at this moment, whew. It sounds like I should ask her if she could test every day, or at least every other day. Let me see. If the preshot numbers remain in the 300s could he remain at 3u; and if they're below 300 go to2.75?

The good news is you've never seen a happier kitty .

 

I’m so glad he’s feeling better!!!

If she can’t test before every PS, I’d drop the dose back to 2.75u as you can already see that at 3u, he was able to get into blue. You’ve increased the dose to 3.25u and when you do reduce, there will be some subsequent depot action for a few cycles.

The one time we left Gracie with a dear friend who was also an FDMB member just for two days, I dropped her dose back a bit (about 0.1u) as we were only one hour away, she had just been getting into mid blues, we could easily talk to him and he was experienced (he was testing her as we would...in fact, he’d test, text us, and we’d tell him what to feed her). The Lil Stinka’ (Gracie, not our friend), decided one night to drop to 70 out of the clear blue. Thankfully, it was the night before we were coming home so I had him give her some carbs. But I did not expect her to drop into green on a decreased dose.

 

Will do! Thank you. Whew. Good to have a clear number. Wish you and that adorable would-be creche-crasher a very Merry Christmas!

 

Thanks, sweetie!!! I’ll be around this weekend and since you don’t leave until the 25th, if you want to tag me tomorrow evening, we can see where he is and chat again.

Last night before we had a dinner party, I had put the table cloth on the table but not set it yet. There are some Christmas bangles hanging from the chandelier. I walked into the dining room and Livia aka the creche crasher was on the table in her very best “prairie dog” position, swatting the bangles

She’s a busy girl.

Merry Christmas!

 

OMG thank you, Marje. You seriously rock LOL "But of course, Mommy, you put those bangles there just for me, didn't you??" We are so lucky to have these rascals in our lives

 

Yes, we are.....that is so very true.

 

Yes, no worries, I understood that. I was pointing it out not as criticism but as something to take into account in interpreting the numbers you're seeing and guesstimating what to do next.

 

Thank you, Stephanie. Understood and appreciate it.

 

MarjeAngel just read AM 185 (was 178 at +4 and 170 at +6 last night); am giving him 1.5 u this morning.

He finished his 10 day course of metronidazole last morning; I wonder if that's what was keeping his bg so high. Just looked it up and at least one site says it can raise bgs in cats.

EDITED: no worries . Gave him 1.5 u to be safe.

 

Are you home today? I’m just worried that with all this dose hopping, you aren’t going to be able to tell what a good dose is for him while you are gone.

I would have suggested you shoot the full dose (3u) this morning. I don’t know if metronidazole will make them high; I haven’t seen it happen but ECID.

 

Wow, really, the full 3u, huh? Sorry . I thought that would be dangerous. I am home all day today, and will do a curve. I know, I'm worried too about what will be a good dose while I'm gone. I don't mean to take up your time, Marge, on Christmas, and very much appreciate your responding . I do have another question, though: we leave at 2 PM tomorrow, and as of now the vet tech will not be able to come by tomorrow evening to give Angel his evening shot since it's Christmas day. Would it be okay to just skip a dose, or would it be better for me to give him a teeny shot (like 1 unit) to just tide him over just before I leave at 2 PM? I'm so sorry this is all so complicated.

 

Absolutely the full dose. I think we need to help you learn to shoot everything above 50 as long as you are available to monitor and have all the supplies. Except for brand new members, shooting a reduced dose, stalling, and skipping (unless numbers are below 50 on human, 68 on AT, or inability to monitor) are not for the kitty. They just make you feel safe. However, because of the depot, the cycle will likely play out as it would have if you’d shot 3u until at least late in it or in tonight’s cycle. You can’t underestimate that depot!

What is your normal shot time (I can’t tell if it’s 9:30 or 10) and what time will you shoot tomorrow morning? And will the petsitter be testing him or not? It’s not complicated but his depot is really going to be wonky and I want to be sure we have him at a safe dose. What time will your Petsitter be shooting?

You aren’t taking up my time....Mike is flying through Christmas so I’m around, except for a few hours tomorrow for dinner at a friend’s house, and told other experienced members that I’d keep an eye on things in L/L Land (for emergencies, etc) so they can be with families. We take turns

BTW, altho the SS says you’ve switched to a human meter, might I suggest you revise the signature block to indicate it as well? Thanks, Shefali!!

I’ll be back later and definitely long before his shot time to talk about this more and a dose for tonight and tomorrow.

 

You take turns? OMG, you guys really rock. As I mentioned in another post, we're doing our yearly donations tonight and I'll definitely be including FDMB. I cannot believe what absolute angels you all are. Thank you a million.

Will change my signature block immediately.

I'd asked the pet sitter to let me know what time she'll going to be doing Angel morning and evening so I can try and adjust to her schedule a bit before I leave -- as of now I do him around 9:30 (or try to); I've also asked if she can test him. She's a wonderful young woman and usually very quick with responding, but I can understand how busy she must be with Christmas. Will be back with more concrete answers once I have them. The Angel Boy is sitting next to me purring right now; I just tested him and he LOVES testing time with all the kisses and cuddles and treats -- it is just too adorable. Not that he's exactly short of cuddles and kisses the rest of the time, lol.

 

Well, yes, we try to coordinate so we know who might be around. I’m sure the webmaster would really appreciate the donations. Thanks for updating the SS.

Oh my dear.......we do need to have a serious discussion about your dosing of this sweet boy but I don’t want to do it on Christmas Eve when you are leaving tomorrow. I will just say that he will do much better if you can try and shoot within 30 min of the previous shot. While it is possible to shoot early when numbers are high, you do have to have “some” consistency and I think his BG is a bit all over the place because the shooting times and the dose are all over the place. If you let the high numbers cause you to panic and you change the dose rapidly, you could go way past his good dose. Normally to go between 1u and 3.25u, if you are following TR and if he’s not in red and black, should take more like three weeks instead of nine days. I’m not chastising you at all, my friend. Just want you to see what it should have taken.

The petsitter will need to shoot a consistent dose unless he’s low and when you get back, I hope you will post so we can discuss how to get him back on track.

It looks to me like he’s likely lost some duration from the BCS and he might bounce as well. We’ll see where he goes. I know you are in CA and so you are one hour behind me so I’ll keep checking back long before you shoot tonight as long as you are planning on shooting about 9:30. I hope the petsitter will respond.

 

Thank you, Marje, I so much appreciate the time you're taking and the advice, and understand that you're not chastising . Will work on being more consistent in terms of both dose and timing once I get back -- part of the problem with timing is our schedule tends to be kind of busy and erratic . So! the good news is the vet tech can indeed come Christmas evening to give Angel his evening shot, so that's taken care of! That's the good news. The not so good news is that she can only come between 7-8 (she's going to try and make it as close to 12 hrs as she can), so I'm going to have to be a bit all over the place again and move him earlier this evening and again tomorrow morning so he's closer to a schedule between 7-8 when she comes tomorrow evening. She did not answer the question about testing, but I think she'd be willing to test once each day, or at least every other day. I just tested him at +8 (reading: 313) and will test again at 9:30 and get two more readings during the night, apart from a PS at 9:30 today. Do you think I should go with the 3 units when I shoot at 9:30 tonight? It looks like he'll be in the pinks. Thank you. Angel and I send huge gratitude and wishes for the most beautiful Christmas to you and yours.

 

Can you test at +11? If he’s still pink, I’d shoot then since you have to get him to an earlier schedule. You might also want to shoot 2.75u to start getting him on that dose especially since you are shooting early.

Can you then shoot at 8 in the morning so he will be closer to when the petsitter comes and shoots?

I still would not have her shoot more than 2.75u while you are gone and I’m still thinking 2.5u might be safer. Better he’s in all pinks and yellow while you are gone than greens and blues. If she can test, I would seriously have her test before every single shot and give her a “no shot number”. ..... maybe 150.

If it were me, I’d not be ok with her testing once a day or once every other day. You are risking a lot with that. If he decides to clear a bounce, he could be in low numbers by a preshot and shooting it blind could put him in a Hypo.

Be back by your +11

 

Just to clarify.....if she's going to go to SLGS due to the dry food, shouldn't that be above 90 on either meter?

 

Yes, thanks Chris, for reminding me. It was earlier in the condo yesterday and I spaced it.

Any updates, Shefali?

 

Yes, he's 369 at +11

 

So I shoot 2.75, yes?

 

I would suggest that you do but you hold the syringe

 

Ah, the hand that holds the syringe totally trusts you
I will try and see if petsitter can test each time; or at least once a day.
Also, just to confirm:
-- will ask her to shoot 2.5 to be safe
-- No shot number is 90
Does all this sound okay?
Thank you so so so much, Marge, and Chris!

 

And I'll re-read and re-learn SLGS when I return. It's been a while -- he was doing so well for so long on .5 and 1 unit, that we were just plodding along happily, but things have changed now and I need to re-read the stickies and stuff.

 

Reduction number is 90.
No shot number is 150 although under SLGS, it does state that between 150-200, you can skip, stall without feeding and shoot when numbers head up, or feed and test in two hours and then decide but that won’t work for your petsitter. I think you can decide if you want a not shot number of 150 or 200.

I hope that as part of her petsittung, you will tell her she has to test the PS.

 

Got it. I do have questions but they'll have to wait till I return, and also just reading the posted stickies will probably clarify things instead of making you repeat stuff. Again, thank you so very much, especially since you're taking all this time on Christmas, gosh. Wish all of you and your babies a gorgeous Christmas day

 

Merry Christmas. I’ll check in tomorrow just in case you post.