? BG 73, time to shoot, recent DKA, help?

Discussion in 'Feline Health - (Welcome & Main Forum)' started by AliceMeowliss&Cassandra, Apr 12, 2019.

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  1. AliceMeowliss&Cassandra

    AliceMeowliss&Cassandra Well-Known Member

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    I got her sample 20 min late and it's 30 minutes past time now. Still doing the NPH 3x/day. 3.5u but I can definitely lower it and feed gravy foods. Thoughts? I'm setting up the SS again so it's not ready but there are numbers in another post I'll go get. Thanks!

    ETA numbers:

    4/10

    BG 392, 8AM shoot
    + 10:50 - 227

    Antibiotic at noon

    BG 148, 4PM shoot
    + 6:12p - 294
    + 10:03p - 236

    4/11

    BG 305, Midnight shoot
    +12:49 - 338

    BG 343, 9AM shoot (overslept :( )
    + 11:24 - 177

    Antibiotic at noon

    BG 313, 5PM shoot ??? (Wet shot?)
    + 9:18p - 419
    + 9:55p - 385

    4/12

    BG 436, Midnight shoot
    + 2:12 - 487
    + 2:36 - 475
    + 3:00 - 476
    + 3:53 - 447
    + 4:56 - 397

    BG 356, Morning shoot
    + 10:06 - 196
    + 1:35p - 100

    Antibiotic at 1PM

    BG for 4PM shoot, 73... No shoot yet.
     
    Last edited: Apr 12, 2019
  2. Chris & China (GA)

    Chris & China (GA) Well-Known Member

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    With her lower numbers, it might be good to go ahead and switch to the Lantus now.

    You'd also need to decide what you want your shot times to be since Lantus is only given every 12 hours

    What do you think?
     
  3. AliceMeowliss&Cassandra

    AliceMeowliss&Cassandra Well-Known Member

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    What if she gets too high again? Im not sure I fully understand the cycle process with it yet!
    8-8 are my preferences. That would just mean waiting a little over 3 more hours.
     
    Last edited: Apr 12, 2019
  4. Chris & China (GA)

    Chris & China (GA) Well-Known Member

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    I think it's probably a good time to go ahead and change over to Lantus since she's been running lower lately and there's no ketones in the picture right now....she also seems to be eating pretty well, right?

    How much Novolin is she currently getting?
     
  5. AliceMeowliss&Cassandra

    AliceMeowliss&Cassandra Well-Known Member

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    She is eating quite well, except when she was testing high last night, then I had to encourage eating. I also literally just got a urine sample and ketone test right before BG check (which is what made me a little late). Still trying to interpret. The strips are good, I timed it, photographed it. Still confused.
     
  6. AliceMeowliss&Cassandra

    AliceMeowliss&Cassandra Well-Known Member

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    Oh and 3.5u NN for a daily total of 10.5u
     
  7. AliceMeowliss&Cassandra

    AliceMeowliss&Cassandra Well-Known Member

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    I will be happy to try. I'm just nervous and need sleep again sometime.
     
  8. Chris & China (GA)

    Chris & China (GA) Well-Known Member

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    Well it's not safe to shoot 3.5 of Novolin when she's only at 73, so I think it's probably as good a time as any to switch.

    If you shoot at 8pm, I'd start at 3U of Lantus....now it can take up to 5-7 days before you get the depot full enough to know for sure how well that dose is working, but some cats respond much sooner.

    In her case, if the Lantus doesn't kick in fairly soon, we can discuss fast-tracking her.

    If you shoot at 8 (depending on what her PMPS ends up being), you'd want to test again at 10pm (+2) and then you could get a +4 in at midnight and (hopefully) be able to get some sleep tonight!

    I used to shoot at 6am/6pm so I'd be able to test until +6 at night without having to stay up too late
     
  9. AliceMeowliss&Cassandra

    AliceMeowliss&Cassandra Well-Known Member

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    Alright. What does that mean to fast track? She's definitely quite hungry and chipper again. :)
     
  10. Chris & China (GA)

    Chris & China (GA) Well-Known Member

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    It's something we occasionally recommend in cats that aren't responding ….it basically means to suggest increasing the dose more often than we usually would but it's not something we suggest lightly.

    Usually several of us will discuss it before we recommend it.
     
  11. AliceMeowliss&Cassandra

    AliceMeowliss&Cassandra Well-Known Member

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    Okay. Got a call back from the vet office recommending against doing 3u, because a typical dose is usually lower.... But again, she doesn't have this experience specifically with switching insulins. Will need to shoot 30 min from now. Pressure. :eek:

    What do you think? Obviously will also be good to have her next BGL.

    I have 0% freeze dried chicken, 2% ff, 4% friskies, 14% friskies w gravy, and 14%?? purina dm dry. And syrup. And cerenia, mirtazapine, antibiotic.....

    How long will I be able to try bro sleep if she tests okay at +4, safely?
     
  12. Chris & China (GA)

    Chris & China (GA) Well-Known Member

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    Well there's no way to predict for sure, but usually, there's not much action on the first dose of Lantus.

    It sounds like you're ready for anything though!!

    I truly believe you'll probably be able to get some sleep from around midnight until morning but we always tell people if you happen to get up in the middle of the night, grab a quick test!! Lots of us would drink a big glass of water so we'd have to get up!..LOL

    We do take into consideration the dose the cat has been on before switching and if she's been on 3.5U of Novolin three times a day, I really think starting at 3U is a reasonable starting dose.

    She could prove us wrong and be one of those cats that didn't read the "handbook" but that's why we home test! So we can intervene early and stay away from those expensive ER vets!
     
  13. AliceMeowliss&Cassandra

    AliceMeowliss&Cassandra Well-Known Member

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    It's just... Her poor ears!!!!!!!!!! :'( I'm looking forward to sparing her a little more, someday!
     
  14. AliceMeowliss&Cassandra

    AliceMeowliss&Cassandra Well-Known Member

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    so am I going to inject on the side in the same way as anything else? There are no differences?
     
  15. MrRumps

    MrRumps Member

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    This is what I am having a hard time with. I feel so bad because mr rumps really hates it. Hang in there!
     
  16. AliceMeowliss&Cassandra

    AliceMeowliss&Cassandra Well-Known Member

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    I know, I saw your night. They get more used to it. And you learn to do it more swiftly more often. So it will get easier! There's hope at least. :)
     
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  17. AliceMeowliss&Cassandra

    AliceMeowliss&Cassandra Well-Known Member

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    Alright she tested BG 206 just now. 3u Lantus still sounds okay? How high carb should I start out feeding?

    Thank you.

    I just fed her 1.5 oz ff 2%. And she's soooooo hungry right now!!!
     
  18. AliceMeowliss&Cassandra

    AliceMeowliss&Cassandra Well-Known Member

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  19. AliceMeowliss&Cassandra

    AliceMeowliss&Cassandra Well-Known Member

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    I gave her her shot, 10 min past. How will that affect my charting and testing?
     
  20. Marje and Gracie

    Marje and Gracie Senior Member Moderator

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    It doesn’t. Just record it as your PMPS on the Lantus SS. Ten minutes either side of your normal shot time can be recorded as your normal shot time.
     
  21. Chris & China (GA)

    Chris & China (GA) Well-Known Member

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    Have you got some Neosporin with pain relief ointment? It can help heal those little pokes quicker
     
  22. Chris & China (GA)

    Chris & China (GA) Well-Known Member

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    That's fine.....and yes, I still think the 3U is where you should start.

    Grab a test at +2 and let's see how she's doing.
     
  23. Marje and Gracie

    Marje and Gracie Senior Member Moderator

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    Although it’s too late now, IMHO, 3u bid is too low. We need to be prepared to fast track Alice up. On Wednesday, you were shooting 4u TID or a total of 12u/day and she dipped to 148 which is a safe number.

    As Jill posted the other day, we normally transition from NPH to Lantus at close to the same dose. However, we are at a disadvantage by not seeing any numbers while you were dosing TID. Is 73 the lowest BG you’ve gotten on 3.5u TID? If so, I won’t be surprised to see her needing more Lantus than 3u bid.
     
  24. AliceMeowliss&Cassandra

    AliceMeowliss&Cassandra Well-Known Member

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    I have regular neosporin we have been using.
     
  25. AliceMeowliss&Cassandra

    AliceMeowliss&Cassandra Well-Known Member

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    73 is the lowest, yes.
     
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  26. AliceMeowliss&Cassandra

    AliceMeowliss&Cassandra Well-Known Member

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    I will work on updating her numbers tonight on the SS. I need to email my vet similar things, too. Taking a chance to clean and feed everyone else and maybe myself first.
     
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  27. Chris & China (GA)

    Chris & China (GA) Well-Known Member

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    Yes, I mentioned that earlier.
     
  28. Marje and Gracie

    Marje and Gracie Senior Member Moderator

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    Thank you...I saw that. General rule of thumb when changing from a shorter duration insulin like the Novolin, Humulin, Vetsulin, Caninsulin, and even PZ is to start as close to the dose that was working on that insulin.

    Of course, it’s a challenge here without having a SS to look at. Let’s hope she does well and we won’t have to fast track.
     
    Last edited: Apr 12, 2019
  29. AliceMeowliss&Cassandra

    AliceMeowliss&Cassandra Well-Known Member

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    I'm going to update! Let me know what sorts of negative signs and symptoms to be looking for though, please? Am I more worried about her being high? Better to feed the 2% pate? ...... ?
     
  30. Chris & China (GA)

    Chris & China (GA) Well-Known Member

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    Low numbers can kill quickly so we want to avoid those, but with the DKA in the picture, we also need to keep a close eye on the high ones.

    Anything under 10% is considered low carb.....some cats are very carb sensitive though so if they are, some keep them under 5% (we don't know about Alice yet so don't worry about it right now)
     
  31. AliceMeowliss&Cassandra

    AliceMeowliss&Cassandra Well-Known Member

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    I just mean I have choices. Wet: 2%, 4%, and 14%, and dry: ~14%. What would be ideal in theory? For this particular period of time.
     
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  32. AliceMeowliss&Cassandra

    AliceMeowliss&Cassandra Well-Known Member

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  33. Chris & China (GA)

    Chris & China (GA) Well-Known Member

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    Anything less than 10% so the 2% and 4% are fine as long as she's eating them well.

    If she's not eating well, feed her whatever she wants but try to keep it as low carb as possible. It's important to get as many calories as you can into her for now
     
  34. AliceMeowliss&Cassandra

    AliceMeowliss&Cassandra Well-Known Member

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    Alright then I'll stick towards the 2%. I can also rehydrate some freeze-dried chicken bits for 0%, though they may not be complete, nutritionally.
     
  35. AliceMeowliss&Cassandra

    AliceMeowliss&Cassandra Well-Known Member

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    +4 is 418

    So she is just going to keep climbing....? I'm exhausted. I already fell asleep once.
     
  36. AliceMeowliss&Cassandra

    AliceMeowliss&Cassandra Well-Known Member

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    I just don't know what I should do now to try and bring her back down eventually........?
     
  37. Chris & China (GA)

    Chris & China (GA) Well-Known Member

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    Go ahead and get some sleep.....You're just starting to load the depot so it's expected that she won't drop suddenly.
     
  38. AliceMeowliss&Cassandra

    AliceMeowliss&Cassandra Well-Known Member

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    How high can I let her get before it is too high?
     
  39. AliceMeowliss&Cassandra

    AliceMeowliss&Cassandra Well-Known Member

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    +6 (ten minutes shy anyway), 430
     
  40. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    There is nothing you can do about the higher numbers this cycle. The depot has to load and that takes up to 6 cycles. It is a different type of insulin and does not bring the BSL down as hard as the Novolon.
    I'd just make sure Alice is eating and drinking plenty and getting another ketone test in.
    And try and get some sleep
     
  41. AliceMeowliss&Cassandra

    AliceMeowliss&Cassandra Well-Known Member

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    She is eating and drinking, has urinated and had a bowel movement. She's chipper and hungry and she doesn't talk as much if she is uncomfortably high. So I am super groggy and stopped pricking her poor ears. Just waking up for a snack for her again before I withhold for 2 hours....
     
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  42. AliceMeowliss&Cassandra

    AliceMeowliss&Cassandra Well-Known Member

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    Good morning, anyone up and around? Do I shoot 3u again? I am about to test. :)
     
  43. AliceMeowliss&Cassandra

    AliceMeowliss&Cassandra Well-Known Member

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  44. Sharon14

    Sharon14 Well-Known Member

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    Nice drop @+2! How’s she doing?
     
  45. Chris & China (GA)

    Chris & China (GA) Well-Known Member

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    How's she doing Alice?

    That's a pretty big drop for so early in the cycle.

    How much did you end up giving? It doesn't say on your spreadsheet
     
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  46. AliceMeowliss&Cassandra

    AliceMeowliss&Cassandra Well-Known Member

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    3u, and I corrected +2, it was 30 points higher than my partner told me when I checked meter history. She's back in the 400s now. She's had almost exclusively ff 2% mixed with water, but I did give her some friskies at 4% (w/water) when she was lower. She is thirsty and drinking a fair amount, urinating, had another (solid!) bowel movement with a good rich color to it. (This was previously an issue.)
     
  47. AliceMeowliss&Cassandra

    AliceMeowliss&Cassandra Well-Known Member

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    She's back up though, 422 @ +6.

    Should I assume to give her 3u tonight? I mean obviously waiting to see numbers. Can I drop back from testing every two hours, or should I continue since it is climbing again?
     
  48. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

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    I think it's fine to not test for a while. How about testing at +9?

    As for the dose tonight, I'm consulting with a few folks. The minimum dose would be 3.0u. I tend to agree with Marje that Alice should have been started at the same dose of NPH.
     
  49. AliceMeowliss&Cassandra

    AliceMeowliss&Cassandra Well-Known Member

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    Okay. 4u? 3.5u? Just let me know what y'all think is best.

    I have been napping all night and day but haven't gotten a complete sleep cycle so it's not very recuperative. The exhaustion is starting to catch up as I've been extremely nauseous and had to take meds since yesterday.

    My point being, I will stay up and I absolutely will do whatever she needs, whatever I have to do, but I desperately do need rest if possible for 4 solid hours tonight. Whatever is going to stabilize her best so I can rest and be able to continue her care.

    Thank you all so much.
     
  50. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

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    First things first. You have to take care of yourself or you won't be able to care for Alice. If you're exhausted, that's when mistakes happen. I'm going to lay out some options so you know that you have choices and can think things through.

    The first really isn't an option. It's a suggestion. You may want to start posting on the Lantus board. Many of us Lantus regulars confine our time to that Board given its size. The reason I stopped by was Chris asking me to lend a hand.

    As I understand Alice's history, you were shooting 3.5u of NPH three times/day -- 10.5u per day. As Marje and Jill noted, when transitioning from a shorter acting insulin to Lantus, we get the Lantus dose as close to your previous dose as possible. As such, 3.0u twice a day is a lot less insulin than Alice was getting. Too little insulin in a cat that is recently post-DKA can be a concern. My foremost question is whether you're testing for ketones? If not, please get some Ketostix and start doing so. If you are, can you put the information on Alice's spreadsheet in the comments section?

    Dose... Here are our collective thoughts:

    • You've shot 2 cycles at 3.0u. Numbers are not lovely -- not awful, but not lovely. You can either
      • raise 0.5u every 2-4 cycles
      • or shoot 4u starting tonight
      • or leave things as they are and raise the dose tomorrow
    Marje and I are both veteran Tight Regulation Protocol people -- which is what I'd recommend as a dosing approach given Alice's DKA history. Even with TR, we would modify a bit given the DKA and the previous 10.5u dose.The TR voice always leans towards increasing the dose by 0.5u every 2-4 cycles to fast track. But, the out of the box, the DKA-worried voice wants you raise the dose to 4 or 4.5u tonight. Of course, we want to take your level of fatigue into account before you raise a dose at night. Still....the depot has barely begun to fill which may mean you won't see much movement for at least 5 days.

    Given how you're feeling, you need to decide what makes the most sense.
     
  51. Chris & China (GA)

    Chris & China (GA) Well-Known Member

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    Cassandra...I was really hoping you'd get some rest and that's part of the reason I suggested you start a little lower at 3U but I agree with Sienne …...let's take her up and see if we can get her numbers down a little more.

    I think you could go to 4U tonight......the depot still has to fill and it may still be several days before you see much change, but you really need to try to get some rest.

    Tired people make stupid mistakes.....trust me!

    If you shoot 4U tonight and get a +2, let's see where we are then.

    It would really help if you get some ketone strips that just measure ketones. With all those other tests on the strips you're using, it's hard to make sure you're getting a good test for just the ketones and that's what's most important right now....not the other stuff.
     
  52. AliceMeowliss&Cassandra

    AliceMeowliss&Cassandra Well-Known Member

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    I was supposed to pick some ketostix up today from a friend but I've ended up not leaving the house between naps and nausea and tests, plus the weather.

    I'm okay. I am getting every bit of sleep I can.

    My last ketone test looked the same as all the others. Last night? I'll see if I have enough cash to just run to Walmart in a bit.

    Her +9 is 420 and she is SO HUNGRY. Between snacks she apparently tried to climb up on the second shelf after food and knocked some supplies over.

    She has had I think maybe 2-3 cans ff 3oz 2%, some 0% chicken, and half a can 4% friskies today. With water.
     
  53. AliceMeowliss&Cassandra

    AliceMeowliss&Cassandra Well-Known Member

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    @Sienne and Gabby (GA) , what are the risks of shooting 4u tonight? I want to see her down in the 300s regularly before I'm going to be able to rest more significantly.

    And what do I do regarding her appetite?

    I'll try a ketone test next time I catch a pee. Almost got one a min ago. Almost.
     
  54. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

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    You might want to consider getting a ketone meter. It tests blood. The strips are pricey but you can use it once a day and try to catch urinary ketones at other times. The blood ketones give you an immediate answer vs urinary ketones which reflect information that's hours old.

    I suspect Alice will be fine if you increase the dose. I just wish I could give you a guarantee but I can't. Like Chris said, get a +2 or a +3 and let's see what the numbers say.

    As for appetite, Alice is going to be ravenous until her numbers settle down. Glucose is the end product of metabolism. If the glucose is floating around in the blood, it's not getting into the cells and Alice is literally starving. As numbers come down, more glucose is getting into the cells and Alice's appetite will taper down. Until that starts to happen, up her amount of food. As long as she doesn't become too "fluffy," it should be fine.
     
  55. AliceMeowliss&Cassandra

    AliceMeowliss&Cassandra Well-Known Member

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    She's so underweight it truly makes her look like one of those save the children ads. (I feel like that sounds terrible to say but last week I saw a picture I had taken and just.... Sigh!) She was always petite but long and slim. Her brother had the exact same build but a male, larger version. So "fluffy" isn't a risk.

    As far as the meter goes, I'm already receiving DCIN help.

    My friend is bringing regular ketostix in about an hour. 40 min to test and shoot time.

    Is there a risk of 4u being too high, and if so, when is that nadir most likely?
     
  56. Chris & China (GA)

    Chris & China (GA) Well-Known Member

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    Look at China's Profile in my signature.....she went from a skeleton to "fluffy" in 5-6 months!

    I doubt it....if she was able to take 4U of Novolin without crashing, I doubt if 4U of Lantus will cause her to go really low.

    The nadir on Lantus is usually 5-7 hours after the shot, but ECID so there's really no way to know for sure until you have more data on Alice.
     
  57. AliceMeowliss&Cassandra

    AliceMeowliss&Cassandra Well-Known Member

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    ECID?

    So if I do a +2 then nap then get up I might be able to give her ears a break AND get a sleep cycle? Then test at +7.....?

    Alice has never never been overweight. In fact I've never had an overweight cat until I neutered my youngest. He has other issues though and is kind of neurotic. So I just cannot imagine it with Alice!
    When they start gaining, how difficult is it to gain muscle vs fat tissue? Because she's not just skinny, she is wasted. I don't know that science. I'd like to go learn it.
     
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  58. AliceMeowliss&Cassandra

    AliceMeowliss&Cassandra Well-Known Member

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    BGL 390. Shoot 4u? Thoughts?
     
  59. Chris & China (GA)

    Chris & China (GA) Well-Known Member

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    Every Cat Is Different

    If it would make you feel more confident, you could go with 3.5 for a few cycles. We are being more aggressive with her dosing than we normally would be due to the DKA
     
  60. Krystina & Nelli

    Krystina & Nelli Well-Known Member

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  61. AliceMeowliss&Cassandra

    AliceMeowliss&Cassandra Well-Known Member

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    Aggressive is the only thing that has worked so far. I'm for it. 4u now!
     
  62. AliceMeowliss&Cassandra

    AliceMeowliss&Cassandra Well-Known Member

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    Oh... And ECID I know. I don't have enough Alice-specific data yet, therefore it is reasonable and expected that I should rely on general data of other cats. I don't want you to think I'm taking it like a sure thing. It's an informational guideline at this point.

    She's finally calm again now that her belly is full.

    Did I read somewhere today that Lantus may sting going in? It sure would help me be sure she got it and I didn't miss, but poor baby yelps each time. :(

    .....For the greater good.
     
  63. Chris & China (GA)

    Chris & China (GA) Well-Known Member

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    Lantus can sting at higher doses, but most cats don't even notice. But it's possible she's one of the cats that is extra-sensitive to it
     
  64. Marje and Gracie

    Marje and Gracie Senior Member Moderator

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    Yes it can sting and it depends on the cat as to how much insulin causes it to sting. At 1.25u, my Gracie flinched but I’ve seen other cats on 8u and the Caregiver said they didn’t move a muscle. If you didn’t get it all in, you’ll smell a smell like bandaids. You can’t miss it. Pick her up and smell her and see if her fur is wet.

    BTW, if you ever think you’ve given a fur shot or a partial fur shot, do not reshoot insulin. Wait until the next scheduled time to give it in case you got in more than you thought you did.

    I”m glad you increased the dose to 4u. After a couple cycles, we will see where she is and then decide which way the dose needs to go (unless, of course, she earns a reduction). Great job!! And I hope we see you in Lantus/Basalgar/Levemir Land!
     
  65. AliceMeowliss&Cassandra

    AliceMeowliss&Cassandra Well-Known Member

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    I'll be making my way there tomorrow probably. Lol. Thanks!
     
  66. Marje and Gracie

    Marje and Gracie Senior Member Moderator

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    Superb!!!
     
  67. AliceMeowliss&Cassandra

    AliceMeowliss&Cassandra Well-Known Member

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    Ketone strips dropped off. It's the same, it always looks grayish lilac to me.
    The one just of the strip is exactly at 15 seconds. Maybe 16.
     

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  68. AliceMeowliss&Cassandra

    AliceMeowliss&Cassandra Well-Known Member

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  69. billysmom (GA)

    billysmom (GA) Member

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    You could try it on your urine and see what you get.
     
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