? Dosing advice for tonight 4/1 Sally AMPS 639;+2 549;+5 414:+8 404 didn't eat much today

Discussion in 'Lantus / Basaglar (glargine) and Levemir (detemir)' started by Ter and Sally, Apr 1, 2018.

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  1. Ter and Sally

    Ter and Sally Member

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    Jan 9, 2018
    What is recommended when there is a hypo after a dose increase? Sally dropped to 30 last night at +3; pmps was 229. We shot the full dose because we did so the other day and while she went low we were able to steer it with food. We didn't think the depot would effect this kind of drop, and so quickly, although we were again steering with food. On her SS we haven't filled in all our bg's yet but we had started feeding her shortly after she started dropping and when she continued to drop we gave her treats and then karo. She stayed at 30 for about 8 minutes and then she started going up, next reading was 83, 5 minutes later 91, we kept testing every 10 minutes or so till she got to 126. I'm entering the readings in my notes now; she is now at 345 +7. I feel that we jumped the gun on increasing to 0.75 from 0.50. What option do we have for the morning? Based on her current rate of increase she will probably be in the upper 500's. Do we go back to 0.50? Any idea how the depot effects tomorrow?
    I hope my post makes sense I'm very tired and I don't know if I am expressing myself clearly.
     
    Last edited: Apr 1, 2018
  2. Steph & Quintus & L & O

    Steph & Quintus & L & O Well-Known Member

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    From the black AMPS on 31st she probably went low the night before, too. I would tend to say go back to 0.5, particularly as you don't have complete data on how she was doing on that dose (no preshot tests, etc). With 0.75 on the 29th you had to prop her up with food, and again last night. So it might be too much.

    SLGS guidelines tell you to decrease the dose if the cat goes below 90, so you actually would have decreased already on the 29th.
     
  3. Ter and Sally

    Ter and Sally Member

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    Thanks Stephanie that's my gut feeling. I'm just starting to doubt my decisions now! That low afternoon made me nervous but in the past she would have a low day then go back up into the 200's and 300's and stay there so we thought she would do the same with the increase so we were staying at that dose. Some of that info is missing because she had 3 weeks with a burst anal gland which was horrible for her. Any thoughts on whether the depot will still be driving down the numbers or is it just keep a very close watch on it?
     
  4. Tricia Cinco(GA) & Harvey

    Tricia Cinco(GA) & Harvey Well-Known Member

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    With that 30, she earned a decrease to .50. Since you are following SLGS, you actually should have reduced on Friday after she went down to 67 - the decrease number in SLGS is 90.

    When she hit 30 did you notice any symptoms of hypo, like confusing, weakness, etc.? The reason I ask is that after a symptomatic hypo, many cats are more sensitive to insulin for a while.

    The depot can take up to 6 cycles to readjust, so it can affect her for that long.
     
  5. Tricia Cinco(GA) & Harvey

    Tricia Cinco(GA) & Harvey Well-Known Member

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    She's bouncing now, but it looks like she's breaking her bounces in about four or five cycles. Keep in mind that, even if she's bouncing, it's still a good idea to get a mid-cycle test or two, because the length of bounces can change, especially if something has changed with her pancreas.

    BTW, it takes at least 15-20 minutes for food to affect the BG, so you don't need to test every 10 minutes when she's low - 20 minutes is fine.
     
  6. Ter and Sally

    Ter and Sally Member

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    She has never shown any signs when she was hypo. You would not know unless you were testing. That is interesting about the bounces. She is a diver and a bouncer. She was that way on PZI too. Had we understood about bouncing back then we could have handled that insulin differently. Tonight was such a scary night when she started going down fast, my husband was doing the testing and I didn't know how frequently he was doing them! It was all slow motion to me. Good to know the timing, we were wonderingg what food we could give that might work the quickest. Then settled on the karo when it dropped so quickly to 30.
     
  7. Tricia Cinco(GA) & Harvey

    Tricia Cinco(GA) & Harvey Well-Known Member

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    She wasn't dropping very far, just fast. That 30 really came out of nowhere - the insulin must have fully onset right then. It's a really good thing you were testing.

    At what point did you start feeding, +2? Sometimes it helps if you give a small at +1, +2 and +3.

    When she started dropping, were you feeding High Carb?
     
  8. Ter and Sally

    Ter and Sally Member

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    Yes sorry that's what I meant to say that it was fast real fast. And the 30 just blindsided us. We fed at each, +1,2 and 3 and kept feeding ,then gave her some dry and then Temptations treats. We had the karo ready when we saw how fast it was going but we were hoping the food would turn it around. I didn't have any wet food with gravy so used the dry and treats,before that we were just giving her extra FF.
    We've been feeding a few times a day, normally early in the cycle and extra before bed.
    Stopped testing now because she is in the 300's and we've been up 24hours straight. Now I'm so tired I can't sleep and worried about the next injection which would be due in an hour.
     
  9. Ter and Sally

    Ter and Sally Member

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    If the reading is still 300 or higher would I give .50, a token amount or let the depot drain?
     
  10. Ter and Sally

    Ter and Sally Member

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    Jan 9, 2018
    Our first inclination is to skip this morning's shot regardless because we don't know for sure how what is already in the depot is going to affect it.
     
  11. Chris & China (GA)

    Chris & China (GA) Well-Known Member

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    May 10, 2013
    I'd go with the .5.....she's bounced really high so she needs the insulin.
     
  12. Ter and Sally

    Ter and Sally Member

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    Jan 9, 2018
    We're just super scared this morning with no sleep, after last night's 30 and still with the depot that's built up over these last 5 days. We're thinking what are the chances of her going down 200 in 3 hours?
     
  13. Tricia Cinco(GA) & Harvey

    Tricia Cinco(GA) & Harvey Well-Known Member

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    It looks like you went with the .5. I think that was a good call. Now you can go back to bed for at least a couple of hours, but I'd check her by +3 just in case....
     
  14. Ter and Sally

    Ter and Sally Member

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    I was going to but now she's not interested in her food so she hasn't eaten yet. She did have some diarrhea last night. Now wejust don't know what to do or what to give!
     
  15. Ter and Sally

    Ter and Sally Member

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    Whenever Sally has been stressed, like a car ride or going to the vet, she's off for a few hours. So this morning she came looking for her food but only licked at it. I was afraid to giv the dose but I remember someone saying here to give the dose because when they're high it only compounds the problem when they don't get insulin. Vets usually say skip the dose. I'm thinking that with the stress, the dry food and karo she got laet night that hopefully I didn't just componud my problems by giving the 0.50. No sleep for me today.
     
  16. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

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    Dec 28, 2009
    It also helps to remember that typically, Lantus onset isn't until +2.

    Just a thought about last night, did you happen to re-test when you saw the 30? It was a fast drop and it's entirely possible for a kitty to drop like that. It's also possible it was a bad strip or a bad test. Whenever Gabby would toss me what seemed to be an out of context number, I would immediately re-test.
     
  17. Ter and Sally

    Ter and Sally Member

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    No not for about 10minutes, we were heading out into the car in case we had an emergency on our hands. I thoughtvof that briefly later you know how things go thru your mind. Now I'm worried about her not eating. It's one thing she does always shows up for food no matter when. But I guess once in awhile especially after a night like last night....just afraid of giving a shot when she doesn't eat it was always drilled into us to make sure they eat first.
     
  18. Ter and Sally

    Ter and Sally Member

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    Jan 9, 2018
    I guess I'll just keep her food out for her if she becomes interested?
     
  19. Ter and Sally

    Ter and Sally Member

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    Jan 9, 2018
    At almost +2 she's 549 which is about where she started yesterday. After drinking a bit she laid down and I put her in her bed. I'm sure she's exhausted.
    Looking back over these weeks and the bounces I was thinking she had to get used to the blues mainly because during the day it looked like she was bouncing off those. I really didn' t think she was bouncing off anything lower, I thought she wasn't recognizing the blues. We both thought that.
     
  20. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

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    It's all a learning curve. In general, you're certainly testing enough with Lantus that you're likely to catch low numbers. Since Sally seems to have a flare for the dramatic, I'd encourage you to do a few additional things. Always get a pre-shot test. While dosing is based on nadir, you need to be sure it's safe to shoot. I followed TR with Gabby and would shoot anything above 50. SLGS is a bit different so you will need to figure out where you're comfortable shooting. Ultimately, you want to be able to shoot low.

    Always get a before bed test. May cats like to spend time in lower numbers at night. In addition, if you're not getting any tests at night, you're missing half of your data. Even if Sally is in really high numbers at pre-shot times, get test(s) in. Gabby was a kitty who could start in the 400s, drop into the 40s, and zoom back to the 400s. If I hadn't been testing, I would have missed the low numbers and increased her dose vs giving her the decrease that was warranted.

     
  21. Ter and Sally

    Ter and Sally Member

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    Jan 9, 2018
    Thanks Sienne. The thing that makes everyone go mad is that there are no concrete answers even for your own cat.
    We were all just taking a 15 minute kinda sorta nap. She got out of her bed and had a few bites of food with gusto then had a pee.
    She's laying on her bathroom rug now. It's kind of cool in there so maybe she was too warm in her bed. We have the heat on in here because we humans are run down and freezing.
    It's hard to tell sometimes if she is doing something weird or if it's her normal thing because she has a wobbly walk due to a misaligned fractured foot and spinal injury.
    I guess we just have to base what we do today and the next few days as far as feeding times on what her tests are.

    Ok to just free feed today because she didn't eat her breakfast I assume?
     
  22. Ter and Sally

    Ter and Sally Member

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    Jan 9, 2018
    SLGS. Gave 0.50 this morning she's been sleeping all day. She didn't eat breakfast but did have small amount of her FF on her own earlier today. She usually doesn't drink much but had a couple of long drinks and a good pee.
    I' m thinking she'll eat something but want to be prepared for what I should do if she still doesn't have much appetite. She never misses a meal.
    What do I do if she doesn't want to eat or doesn't want to eat much??
     
    Last edited: Apr 1, 2018
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