Discussion in 'Feline Health - (The Main Forum)' started by Beth 73, Dec 9, 2016.
New thread begun cos got so much fabulous help on prior post !
PMPS...202 .........+2..102(1 t low carb snack given)
Here's your earlier post .....we like to put the link to the prior post in the new thread so it's easy to go back and see what's been going on
Now Elmo.....how about a nice safe surf tonight? Leave the high dives to the pro's for now!!
Hey Chris..glad to see you !! Will never forget you and China were Elmo and my first FD guardian angels .... just took +3 and was 93...... gave him 1 teaspoon 8 carb snack.....at +2 BG was 102 and gave 1 teaspoon 5 carb ...thoughts??
@Kris & Teasel .....Kris, ur thots on Elmo's BGs so far tonight ??
Tonight's BGs thus far: +2 102. Gave 1 teaspoon 5 carb.......+3 93. Gave 1 teaspoon 8 carb......+4 104 gave 1 teaspoon 8 carb
Looking good tonight!!
That was another pretty big drop at +2.....I'd really consider switching insulins if there's any way you can swing it
Hi Chris...I'm staying up to take a +6 here in a few minutes....he was 132 at +5 and I gave no snack ....Mogs has also suggested an insulin change and I believe suggested Lantus .... after smoke clears from this hypo and I've slept a bit I will check with my vet...what r ur thots on his other BGs tonight?
I'm a big fan of Lantus too.....of course it's what I use on China too!
I wish I could see your spreadsheet but for some reason, it won't let me scroll down past 9/6/16
If you haven't fed him since +4, if he's still surfing at +6, I think you could probably give him a late night snack of regular LC food and call it a night
I am iPad impaired.... my reply ended up within ur post above....mercy
Looks like he's got a nice safe surf on to me!!
Without being able to see your spreadsheet, I can't see when he usually nadirs, but with Vetsulin, it's usually earlier rather than later, so I'd think you'd be OK.....but if your gut tells you to test again at +7, that's fine too
Gave 1 teaspoon low carb after +6 and am calling it a night...or is it calling it a morning ......thank u, Chris, for being here once again in the wee Ozarks hours...give China a hug from us
Don't worry so much about getting the quote in.....if someone is watching you, they'll get a notification that you've replied
Hmmmmm.... before this his nadir was usually +4...my gut is punch drunk but it's only about 30 minutes so I could give him one last poke, bless his heart
Think I'll leave him be...he's all snuggled in for the night....thanks for late night hand holding once again
Great job monitoring again - and a good call giving the bit of food at +2; it probably helped to slow the drop.
Now you can see what I was talking about yesterday: even with the higher preshot the 0.25 dose the smaller dose of Vetsulin was still enough to take Elmo down through a larger drop than you were expecting - and again very quickly - to a fairly low nadir (thankfully in safer numbers).
I've seen advice from our own vets and reports of advice from the vets of other members here to only pay attention to the preshot BG when making dosing decisions for Caninsulin/Vetsulin (C/V). Based on my experience I think it is VITAL to also consider nadir BG when treating with C/V - especially when a cat starts seeing low nadir BG levels. When Saoirse's numbers started getting into a healthier range on low carb food I found that previous nadirs were a better guide to safe dosing than preshot BGs (but obviously one needs to look at the pattern of response for the individual cat).
As you see from Elmo's numbers yesterday if you had used sliding scale dosing and increased the dose above 0.25 IU because of last night's higher PMPS he might very likely have gone too low again.
Job well done, Beth.
Turned in early last night and am just now seeing this. Elmo looks like he's on a mission and while you had to steer him a little last night, he had a beautiful cycle. You handled the situation like a pro. KUDOS!
I too think a switch to a longer acting insulin like Lantus or Levemir would give you a little more breathing space and keep Elmo surfing rather than jumping off cliffs early in the cycle. In the meantime, did you get/order the U100 syringes yet? They would give you the ability to finesses the dose down another little bit to 0.2u or perhaps even 0.1u with a good magnifying glass.
I couldn't agree with Mogs more about the nadir being the critical consideration when dosing especially with Vetsulin and it boggles my mind that so many vets suggest using pre-shot readings to determine dose.
@MrWorfMen's Mom -
For C/V at low numbers I consider the nadir to be the key metric to use for dosing decisions. For cats running in high numbers both preshot and nadir need to be considered (but I personally always give greater weight to how low a dose might take the cat; I'm a big fan of safety buffers, especially on a harsher-acting insulin like C/V.
If Elmo were my kitty I wouldn't want to see him go any lower on Vetsulin than the range he was in yesterday (and I might actually shave a bit off that 0.25IU dose to be on the safe side - especially after last night's dip into double digits so early in the cycle). If the kitty was getting these numbers but not quite heading for remission I'd look to go for tighter regulation using an L insulin; the gentler action facilitates tighter control because, with appropriate testing and dosing, an L insulin is much less likely to tank BG numbers.
Being able to safely continue insulin treatment for a longer period could make the difference between a kitty achieving remission versus having to remain dependent on insulin.
Congratulations, Beth! You got through another intensive "learning experience".
I agree with the focus on the nadir because AM/PMPSs can be unpredictable because of bouncing, insulin duration, etc. In fact, I like to look closely at the middle third of a cycle to get a clear (-ish, because Teasel's hardly ever clear) picture of what's going on and generally give only a nod to the PSs.
Thank u to u all!! This morning has begun nicely...appears Elmo is taking pity on me ! Negative for ketones, ate well and one of the best poops in many days, so all in all today is off to a good start. And I will be contacting vet Monday morning...it will probably require a visit which Elmo is not a fan of but he will get over it. Monday is also the day ADW will contact him for ok on U100s...my vet is a wonderful lover of kitties and I am sure will be open to both insulin switch and needles. Thank u to u all for the wisdom u have given that instructs 24/7 ....what a blessing !!!
An auspicious start to the day, Beth. May the day continue in the same positive vein.
BTW here is a link to Saoirse's 2014 spreadsheet. The values are Alphatrak. It may help you and your vet to have a look at it to see the difference in how her BGs were on both Caninsulin (aka Vetsulin) and Lantus. (Feel free to email the link to your vet if you feel it might be helpful to you both.)
The above link should take you directly to the tab with Saoirse's numbers in US units. NB: I customised the colour coding and number ranges for Saoirse's spreadsheets to better reflect the relationship between normal blood glucose levels and Alphatrak meter readings. All of the BG values where the background is a shade of green are in the normal reference range provided to me by our vet as measured on an Alphatrak (70 - 150mg/dL US / 3.9 - 8.3mmol/L international); the darker the green, the lower in the normal range the BG level.
As you'll be able to see from the data, after the food change Saoirse's numbers improved a great deal and very quickly. Within a week it became dangerous to give her even a tiny dose of Caninsulin (plus it was making her feel absolutely lousy). Our vet insisted that I stop insulin treatment because he thought she was in remission. I disagreed. After a very short period without any insulin Saoirse's BG levels started to deteriorate again so he agreed to give me an Rx for Lantus. I was able to continue Saoirse's treatment on the new, gentler-acting insulin. Her first OTJ trial was unsuccessful but because I was able to continue treatment safely for a little longer on the Lantus her second OTJ trial was successful.
Note that I set the hypo warning threshold on the spreadsheet to 80mg/dL (4.4mmol/L) because I much prefer to be extra-cautious. It should be noted that sometimes a big drop from a high BG level to a low BG level can trigger hypo symptoms even when a cat's BG level remains ABOVE the nominal hypo threshold, hence my love affair with aiming for nadir BGs where there is a decent safety buffer - especially when treating with one of the harsher-acting insulins like C/V; a sputtering pancreas could decide to join the party (no way of predicting this) or the cat might vomit up its food mid-cycle and numbers could go dangerously low if there's very little in the way of wiggle room BG-wise.
An example: Saoirse's one and only symptomatic hypo occurred when she dropped from 310 PMPS down to 77mg/dL by PM+3 (see data for 13.07.14). I wanted to reduce the dose that night because she was going through the diet transition to low carbs but the vet on call that night insisted I keep her at the 3IU. Very definitely a night for weapons-grade brown trousers. Thank the goddess for home testing and FDMB; saved her life that night. From that point onwards I trusted what Saoirse's body was telling me about her insulin needs, not a vet's instructions; granted I was also learning a great deal here at the time about how insulin works in real life cf. how a textbook says it's supposed to work.
Hope some of the above is useful.
PS: If you've got any spare 'good poop' vibes going begging please send some over here to Lúnasa.
Thank u is not adequate, Mogs....and my secret poop weapon is 1-2 teaspoons pumpkin, warmed with a little added water 2x daily....was recommended by my homeopathic vet years ago and have used it on all our kitties for 30+ years( and even my 94 year old momma)....
Pumpkin worked an absolute charm for Saoirse but, much to my disappointment and frustration, it disagrees with the Noodlebug.
Bummer...btw elmo +2 is 94..steering up with little bit lo carb...or is his nadir changing to +2 because of hypo or just cos it wants to..i know u said that is what Saoirse did
...btw..should i take BG at +3 since got 94 at +2 just in case of needing to stop further drop?
The time of onset depends on the cat, Beth; Saoirse tended to metabolise insulin very quickly in general and therefor have early nadirs (both on Caninsulin and Lantus) but some cats don't see BG dipping till later in the cycle.
I did notice that as Saoirse's pancreas got more rest both time of onset of dose and nadir BG started coming earlier in the cycle so I know from her it's something to watch out for that may be an early warning sign of better pancreas function. I have seen other members comment that early nadirs may point to a dose being on the high side.
When on insulin Saoirse would snooze for a while after her PS meal and insulin dose. I would then keep an eye out for first sign of an appetite uptick as this let me know the time of dose onset (under normal circumstances this should come before nadir). When Saoirse was heading for remission both her appetite uptick and nadir started coming earlier in the cycle. There's no guarantee whether something similar might be happening in Elmo's body but I did find monitoring these signs helped me to keep Saoirse safe so I thought I'd share these experiences with you.
BTW, that 41 was very low the other day. Sometimes when cats go low their bodies become more sensitive to insulin.
Very much yes to a +3, Beth.
Will do ...
+3 118...no snack.....+4 137...no snack
QUOTE="Critter Mom, post: 1838960, member: 10789"]Surf's up!
.[/QUOTE].....u r far too funny and witty
I'm faking it.
Now I have surfing guitar song "Wipe Out" in my head
Also finding doing back to back all nighters with Elmo is an EXCELLENT excuse to just sit and nap !!!
A well-deserved nap, Beth; you're doing a sterling job with your handsome boy. (((Elmo)))
High praise indeed, Mogs, high praise indeed. A wonderful side note : he briefly played under the Thanksgiving tablecloth still covering our table....worth a million to see that
Oh Beth, that's wonderful to hear! Well done, Elmo, for making your mama happy!
Out of curiosity, has Elmo ever shown signs of lethargy in the middle of an insulin cycle compared to his energy levels before you give the dose?
His energy level seems best before eat/shoot time and immediately after...within ab an hour of insulin he is on his current favorite sleep place for the next 5-8 hours.....so, all that to say , yes ,he is most lethargic mid cycle .
When you made such a point about how good it was to see Elmo's activity level being better earlier on I did wonder whether that might be the case. That dip in energy could possibly be due to the Vetsulin.
Many cats get on great with C/V but it is worth noting that it may disagree with some cats' systems, even when their BG may be quite well-regulated while being treated with it. Lethargy mid-cycle may be a warning flag. It is important to monitor clinical signs as well as BG to assess the overall effect of any treatment.
It would be helpful to you and your vet if you were to record a brief daily note about Elmo's general clinical signs in the Remarks column of his spreadsheet (including things like lethargy and the point in the cycle when it occurs, or when in the cycle Elmo seems to have more energy and/or brighter mood) and sharing this info with your vet in addition to Elmo's BG data.
For information, Saoirse had a very hard time on Caninsulin. She'd be fine when a dose was wearing off but a couple of hours after the next dose was given she'd be wiped out, withdrawn and low in mood; as I remarked to our vets at the time, it was like having two different cats! She became much perkier and happier after the switch to an insulin which suited her better: I got my cat back! Jayla and some other members have reported similar experiences with their kitties.
Just took Elmo PMPS ...was 150...rechecked and got 167....taking into consideration hypo what do I shoot here in ab 45 minutes ???? Help please ......
stall without food and retest in 20 minutes. Repeat for another 20 minutes if needed. you want his BG to be rising and to get up to a shoot number you're familiar with and give a skinny 0.25 u 0.25 u minus a drop). Be ready to monitor/feed.
draw up 0.25 u and let out drops until you're at an eyeballed 0.125 u or less. Be ready to monitor/feed.
no shot tonight.
Elmo is probably still very insulin sensitive after the hypo. This can persist for a while. How's your coffee stock?
Already started feeding.... now what ??? Has maybe eaten his first 1/4 can ( 1.2oz)
OK, then choice #1 is off the table. What do you think of #2 or #3?
Kris , I really don't know...have never skipped a shot and don't know what to expect.....and not sure about trying to eyeball that tiny of an amount(waiting on vet to ok u100)...what are scenarios of the no shot ??? Or looking at Elmo's recent hypo history what of giving the teeny eyeballed amount... just not sure
Will remember for future reference tho...
Number 1 I meant
If you don't give a dose tonight his BG might be higher in the AM but he'll be absolutely safe wrt hypo. Based on his records, it'll be easy for you to get back to where you were with him. It might be a worthwhile experiment for you so you find out what his reaction is under "no dose" circumstances.
I agree that it's hard to eyeball tiny doses with a U40 syringe but that's what you have right now. You just don't have the data for tiny doses after a hypo so it would be guesswork. While you're waiting you could take another syringe and put coloured water in it to find out/practice what tiny doses are possible by letting out drops, etc.
So u don't think he could go too high without a shot tonight....frankly, both options are intimidating to me...
Weird also that when I got the 150 I immediately rechecked the same blood with a new strip and got 27 points higher
Additional info,...he only ate the 1/4 can( ab 1.2 oz) and walked off...usually eats bit more before shot time...should I encourage him to eat or leave him be ??? What if he gets hungry later? Usually let him eat for up to hour after shot
If I skip shot tonight do I let him eat in the next hour as usual or withhold food til tomorrow ??
If it were me, I'd skip. Reason? Better too high for a day than too low for a minute. (Other members may have different suggestions.)
It is looking more and more like Elmo needs less and less insulin.
If he sticks like this I think you may need to have the L-insulin conversation with your vet very, very soon (like Monday).
We have no way of knowing how high he'll go Beth. I know going without insulin worries you because of his DKA. We also have no data on how effective a dose of "one drop" would be. I'd still go play with coloured water in a syringe while you give him more time to eat and you more time to think.
Unfortunately, situations like this where we have no past experience to draw upon can happen. All we can do then is make a decision we can live with and be prepared to react. Too much insulin could well drop him into hypo again and that can be immediately threatening. Generally cats don't drop immediately into DKA especially when they've been in good numbers quite a while and are otherwise healthy. DKA seems to be the lesser threat to me.
What is your gut telling you?
That's within the 20% meter reading variance allowed by law, Beth. Ain't technology grand!
Kris u r exactly right...that DKA back in July was awful.. the 3 days in hospital...them telling me he could die...not good....if I do skip shot tonight do I : 1. Let him eat within the next hour or withhold food ???? 2. Monitor BG and respond with food if it drops ??
As far as my gut goes , it is operating of two nights of little sleep and can be more prone to panic than my usual self( i know this is familiar territory to you and all here )
Beth, I understand your worry about ketones. Can you stay up to monitor Elmo through the night?
@Kris & Teasel - the board is very quiet today and I'm absolutely shattered. Would you be around to help Beth if she ran into difficulties with low numbers?
Just not sure.....should I encourage him to eat ??... he is acting normal , not sick...
If you skip his shot tonight, let him eat whenever he wants. You can monitor his BG once or twice before bed if you like. It shouldn't drop very much because his AM dose has worn off or is on the wane.
I understand your fear of DKA. Teasel was in ICU for three days at the end of March this year with a very scary, very $$$$ episode.
Yes, I'm around.
Please take care of yourself, Mogs...I see @Chris & China are currently online too...I am in great hands with the Kris/Chris es...
You can also check his ketones sometime this evening, Beth. He'll likely be fine but you'll feel better.
Glad u understand ab DKA...that was gut wrenching
I know I blubber this with regularity but I sincerely do not know what I would do without u all....this board is a gift and blessing to Elmo and I.....thank you just doesn't cover it
With Kris around to help you if numbers go low you might be OK to give as skinny a dose as you can manage.
Another question, Beth: would you be OK to get Elmo to an ER should the need arise?
We WANT to help, Beth, because we all understand how scary and confusing this is - especially when things go awry.
That's why I was suggesting you go play with coloured water in a syringe, Beth.
Speaking of DKA...do I run to ER vet if I find ketones ? Crazy as it sounds, a hypo scares me less cos I know what to do and can do it...I'm not complacent but hypo doesn't scare as much as DKA...
I feel exactly the same way about the members of FDMB. If I were to live several lifetimes I would never be able to repay the kindness and help of the people here.
I've not been through DKA but I have been through major pancreatitis episodes and also an absolute nightmare when Saoirse developed uveitis. I fully understand how such things haunt you afterwards.
The stuff where one is powerless is much harder.
Yes it's a 45 minute drive but we've done it several times
Gotta feed the Noodler. Back when I've sorted her grub.
Are weather conditions OK for the trip?
If the keto strip is negative, you're OK. If you get "trace" the usual advice here is to call a vet for input. Anything over trace warrants a trip to the vet immediately. On my Bayer KetoDiastix, the colour difference between negative and trace can be very hard to distinguish.
I use Bayer strips too... I was at fault in July for the DKA...it was early on in diagnosis, I hadn't found this board/oasis..I had no idea about home testing...just blindly gave the shots...he started acting ill so my inexperience thot hypo and I gave way too much syrup in a panic....it was totally my uninformed fault...awful
You did what you thought was right at the time and now you have more and better information to guide your actions. Don't be too hard on yourself, Beth.
Have you decided what you're going to do - no shot or a tiny drop of insulin?
Not your fault, Beth; your vet's fault. S/he didn't give you enough information (and s/he's not the exception, unfortunately ).
Beth, you are a wonderful kitty mama. Don't ever for even one second think otherwise.
Thank u, dear Mogs...really shook my over 15 year confidence in the practice...I have my own mind but did trust them pretty much...not so much anymore...that combined with the homeopathic vet I phone consult with from time to time
To shoot or not to shoot.....hmmmmmm....he is currently eating more....have been playing with color water, per ur suggestion...am amazed at the might those tiny drops contain.....still not sure....isn't 140 the number below which u don't shoot??? And he was at 150....
Here's a technique for drawing up and administering a very tiny dose of insulin:
1. Push the syringe plunger right the way down to the bottom of the syringe barrel.
2. Insert the needle into the inverted insulin vial/cartridge as normal and then push hard on the plunger.
2. Release the plunger while the needle is still in the vial. It should sip up a tiny droplet of insulin.
4. Withdraw the needle from the vial.
Have a few practice goes at this technique. On the practice runs after you have removed the needle from the vial squeeze down hard on the plunger to make sure that your technique is OK; you should see a very small droplet of insulin appear at the end of the needle.
If you're OK with the technique and wish to actually go ahead use a fresh syringe and draw up another microdose. Insert the needle into the skin tent as normal, push down hard on the syringe plunger and keep it pressed down for a count of 5 seconds (one-elephant, two-elephant, etc.) to give a chance for the droplet to be absorbed. Then retract the needle as normal. Test at the usual times.
Reading over and taking quick notes on U and Mogs posts to summarize in my head...also going to take aBG just out of curiosity here when he stops eating....
BG was 158 just now....
Also thot of his nadir today of 93 as being another indicator of shot needed or not....both his AM nadir and PMPS BG were low....still not sure....would giving him a tiny a drop as I can be a good middle ground ??
How long after PMPS test and how long after he ate (and was the food low carb?)
Yes, I think so and I really like Mogs' method described above.
The no shoot number can vary once you have a lot of data/experience. Sometimes, a microdose will be suggested instead of no dose.
Just took BG...172... just ate 4carb...has been 2 hours since pmps
The BG is a bit higher because he ate within the last 2 hours. He hasn't had any insulin so there isn't a drop as you've seen recently at +2. Have you decided about giving a tiny dose? You could wait longer and do it when he's closer to 200.
Playing with water...there r approximately 5 drops in the syringe when placed at .25 and squeezed out drop by drop...what would be a micro dose considering current BG of 172...
At 200 could give .25 regular dose???
Highly inaccurate, but let's say that if 5 drops = 0.25 u, then each drop is about 0.05 u. Your choice - one drop or two drops?
I think I'll go with two
Are you going to be able to adjust your shot schedule? If it's already been 2 hours since PMPS, you're going to need to adjust the shot for a few cycles
Sorry, I wasn't clear. I should have said a micro dose of a drop or two, NOT 0.25 u.
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