Martini 02/18 Food,Carryover, Depot

This disease has me thoroughly bamboozled!!
Last night 2 hours before PMPS Martini had really really runny poo and vomited. She hardly ate dinner so instead of 2.5, I shot 1.25 just in case she was sick again, and yes whatever food I had gotten into her came out projectile again.
This morning she was relatively hungry and ate pretty well. I did shoot 1.5 just in case she was sick again.
So far 6 hours later she hasn't been sick again. (Fingers crossed). No clue what caused this.
I have a few questions if someone can please help answer them.
1) How much food does a cat have to have in them to shoot 'anything' and their 'full amounts'. Assuming normal 10-12 lb cat.
2) I believe I understand 'depot' as spare tank, but carryover is confusing me. Is this carryover with her or depot or?
3) With Martini's numbers from today I don't truly understand yet again what is going on. Should I shoot 2 tonight (assuming she is eating well/not vomiting) and then work up to 2.25 and 2.5 as before? Or should I stay on 1.5 and wait for a few days to see what happens to her numbers? (Pretty sure they will shoot up again after the depot clears a bit, is this correct?) Next test in 15 or so minutes to see she does not go much lower.
4) Why so low anyway with less insulin??
Thank you so much in advance.

 

Trying to answer a bit, as best I can.

1) With Lantus if the cat is going to eat "later" or you can feed during the cycle it's a bit less critical than with a fast-acting insulin. We like to have "some" food on board before shooting, also to make sure the cat is eating and hungry and will continue to do so. In this case, as she threw up everything, I think you did well to shoot a reduced dose (or you could have skipped). I've seen again and again that skipping vs reduced dose doesn't make that much of a difference in the long run. It messes up the depot anyway, so if you're worried with a pukey cat, you might as well skip if you're unsure.

2) It's a bit more than a spare tank, it is the tank the insulin goes into the bloodstream from. The depot is a precipitate under the skin of an insoluble form of the insulin. It slowly dissolves into the bloodstream (chemical reactions are always equilibriums, so the size of the depot and the concentration of insulin already in the bloodstream will impact the speed of it). Carryover is, as I understand it, because the insulin in the bloodstream is not directly bioavailable, so there is also some latency (another of these equilibrium things going on). So when you give a shot of insulin, it precipitates, increases the size of the depot by quite a bit, accelerates the rate at which insulin goes into the bloodstream, and so you have more insulin in the bloodstream for a while after that -- that "while" can be longer than 12h, and that's what is called carryover. Again, as I understand it.

3) You're indeed getting the "effect" of the 2.5 depot that is still draining with the lower doses you shot. She could be low this morning because she didn't get food last night? As for what to shoot, if she is eating normally you might want to go back to where you were OR if you're concerned about the greens, go back to a reduced dose. The depot is messed up anyway, so I'd go with what you're comfortable with. But maybe more savvy people will have something a little less wishy-washy to offer.

4) Probably the food she didn't eat last night?

 

Thanks Stephanie. Great thoughts, wishy washy is not so bad. I'm concerned she will be sick again and I've shot the full 2.5 and then what do I do -just corn syrup and honey? She ate quite well this morning so I'm not sure I understand how last night's missed meal affects her lows today. I just don't know what to do. Any other advice out there before I have to shoot PMPS?

 

Maybe to reduce the chance of sickness, if she got an upset tummy, try giving her smaller portions? You can spread out the food over the first few hours of the cycle, easily.

Oh: are you testing for ketones? If you aren't, you should, to make sure that is not an issue that is creeping up. They can make a cat puke and go off their food, and if that's what's going on, it's dangerous and complicated to treat and you want to be able to act on it asap. You can get ketostix from a pharmacy.

For tonight: one thing to take into account is weather you can stick around to test and know how to deal with low numbers if she goes there. That could determine whether you go with the "normal" dose or shoot reduced. What do things look like for you tonight? Are you comfortable dealing with low numbers?

 

The depot can impact 4-6 cycles past a reduction, you could still be seeing the effects of the 2.5 unit depot today. Carryover is when you see action from a shot, beyond the time of the normal duration. When Neko was at a good dose, she could get some carryover with it seeming like the shot was lasting longer.

As for food, I was happy if Neko would eat at least 2/3 of her regular amount of food, sometime during the cycle. If needed, there were times when she was sick that I had to supplement with syringe feeding. Only once did I take a hair off of her dose because she wasn't eating and that was when she was close to asking for a reduction and gave me a low number at PMPS. I like sleep. Some cats here are grazers, you don't have to get all the food in them at the beginning of the cycle. One technique I would occasionally use is a slightly higher carb food, like 8% instead, to give me a bit of buffer.

If we do a reduced dose for whatever reason, we go back to the last good dose, which would be 2.5 units.

 

The numbers you are seeing aren't unlike other cycles where she has dipped in to green on this dose. Like Wendy and Stephanie said, the depot can be in play and still make it act like you didn't reduce the dose. I personally have never had luck with BCS dose reductions on the cycle I wanted them to impact, the cycle has always played out like I gave the full dose and subsequent cycles were impacted with higher numbers.

As far as what you shoot when Martini isn't feeling well, that has to be a "know thy cat" call. I gave Asia a full dose once when she was having some inappetence issues, she ate at shot time but then stopped eating and her numbers dropped and kept dropping. I knew if nothing else, I could put Karo in her mouth all night as needed (which is what I did). I also skipped a couple shots during that period because she wasn't eating much and she gave me a very low preshot. I hate to skip shots because when I have in the past, most of the time she gets to red and black within that 12 hours. Some people skip shots and their cat is sitting pretty in blue or yellow come shot time. But if your cat is sick, sometimes that's the best thing to do, of course, depends on the numbers you are seeing and what's going on with your cat.

What's more of a concern is figuring out what is going on with Martini vomiting and having diarrhea. If it doesn't resolve soon it would be a good idea to see your vet. I also think it's a good idea to have some meds on hand for cats of a certain age for nausea and inappetence if your vet would agree. Especially with insulin in the picture, having some cerenia and things like that are helpful when things happen after hours and you can't consult your vet. I also like Wendy's idea of feeding a higher carb food if you know appetite is an issue right now.

I hope Martini feels better soon!

 

Martini has been eating the same amount for all her 15+years - she likes it all at once or believe me I 'hear' about it! I don't check often for ketones as I don't catch her peeing and she doesn't like the 'crystal' like/celophane litters. She has always had a sensitive tummy. Thank you for the thought!
Thanks also Wendy. She definitely is not a grazer. And thank you on the dosing tonight, she has not been sick so unless she is really low, I will up it and hope for the best..

 

Thanks Stacy. Her tummy has always been sensitive. Too many stains on concrete and carpets over the years. BCS is most probably my middle name!