**Need help/advice**

Nightrider was low this morning. Here is the link to the conversations I had earlier

http://www.felinediabetes.com/FDMB/threads/nightriders-in-dka.150475/

I need advice on what to do next. I will check sugar @1800. Then give .5 again if >200 and recheck in 3 hrs is what I was planning. I'm using an Alpha Track 2.
History: Nightrider has been home for 2.5 days after 3+ days of kitty ICU for DKA, we have just been diagnosed. we're just beginning our journey. Side note: he's doing well. eating well, purring, drinking water (not excessively)

 

Welcome to Lantus/Lev Land.

It will help us enormously if you can set up a spreadsheet so it's easier for you and us to follow your kitty's numbers. The instructions for setting up a spreadsheet are in this link.

I'm not sure when your 1800 hours is. We are scattered all over the various time zones. How long from when you posted is your shot time?

It looks like a dose of 0.5u put your AM numbers very low (28). The dilemma here is that with a cat recently discharged from the hospital after DKA, you want to get as much insulin into him as possible.It may be wise to reduce the insulin to 0.25u twice a day but I would like to get some experienced members to chime in. DKA is typically the result of an infection/inflammation, not eating, and not enough insulin. Hence the balancing act with insulin and low numbers. You may need to be feeding a higher carb food in order to insure that Nightrider is getting the needed amount of insulin and keeping his numbers out of a danger zone. Given the recent DKA, I would not encourage you to skip shots.

Are you testing for ketones? If not, please get Ketostix at a pharmacy if you want to test for urinary ketones. The alternative is a meter which will allow you to test for blood ketones. The latter is more accurate and to the minute but the strips are expensive. There is a machine made by Novamax and the Precision Xtra.

 

Hi Jen,
Welcome--you are in the right place!

 

I’m going to bring his BG info forward for this thread as it is easier than going back and forth to the other thread.

Jen...I can quickly do a spreadsheet for Nightrider if you like. I’ll send you a private message so if you look in the upper right corner, you’ll see “Inbox” and a number by it. Click there and you’ll see my PM.

If I’m reading this correctly, last Tuesday was his very first dose of lantus or if not, when was it and I believe he was started on 1u? Do you have any of the BGs and doses while he was in the hospital? Then he got low (35) by his AMBG yesterday morning so we know 1u is way too much insulin for him. The low numbers caused him to bounce way up last night so you gave a reduced dose of 0.5u (very smart) at PMPS and he was low again this morning at AMBG (28) and appears he stayed low for over two hours (to +14). Because lantus is a depot insulin, “normally” we would think that his numbers today were still from the 1u depot although the skipped shot at AMBG 1/9 should have drained the depot a bit.

I also have the same concerns as Sienne with a cat recovering from DKA....we have to be cautious about taking the dose down too much. OTOH, we sure don’t want him in the 20s or 30s on any meter but especially not on an AT (which would “typically” read a tiny bit higher at these low numbers). If we weren’t dealing with DKA, I’d definitely think about reducing to 0.25u to drain the depot a little more.

How is he doing.....is he eating? Drinking? Is he on antibiotics? If the answer to all of those questions is “yes”, I might be tempted to drop the dose to 0.25u and test twice a day for ketones. If he’s eating, drinking, etc., then the possibility of DKA is pretty low (nonexistent?) but things can change rapidly. So I’m thinking if you continue to monitor the ketones and he continues to eat and drink really well (and I’d push the fluids by adding a couple of tsps of water to every single meal), then you could reduce the dose to 0.25u BUT raise it back to 0.5u if you see any ketones or he starts to become inappetent. The other option is, as Sienne suggested, feed a higher low carb food (10% calories from carbs) in order to get a bit more insulin in him and if he’s not eating well or drinking, I’d definitely be more prone to try this approach and stay on top of monitoring his BG frequently to catch any drops before they get low.

Sienne put out a PM to our two most experienced members so hopefully they will also weigh in.

 

He is getting a antibiotic BID currently post Vet d/c. ( Vet could not rule out infection). I have not created a spreadsheet, yet. Working with pen and paper at this time.
Have not purchased keytone testing strips, yet.
I'm not sure I can accurately draw up .25 units.
He's eating fancy feast wet food. He had taste of the wild dry food (left from before diagnosis) and I have given him limited amounts, I have a sample of Blue Wilderness (gluten free, high protein: waiting to hear back from company re: % of carbohydrate).
1800 my time is in 34 minutes

 

BG is 394! My thoughts are give 1 unit, recheck in 3 hrs, then 3 hrs after that

 

Is he eating well? I know that there are 3 factors for DKA, infection/low insulin/not eating.

Never had a DKA with either of my diabetics so I do not feel comfortable giving dosing advice. Maybe @julie & punkin (ga) can help

 

NO!!....What you're seeing tonight is called a "bounce".....it happens when they drop too low (like today's 20's!) and the liver releases stored sugars and hormones to bring them back up

Bounces can take up to 3 days (6 cycles) to clear

We already know that 1 unit can take NightRider too low....so I wouldn't give more than .5 as long as he's eating well otherwise and test again in about 2 hours

Lantus dosing is based on how LOW it takes them....so you just have to kind of ignore the high Pre-shot numbers to keep him safe

 

ok. we'll do that, then test him in 2 hrs.
he is eating well

 

You're going to need to adjust your thinking about insulin. Lantus does not act like a bolus insulin. If you try to use it that way, you will be fighting with symptomatic hypoglycemia with every shot. The AMPS number this morning gave you a reasonable idea of where the 0.5u dose will take your kitty's numbers. I would not dose more than 0.5u and I'm leaning more toward 0.25u.

The other issue with Lantus is that there is carryover from previous, higher doses. This is due to it being a depot insulin.

 

Do you have syringes with half unit markings? They make doing the .25 doses a lot easier

Here's what .25 looks like (and what's most important is not that it's exactly .25 but that whatever you decide .25 is is as consistent as possible)

 

I do not have syringes with half markings. I will look for those. Thank you.
I read somewhere that Freestyle Lite strips are compatible with Alpha Track 2. can anyone confirm.

 

If you live in the US, you can get them at WalMart .....their Relion brand syringes come with half unit markings

There are several other brands that also have them but you may have to call around (and possibly even actually go LOOK at them) to find them....a lot of pharmacists don't seem to know that they DO make syringes with half unit markings!!

These are the ones from WalMart

 

There are members here that do that but, I, personally, would never do it and I also have an AT2. The meters are calibrated differently. Would a human use an AT2 strip in their human meter just because it looked like a FS lite strip? Probably not. I know some members have run side-by-side tests using the FS lite strips but for me, my baby girl’s safety was always first and I would not take that chance.

Many members use a ReliOn Micro or Confirm meter from Wal Mart. The strips are much cheaper and easily accessible if you run out. You are looking for trends. You can look on my Gracie’s SS and I’ve got a tab where I ran comparisons on my Micro and AT2. You can see the trends there although, based on my pretty extensive knowledge about meters , I have never been comfortable extrapolating data for comparisons any further than the two meters I, personally, am using. In other words, I wouldn’t say that a Micro you have would read the same exact numbers as mine or that the number you get on a specific Micro would be equivalent to the number I got on my AT2. I used my AT2 primarily to check low numbers to see if Gracie was as low as the Micro might indicate (Micros “generally” read lower than the AT2 at low numbers).

I agree on the dose that you should not shoot 1u. He’s done with that dose at least for now.

 

Just wanted to say hello and welcome you to the group! I was asked to look in here to see if there was anything I could add. I think the ladies have given you some sound advice. I don't have a lot to add at this time, but I imagine we'll be talking again.

I did want to mention the methods used on the FDMB to regulate our kitties give reference numbers for blood glucose meters calibrated for humans, not pet-specific meters. You may want to consider using a human meter. Like others have mentioned, the bonus is it's a whole lot cheaper to go with a human meter.

Hope to see you posting often!
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