? Sebastian PMPS 42 +1 87 +2 123 +4 57 +5 135 +7 94 +8 78 +9 60 +10 68 +11 69 Ketones +9 0.8. 7u

Yesterday

AMPS is 94. I need to go read the low numbers post but I'm assuming I need to lower the dosage and monitor closer. However I'm having trouble getting him to eat. He goes and sniffs at it but doesn't want to eat.

 

Okay he's eating a bit of the beef baby food, and now a bit of the Dr Elsey. Also I know 94 isn't really low, it's just low for him, much lower than I was expecting.

 

Which method are you following? SLGS or TR? When you get a low number or one lower than you are expecting, double check it. Then you can stall (don’t give any food) and recheck in 15-20 min to see if the number is rising on its own.

 

Which method are you following? SLGS or TR? When you get a low number or one lower than you are expecting, double check it. Then you can stall (don’t give any food) and recheck in 15-20 min to see if the number is rising on its own.

 

Honestly I've read both and I don't really see what the difference is other than how frequently you adjust. I was told that since he's not on a wet food diet we're doing SLGS. We've been on the current dose for 11 cycles. I see on the guide it says if it's below 90 don't give insulin. I did two checks, one was 94 the other was 88. So it sounds like I shouldn't give insulin and test again in a bit. He's already, although not much and he's acting like he's nauseous and I think he might throw up.

 

I did not shoot this morning. Per the SLGS it says to not shoot if they're below 90 and that's where he was. +1 is 78. Blood ketones is 0.3. He didn't really eat much for breakfast but he didn't throw up. Looked like he was going to vomit for a bit, he was drooling and keep moving over to the carpet like he was going to but the Cerenia must have kicked in.

 

Sorry my internet wasn’t working. I didn’t even thing my last post went through. I’m not familiar with DKA, but I think you don’t want to skip shots with that in the picture. I’ll tag @Wendy&Neko and maybe she can offer some better advice.

 

Justin --

I want to offer a suggestion. You have a kitty that is prone to ketones developing. In this situation, ketones trump literally everything else since this can develop into a legitimate emergency in a heartbeat. The best way to keep ketones at bay is to get as much insulin and food into your cat as possible. In Sebastian's case, this means not skipping shots. Also, if you are giving Cerenia, give the pill about 30 min before a meal -- give it a chance to work before you offer food. Did your vet give you an appetite stimulant (e.g., mirtazepine or cyproheptadine)?

If numbers are dropping, I'd encourage you to intervene with food. You do not want Sebastian to earn dose reductions right now. Prop up his numbers with food as best you can. He may end up getting a dose reduction but do your best to prevent it.

With a ketone prone cat, the guidelines for a dosing method may not applying every situation.

 

Okay, we gave him his sub-q, gave him his usual dosage, and I put out a can of the FF Gravy, which he is eating right up.

 

Since this is the lowest number you have shot, make sure you start by grabbing a +1 and a +2 and +3.

The Carbs in the gravy can wear off and it's not uncommon to see numbers drop when that happens. It can take up to two hours for the carbs to wear off , but sometimes sooner.
First of all see what he is at at +1.

BTW whatever the shot time was that now becomes your new shot time, and +1 will be one hour after you shot.
To reflect accurately what has gone on this morning
The 78 would go in the amps column, so you would put 94@+12 78@+13,
Did you get another test after the 78? or did you shoot straight after that?
If the 78 was your amps then right amps@+13 if it was later amps@+13.5 (or whatever it was)

 

I'm not really following. There's no +12 or +13 columns.
78 was before he ate. 94 was about an hour later, after he ate but before I dosed him.

 

Sorry I said that backwards. 94 was before he ate, 78 was after he ate but before I dosed him.

 

Good Morning Justin. Good job shooting this morning. As it's been said, with a kitty and ketones and a recent DKA, skipping is not a good choice. The recipe for another DKA episode is + Not enough insulin + in appetence + a systemic stress or infection ( ie pancreatitis )

It is scary when they won't eat in cases like this. Have you seen the list of things to try when kitty goes off their feed?

Jill's List
-making a buffet to give him choices
sprinkle food with :
- forta flora -- a probiotic you can get at vets or online. is very smelly and cats love the taste of it.
- heating food
- parm. cheese
- smashed crumbles of dry food
- bonito tuna flakes
- halo chicken treats -- crumble into dust over food
- poor a little water from tuna in water over food ( I use low sodium/no sodium added as other kinds in water has veg. broth in it and I assume that means onions, which are toxic to cats-- check labels)
-powdered oregano. yep sounds weird . but some cats like it and it will entice them to eat.
other ideas of foods to offer your kitty to stim appy:
- trader joe tuna for cats
-baby food -- beechnut turkey and broth or chicken and broth. they have no onions or other additives. some babyfoods have onions . please read labels if you can't find beechnut.
- kentucky fried chicken
- deli turkey /chicken
- plain cooked ( boiled or baked ) chicken breast
-canned chicken for people (watch the label that their are no onions)
- chicken broth -- low sodium

Cats that are not eating much for a few days are at risk for hepatic lipidosis
Last resort to eat give Medium or the high carb, wet food

sometimes in order to get a cat to eat you even have to resort to dry it is more important that they eat. there are a couple low carb / grain free brands -- EVO and wellness core. Dr. Elsey's * I have added Young Again Zero Carb

 

Yeah, i tried most of those things. Warmed the food, used forti flora. Put out a bunch of different foods (Wellness Core Turkey & Duck, chicken baby food, turkey baby food, beef baby food, and Dr Elseys) and he didn't really want any of it. Just sniffed at it, ate maybe 2-3 kibbles of Dr Elsey and that's it. I finally put out some of the FF Gravy and he licked up the gravy but didn't eat as much as I'd like so I finally blended some up and syringe fed him, which he had no problem with and has kept down.

 

Keep up on the testing as Gill said the higher carb food wears off fast.

 

No there isn't.
Sorry I didn't make it clear.
You put all that info in the amps column and then you will have to colour it green manually.

Have a look on Georges ss for an example, look on the 2015 tab date 15/12/2015, you see I stalled that morning and the info all went into that one column. You may need to make sure that you select text wrapping on that cell so that you can see the numbers and info.

 

Okay I gotcha. Just did his +1 and it's 189

 

Looks like you earned these today shooting a green number.



You will need to really stay on top of the testing today. Is your vet open today? I’m asking because you might want to get a prescription for ondansetron 4 mg which is a human drug and you’ll have to take to the pharmacy. I’d ask for just ten with refills because it’s expensive and you’ll give 1/4 twice a day although you can dose three times a day if needed. It’s for nausea and it has been my experience that it works better than cerenia although using them in combo is perfect as they address nausea from different modalities.

If your vet is not familiar with it, as mine wasn’t, have her look it up in Merck’s. It is a great thing to have in your toolbox. If he’s not nauseous, he will eat better and if he’s drooling, he’s nauseous.

The other thing is to be careful when you give fluids. We’ve found in “some” cats, giving fluid can drop the BG. It doesn’t happen to them all and never happened to my Gracie but we’ve had enough around here that it’s smart to be cautious when thrnBG is running low until you know if it has that effect on him.

 

That's good. Well he's gone up not surprising as the shot will more than likely not have onset and he's had some HC.
No food now and grab that +2.
See if we can see when he onsets, he may be starting a bounce, since he probably hasn't seen any green in quite a while, but you never know.

When I saw that green this morning, I thought 'hmm that 110, doesn't look so out of place now'

 

Yeah, I'll be testing every hour, maybe every half if he gets low again. Vet is open today, just called them and they're prepping an ondansetron (that's a mouthful to pronounce) rx for him right now.

 

It's been 4 years, but back then I found my local grocery store pharmacy sold Ondansetron for $3.00 a pill and Costco sold them for $0.30 a pill, so I've always found it pays to shop around. You don't need a Costco membership to use their pharmacy. Just saying.

 

It’s also known as zofran You also want to give it 30-45 mins before he eats; when you give the cerenia, you can also give the zofran but the latter can be dosed more often and that’s a good thing!

 

Justin, when you have a chance or some time, can you add his ketone numbers to the remarks column in your spreadsheet and maybe how much he ate and how he's feeling. Those extra remarks may help you in the future to look back on in a similar situation, and will help others to help you.

I would get another test before running out to the vet and/or then the pharmacy to make sure he is in safe numbers.

I'm glad he took the syringe feeding well. That's good.

 

+2 285

 

+2 is 285. I'll add some notes.

 

I have to leave for the afternoon (I'm going to my first animal CPR class ).
Please get another ketone test this afternoon, and keep trying to get food into him throughout the day. Best Of Luck.

 

If you haven’t been to the vet, an appetite stimulant might also be a good idea. Both mirtazepine and cyproheptadine are human drugs but the vet may stock these.

 

Yeah I'll be ketone testing him around +6. I was told to hold off on food until we get another reading so we can measure the onset. +3 is coming up, so I'm assuming I should try to feed him after I get that reading?

Don't think we're going to get to the vet today since they closed at noon and I caught them pretty late with the zofran request. They're open again tomorrow at noon so I'll get to them first thing to get the zofran and some stimulant.

 

Yes, get that +3 and then see if he will eat..
But although I suggested holding off feeding, if you had had to go out feeding, to er on the side of caution would have been the correct thing to do.

It looks like he is bouncing, the +3 should confirm that. Unfortunately that means we won't be able to see where he onsets.

Here's an explanation of Bouncing taken from the new to the group sticky

• Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).

In Sebastian's case, if we assume the 110 the other day was good, it looks like it took 3 cycles for him to clear the bounce. He hit the 110, his numbers went up, then they came down this morning. So I would be looking for signs of him clearing the bounce at around 3 cycles. Of course he could clear quicker, or longer, he is a cat after all. And with the HC dry out of the equation now, what we are seeing may be a drop in his insulin requirement due to the reduction of carbohydrate in his food. The disruption of the depot with the 5u dose may have also impacted the numbers as the depot settles.

If his numbers are up then I would try and get him to eat the low carb food, hopefully he'll fo for it.

 

+3 is 256. Going try and feed him now

 

That 256 is slightly down on the +2, but given meter variance, I would say flattish.

From what you've said on the condo, the last food was at amps and that was gravy lovers? Is that correct?
If that's the case the effect of the carb in the gravy lovers will have subsided and the BG is not being influenced by that anymore.

 

Correct. I just now fed him half a can of Wellness Core wet food. I put out a few different things and he just sniffed at them and didn't eat so I finally just blended it up and syringe fed it.

Also, I caught him in the bathroom and was able to get a keto stick under him. Negative on ketones, but more interestingly, only trace on the glucose. I'm not sure what that means. The vet told me there should always be glucose in the urine for a diabetic, however with us trying to actually reach regulation and those low numbers, I would maybe suspect that to be expected?

I'm still going to do a blood ketone reading on him in a couple hours so we get an current reading since I know the urine is delayed

 

Also wanted to add I got some weight readings on him. I weighed him first thing this morning and he was 10lbs 11ozs. I weighed him again at around 1 which is when I normally do it and he's at 11lbs 4oz. He did get 200ml of sub-q about 4 hours ago so not sure how much that's factoring in.

 

I had luck with parmesan grated on top, it seemed to encourage George to eat when he was feeling crummy with his bad teeth.

There's something we refer to as the 'Renal Threshold' that's the BG point at which glucose stops spilling out into the urine, it varies from cat to cat, for George he stopped having glucose in his urine when he was below 200 BG. So a cat can be diabetic, but if he is regulated and spending most of its time below the renal threshold, then you won't see glucose in the urine. So George, is below the renal threshold at the moment, since he's mostly in the green, but he is still diabetic, just well regulated with his insulin dose.

well 200ml of water is 200g / 7 ounces, so yes I imagine as it absorbs and before it flushes out of his system it could account for the weight difference.

 

Great news.

 

+4 is 211, so it's coming down. Think I should get a +5 or can I give him a break and let him rest a bit and check back at +6 for a BG and ketone reading?

 

I would perhaps try and get him to eat a little more now and then check at +6. It looks like you have a bit of margin there to give him a little break, but no later than +6.
With the numbers dropping this is looking less like a bounce.

 

+6 got a 171 BG and a 0.2 ketone. Looking good. Gonna go syringe another half can of LC wet in this fella.

 

Has he been keeping his food down?

 

Yup, hasn't even been acting like he wants to vomit like he was doing earlier. Been taking the syringe pretty well too, once I get him "primed" he'll start licking it off the plate and the end of the tube. Not going to give him any more now and hope he'll want to eat on his own for dinner time.

Going to give him the Cerenia an hour before food tomorrow. I feel like the half hour wasn't quite enough. It kept the food down but he definitely felt nauseous.

 

It’s good to keep an eye on the blood ketones because you are right; it’s real time and the urine is delayed.

So your vet is incorrect about diabetics always having glucose in their urine. They only dump glucose in the urine when they go above the “renal threshold”. For cats, that can be anywhere between 200-250 on an AT meter. It varies by cat and there have been some cats here that hit renal threshold about 150 on a human meter. You can estimate his renal threshold, if you want, by getting urine glucose test strips (you can actually buy combo ketone/glucose urine test strips) and testing his numbers at lower levels to see when he starts getting glucose in them. It helps if the kitty has been in low blue or green for a cycle or so. Gracie never had glucose in her urine until she hit about 200 on a human meter.

I’m glad he’s keeping food down and eating from a syringe.

You are currently two hours past his normal shot time of 7:30 now. If he starts heading up, be sure you get a +10.5 test and if he’s high yellow or above, you can shoot at +11. That will get you a little closer to your normal shot time. We only shoot that much early if the BG is fairly high and they aren’t going to be clearing a bounce because shooting early “can” act as a dose increase. But if he’s high and headed up, why wait to give him insulin?

 

That's good. Do you think you've managed to get a normal amount of food into him?

I'm not sure about doubling the time for the nausea meds, having never had to use them on George. I don't know if the wear off quickly......

He may not be done dropping so far, I'd probably suggest getting another test in 2 hours, to see if he is still dropping.
If he's started to come up significantyl then you could give yourselves both a break, until +11. (the +11 can be useful if you are faced with a lower than usual PMPS, it tells you in what direction the numbers are heading, if the PS is lower tan +11 then it's a heads up, it can be your first sign that the next cycle is going to be active and will need close monitoring


If he's still dropping, then continue monitoring the cycle until you see him rising. If you need to feed him after +6 to bolster his numbers, just remember no food after +10.

It wouldn't surprise me if you see him continue to drop for a little longer.

Just want to give you the heads up I'll be heading to bed soon, its 10pm here.

 

Yeah that's what I've been using, the Keto-Disatix that have the combo. We picked them up after the p'titis attack in November and I've been using them on him almost daily. Today was the first time I've seen the glucose not maxed out.

Sounds good. Per Gill's advice I'll test again at +8 and see how we're looking.

For sure. He's had 3/4 can of wet food plus a bit of the FF gravy. The 3/4 can wet is on par with what he would normally eat in a 12 hour period, maybe even a bit more.

Have a good night and thanks for all the help. I'm pretty sure he'd have wound up in the hospital without everyone's advice on meds and food and dosing and such so we're just really, really grateful for everything.

 

Look at all those pretty new colours on Sebastian’s spreadsheet. I was always pleased when Neko’s urinalysis came back with negative glucose. My vet got used to it too, though the lab always commented to it.

At Sebastian’s weight, you can give a dose of more than 1/4 4 mg pill of ondansetron. Dosing can be 0.5 mg/kg two times a day to start and can go to double that. He is a little over 5 kg. I would start with the lower dose, and increase to half a pill if needed. BTW, Zofran is the brand name and often considerably more expensive than the generic ondansetron. In Canada the pricing is gold plated.

 

+8 is 85.

What's my next step? Test again in an hour? Half hour?

 

88 is safe, but you could try giving him a couple of teaspoons of LC food, just to see if he'll hold steady.

I would probably test again in 30 Min.

 

I'll see what the +8.5 looks like and if he's still dropping I'll give him a bit of food and do a +9 either way.

 

The idea of giving him a little food now, is that we find that a couple of teaspoons of LC as they first drop into green can help level their bg out. It's best to get ahead of the numbers than to let them overtake you.
He's drones 90pts in 2 hours (45per hour), he's sped up a bit.

 

Gotcha. Still trying to figure out that balance between staying ahead of it and overreacting. It's only a couple minutes til the .5 now but I'll keep that in mind for next time.

 

+8.5 was 73, so looks like the drop is slowing (24/hr vs 45/hr). Gave him 2tsp of wet food. I'll test him again at +9

 

+9 is 65. So what's my gameplan here over the next few hours? How frequently should I test? We're waiting for his numbers to start rising again, correct? And I'll want to stall dinner by up to 1/2 hour if they haven't yet? Will I be reducing the dosage? If I do stall and they haven't started to rise after 1/2 hour, I'll be giving HC Gravy, right? And then continuing to monitor for a few hours until that wears off and we see it rising, similar to what I did this morning?

 

I would try a bit more of LC food as long as it within two hours of his PMPS. You want to be comfortable shooting a lower number again. Those of us with plenty of data shoot anything over 50. You won't have to stall dinner unless he's lower than 50 and /or he's not eating again for you.

ETA: that is over 50 on a human meter which you have switched to.

 

Still dropping. I gave him another 2tsp of LC at +9.75 and then +10 is 48.

 

Looks like we're coming up now, +10.25 61

 

+11 is 46, back down. Not super sure what I should be doing now as far as dosing or HC food goes.

 

As per Sienne in post +7, you don't want him earning reductions right now. Can you be off with your schedule again tomorrow? If so, feed a little bit of LC food and get him up over 50. Then after 2 tests 30 minutes apart with out any more food and if he is holding over 50 shoot. Of course if he continues to drop or not come up, give a little more food. Then tomorrow's shot time will be 12 hours later.

I will try and check in on you soon. I take care of my 91 year old mom so, I just don't know how soon I can get back on.

If you need help, change your title to indicate help ASAP.

 

Not sure I understand. We're already about 2 hours off schedule and I'm not real clear on why we would stall even further instead of just feeding him a full meal. Technically yes I can stall if absolutely necessary but I'm already running way past my normal bedtime and on very little sleep and I can't continue to do this for days on end.

 

Did you feed him some after the +11?

ETA : And get anther test 30 mins from the last one and post.

 

No, the last time he ate was 2tsp of LC about 15 minutes prior to +10. He's due for his regular meal in 10 minutes.

 

When they drop that low, you want to bring him back up with some food. Grab another test please and post.

 

We have a saying to feed the forties. You can test again first, in 10 minutes, and let us know what his number is before you feed him. If he is lower than 40, then feed HC. Hopefully, he has risen by then.

 

Just tested, 42. Everyone has been saying to not feed after +10 so that's what I've been doing.

 

@Dyana , I'm glad you are here, I need to get my mom ready for bed.

 

I've been wondering about the volume of food he's eating. I'm used to him eating a lot, but he's also always been in the 300s. From what I understand, the higher BG makes them need more food. Now that he's low, he's barely eating, he'll eat a few pieces of kibble and a couple bites of wet food and that's it. It feels like it's barely anything, however my other cat who's not diabetic barely eats anything also and she maintains weight just fine. Like I'll put out 1/8 of a cup of kibble for her meal and she won't even eat all of it. So should I be expecting him to eat a lot less now that his BG is lower?

 

I know, normally we don't feed for the last 2 hours before the shot, but the 40s are getting on the edge of when it's not safe. He doesn't have much wiggle room before he goes too low, if you know what I mean.
Unfortunately, it looks like, in this case because he is so low that you will need to feed him just a little (LC or MC) to get him above 50. If you had lots more data in these (low) numbers, once he was above 50, you could shoot, but I'm afraid you do not. I'm thinking, it may be another night of not much sleep for you. I remember the nights, and if I could bring J.D. back, I would do them again. I know TMI. I'm thinking your shot schedule may be even more off than it already was. I'm thinking, you'll need to get him above 50 and hopefully, he'll either start to rise or surf (stay flat) and we can then decide on what (BCS if necessary) dose to give tonight.

Yes, they eat ravenously when they don't have enough insulin to get the food into their cells, and eat a lot less when they have enough insulin.
Have you gotten another blood ketone test lately, I didn't see if you got one this afternoon. I was away and may have missed it. Sorry.

 

I've already dosed him. I'll put out HC if I need to.

I really need to get some consistent info on how I should be treating him. I was told earlier that we never want to hold his shot because of his DKA history. I was also told not to feed him after +10. And now I've heard contradictions to both of those things in the past hour while I'm trying to scramble and figure out what to do. This is already stressful enough without all the questions and misunderstandings.

 

This might not be good advice, but if Max is low and/or dropping a lot faster than usual, I feed no matter what time it is. But I'm a chicken wimp.

 

Justin, I'm sorry it seems confusing right now and I know you are stressed. I would be too.
Did you give him 7 units? I would syringe feed him some HC now, with a couple of drops of honey or syrup mixed in if you can.

 

Yes I gave him 7 units. I put out some DM Dry and he ate a little bit of that but I'll give him some more HC stuff too.
I tried to test him for ketones but when I flipped him over to get the reading he started to lick his lips and then went and threw up what little he had eaten.

 

So...mayday mayday on getting his numbers up. #911

 

Please change your Subject Line to reflect the latest test and that you shot. I'm trying to get more eyes here.
Let us know what the test number is after 30 minutes.
I really hate to alarm you, but how far away is the nearest ER? You may want to call them to let them know you may be bringing in a cat with low blood sugar and is vomiting. They will have dextrose that they can give to him.

 

I don't think it's that bad. He's stomach has already been iffy the past few days and flipping him over immediately after he ate just upset it. He ate a bit of the DM dry after the vomit, which was all LC, and I put out a can of FF Gravy and he's eating that right now.

 

I agree with Dyana, another test in 30 minutes. Do you think you could get a couple of drops of honey or karo in him? You can add it to a tiny bit of baby food or LC if you think he'll eat. Or even add it to the HC gravy.

 

I think you're doing a good job with Sebastian tonight as far as watching, monitoring and feeding. I know it's crazy stressful when their bodies go extreme like this. I don't think it would hurt to give him a little corn syrup or honey, but I'm not the expert here.

 

IMHO, it’s ER time. With a 7u depot and a cat that is vomiting, this can get ahead of you really fast.

 

Justin, the problem is when he gets to 40, you only have a teeny tiny bit of wiggle room before it becomes an emergency hypo situation.

 

He's eating the HC fine, no more throwing up. Just trying to syringe feed him some more now and let that settle for a bit and I'll get another reading.

 

It's been over 1/2 hour since that last test. Also over 1/2 hour since he ate some kibble after the tummy upset. Time for that next test.

 

+1 87

 

I'm going to put him back on a mix of mostly DM Dry with a little Dr Elsey until the vomiting episodes are over. I don't like this sudden and rapid drop in numbers and how this is turning into an emergency every night while I don't have reliable and consistent info on how I should be managing him at these low levels.

I'm going to watch him for another hour to make sure he doesn't vomit and check his BG and I've put out an array of foods for him to eat overnight. He ate a bit of the DM wet that I put out in addition to what he already ate of the HC gravy and what I syringe fed him.

 

Whew! Looks like it's gonna be a long night for you though. Do you have to be up tomorrow?

 

Please know that the HC will wear off quickly (like in about 2 hours or less), and the latest dose of insulin will not usually onset (start to work) until about 2 hours after the shot, so you may be up for a while.
I would give him a little bit more HC (just a tablespoon or so, as you don't want him to get too full so he won't eat later when you might need him to) HC with a couple of drops of some honey or syrup to boost him up before the onset, and put a call into the ER for just in case.
Did you get the Ondansetron today?

 

No, I won't be getting that until tomorrow. I'm leaving HC out for him to eat. I'm not okay with running him borderline like this. We can't be having these emergencies every night so until I can get some consistent info on how we can safely manage him I'm going to back to his normal diet.

 

I would get at least a +2 and then a +3 and probably a +4 tonight, under this situation. I hope you can stay up more tonight, and catch up on sleep tomorrow.

 

Ketones are lo

 

That's good.

 

Another thing I want to re-evalute is his dosage. If you look at the tab for 2018, we have a curves from being on 3u for a month, 4u for a month, and 5u for a month. In May we dropped from 7u to 3u per the vet's recommendation and had no issues with ketones or anything else. If having him at 7u is causing us to have so little margin for error at the low numbers, and we can safely reduce the dosage without going DKA, I think it's worth looking at.

 

Boy do I wish that were the case. My body is very fixed in its sleep schedule and is very sensitive to extended periods of little sleep. I wake up at 3-5am regardless of when I go to bed, that's why I can get a PM +9 but even a pm +1 is pushing it. I rarely am able to catch up on sleep during the day and with the past three nights of staying up late for tests, today was already pretty rough and I'm running pretty ragged right now.

I'll grab a +2 and then I'm going to sleep for a few hours but I'll set an alarm so I can get a +4 or +5. Based on today's numbers it looks like that's about the time he started to come down.

 

I know. I never knew how to nap until I had a diabetic cat. Please let us know what his +2 is. That's coming up soon, right?
Just to let you know, when I had to test at night, I would actually take 45 minute naps on the couch and set my cell phone alarm and put it on the coffee table. I found that setting it and going to bed would put me in too deep of a sleep and I would sometimes turn off the alarm in my drowsy state. Hopefully, Sebatian's liver will kick in soon.

 

15 minutes

 

+2 123.

Gonna catch some zzzs and I'll be back for a +4

 

I just wanted to clarify for you, Justin. That not feeding after +10 is in preparation for taking a PS number. We want to know if kitty's PS number is safe to give a dose and if it's influenced by food being fed close to it, then it can misinform what you should be dosing.

BUT, if at anytime in a cycle, you see low numbers under 50, then it is USUALLY time to intervene with food. The only time you may not feed right away is during shot time granted the number isn't insanely low like under 40. So the FIRST time you test and get a low number, you don't feed just to see if kitty's body is NATURALLY heading up WITHOUT food. If kitty is doing that, then it means they will be higher once the insulin kicks in 2 hours later (lantus typically takes 2 hours after it's injected to start working for the next cycle).

The advice to not feed after +10 is to help determine dosage and prepare us to figure out if a dose is safe to give. The advice to not feed and stall during shot time is to determine if kitty's BSL are naturally headed up without food and to inform us, again, if it is safe to shoot. The advice to feed when kitty reaches a low is to keep kitty SAFE and becomes priority.

Every cat is different though. And you will get different advice and suggestions. It's up to you what you do and up to Sebastian how he responds. So take note of what you do so if in the future this happens again, you have something to refer to.

 

+4 is 57. I'm going to pump the numbers up. I'm definitely decreasing his dosage in the morning also. Given his past history of going to a lower dosage with no issue I don't think it'll be a problem.

 

He has a couple of hours to go until nadir (peak of insulin). Feed some HC, and set an alarm and test again in 1 hour.
I'll keep setting an alarm and checking on you and Sebastien.

 

Will do. He's been eating the HC Gravy on his own while I've been out here. I syringe fed him some of the LC but he didn't really want to sit through it so I only got a few tsp in. I syringe fed him a couple ml of honey also.

 

+5 135. He ate a lot of the HC gravy, pretty much a full can. That should get him through the nadir so I'm going to give myself another 2 hours nap and I'll be back to check again at +7

 

Thanks. The 135 may be mostly the honey, but good job.
I'll "see" you in 2 hours.

 

+7 is 94

 

Good.
I would test again at +10 or +11, and then you can compare that to your PS test and see if he's rising or dropping or staying the same at shot time.

I'm going to bed now. You did good with the testing and feeding tonight.

 

I'm glad his numbers are still up.
I might suggest testing a little before +10, if his numbers are down at that point you can feed him some, before that 2hr window, hopefully that would keep his head above the water till shot time and you will know the number is not food influenced.

It does look like the change to a LC diet has significantly changed the insulin requirement. We need to try and find a dose that is enough insulin to keep the DKA at bay, (especially in light of the pancreatitis flare he has at the moment) and a dose that isn't going to drop him too low.

I'll post some more on the considerations for the dose reduction in a bit.

I'm sorry it's been such a tough night.

 

I fed him a couple tsp of LC to try and get him to level off. I'll do a +10 and see where we're at. It's past 4am so I'm basically "up" at this point so I might do a +8 and/or +9 also.

Please, let me know your thoughts. Honestly my gut tells me 3 would probably be okay given his history. It seems that for whatever reason he was resistant to the Lantus while on HC and 3 has proven enough to keep him out of DKA. I want to say split the difference and do 5 but I feel like that might be too much also. So maybe, in light of the pancreatitis, 4?

My overall thoughts on the dosage are this:

• We started from a)an improper diet and b)a really high dose. Ideally we'd have started on LC from 3 and walked up, not the other way around.
• We altered his diet but didn't alter his dosage.
• History has shown that 3u was enough to keep him from DKA.
• I'm far less concerned about DKA than hypo. Yes, both are serious and deadly but his history has shown me that his DKA gives us at least a day to react to ketones starting to build up, whereas hypo is immediate. Plus, the DKA monitoring used to be done with urine strips but now I'm doing it with blood, meaning I can have even more time to react.