? Still high at +3. Normal? 10/27 Ming 18 hour cycle. 265 or 14.7 PS. Dosed 6 units PMPS 28.4 / 511 s

Previous: http://www.felinediabetes.com/FDMB/threads/10-26-ming-in-hospital-what-dose-should-his-pm-be.205457/

What a wild ride tonight was.

Ming is starting an 18 hour cycle because he received 10 units of insulin in hospital. I picked him up mid day and got home around 3 pm or + 7. I guess he relaxed or his insulin caught up with him and his dose was an overdose so he was low low low when I wanted to shoot him in the PM.

I settled with 5 units. 6 would’ve been ballsy but I didn’t feel like doing damage control if he goes low.

I would like to give his PM earlier than 18 hours later. I don’t like the 8 am/pm schedule. I would prefer 7 am/pm or even 630 am/pm.

I also don’t know what dose to give! Lol. We’ll see what 5 units does.

 

How is Ming feeling? Eating ok? Me, personally, I would be conservative but Gizmo has never had ketone as a factor. What ever is decided on the dose, consistancy and schedule are important and getting the depot stable so you know what you are dealing with.

What are you feeding? All wet, low carb?

Glad Ming is home. I hate it when they are in the hospital, I think I hate it almost as much as they do

 

11.3 or 203 at +2.

Should I be worried he will drop like crazy? I’ll retest in an hour.

@LizzieInTexas Ming seems like he feels great and is eating well. He ate a whole can of FF when I fed him at +18 even though he already ate about 80% of a can at +12. He’s sleeping now but when I gave him his shot, he was playing and disturbing the things on my dresser (ie knocking things down).

I too want to go conservative. I’m so glad I didn’t shoot 7 or 6 units. My vets are going to hate me but they don’t know!!!

 

13.2 or 238 at +3.

Phew!

 

You have to do what keeps Ming safe, regardless of what your vets think. You might see that he's less volatile on Lantus so you won't be tricked into thinking he needs a huge dose because of reds and blacks in his data. I can tell you that my guy bounced like a crazy man on ProZinc - still does but much more moderately on Lantus. You were in a tricky situation when you switched to Lantus, coming off a DKA and very aggressive dosing by your vet(s). It was hard by any measure to know what his Lantus dose should be. Let these folks here help you and follow that guideline of the same dose AM and PM to the extent that you can with steroids in the mix.

 

I also gave him his pred an hour and half late. Can I still give his next pred dose at 8 pm? But also shoot him at 7 pm an hour earlier than 18 hours? Will the later pred affect anything?

Night nurse (NN) suspects pred isn’t affecting him too much anyway.

About to do a test in 10 minutes. I hope he’s in his nadir because then this cycle is working.

 

He’s at 20.8 at +6 or 374.

What should I do?

 

Also hiding under the bed now but he ate his snack

 

I gave some bupe in case he’s painful

 

Did you give insulin this AM or are you doing another long cycle? Don't worry about numbers right now. Get him on a 12/12 schedule and ask for advice on what dose to give. The Lantus depot hasn't settled yet.

 

19.8 or 356 an hour later. At least he’s not rising.

 

Okay! I didn’t give insulin AM.

Sorry he was just looking weird. Hunched and hiding. So I freaked out. The unchanging number makes me feel better and he seems to have relaxed after the bupe.

 

Sorry Kris, could you explain this to me a little?

 

Here is info on depot

http://www.felinediabetes.com/FDMB/threads/what-is-the-insulin-depot.150/

Consistent 12 hour dosing in equal doses are what you are shooting for (haha, no pun intended). Need to start somewhere and get at least 6 cycles (unless he shows you it is too much insulin (too low numbers)). After 6-8 the depot will be stable and you should get an idea what his numbers are on that dose and either hold or increase.

Are you home testing for ketones? With dka history you should be.

I am not comfortable giving dosing advise.

 

Yes I’m home. I’m going to deal with his litter box in a bit so I can test.

 

If you all don’t mind. It helps me to talk it out so I can get confirmation on whether my thinking/interpretation is correct.

After reading that link (thanks Lizzie! Which reminds me, Kris sent me a few links. I need to read those again. I read them but my mind was probably whacked out lol), my understanding is because Ming has had so many dose increases and reductions... he probably has a weird amount left in his body. And we’re waiting for it to go away?

My gut is telling me to try 6 units tonight. Also I still wonder if I can give him his pred early at 7pm. I also gave his pred LATE at 930 am this morning. But if it makes everything easier, I’ll just shoot at 8 pm

 

Not really. The depot insulin work better with consistent dosing.

It is confusing. The way I thought about it early on was like a time release medicine (it is NOT) but the depot kinda acts like a reserve and allows wave like cycles so you don't get the sharp rise/fall in BG numbers (usually ).

 

Oh ok. So when Kris said his insulin depot hasn’t settled in, it means he will rise and it’s okay but he won’t rise and spike. But in a consistently dosed cat, there is enough insulin in the depot to keep a nice steady line even if a shot is missed?

 

Yes. That is the way it should work. But if you dose 3U (example) AM and 1U PM that unsettled the depot as does skipping - sometimes you have to skip, or there is a fur shot, or an increase/decrease in dose, then your cycle count resets and it is 6 cycles to stabilize the depot again. Depot will also be in play when a reduction is earned (per the protocol) because the depot is still in play from the higher dose until the depot is drained and adjusted to the new, lower dose.

See above

I hope I am not completely confusing you.

 

Ok I THINK I sort of get it. The depot is like you said, a delayed response. So even if you reduce one cycle, the depot will drain and but it’s effect will lessen in the future because there was a reduction and it was not replenished at its “normal” dose.

I’m just talking out loud again ahha I’ll get it with time so no need to re explain everything if I’m getting annoying

Anyway, he’s steady: 20.8 or 362 two hours after his last test. This makes me feel ok. I told him he’s doing wonderfully and he’s sleeping so he ignored me. Lol

I sent a long text to the specialist saying sorry sorry but I can’t in good conscious follow your dosing advice because it’s obviously not working for when he’s at home and relaxed. I hope she doesn’t get too frustrated. I mean, I’m frustrated with her but I’m a people pleaser. NN said not to care what she thinks and she’s no help anyway LOL!!! NN has strong opinions and I love her. She said I had to see a specialist just to rule out anything. She’s been working at the clinic for 30+ years and says she hates dealing with specialist with diabetic patients. NN told me to bother her please with anything related to Ming because she feels like Ming is her cat too after caring for him and worrying about him for the last two weeks. I’m so grateful for her and also for all of you guys, of course!!

I really need to relax. Sometimes I think about testing my own BG and just seeing how crazy it is during a freak out LOL

 

My vet has taken a complete hands off approach with the FD. She says "you got that covered, so let me just concentrate on all his other issues, if you need input let me know" Works for me!

Most cats will be higher in a stressful situation. I think hospital would classify as stressful .

You can always increase the dose if necessary but, I think easing into it will be less stressful on you both especially with Ming just getting out of hospital and recovering.

Are you feeding low carb, wet food only? If so, is this a new diet for him? Diet change can drastically influence BG too.

 

I'm feeding him Fancy Feast classics during meal times which is low carb to my understanding from looking at the food chart. He WAS eating raw only before hospitalization two weeks ago and even then, he was newly transitioned from DM wet to raw.

His diet is so messed up. He wouldn't eat in hospital so we just did the give him anything he wants to eat approach. He settled with FF consistently and DM DRY. Then I saw the specialist. At the end of the consult, she said, "Let's try dry snacks and raw fed twice a day." And I said "Um... but the carbs in the dry...?" and she said, "It will be a controlled amount." And I just let it be because 1) I was worried about OTHER things like his darn pancreatitis and his BGs being in the freaking 25s-30s (BLACKS) everyday all day and 2) I thought whatever, we just need to get him to eat normally.

But then on his plan in hospital, he was being fed 1/2 can of DM wet + 2 nuggets of freeze dried raw and getting 1 tsp of DM dry 4 times a day. And I'm just like WHAT? This is not what we discussed.

I had a rough 2-3 days where I texted IM specialist and emailed her saying um.. I'm not comfortable giving him dry food if he's willing to eat FF and his BG is stinkin' ridiculously high!!!!!!!! She didn't really answer me.

I put my foot down and spoke to the hospital vet and said NO MORE DRY! I even ended up crying LOL! Not about the dry. Just about everything. I wasn't planning on crying but she was asking if I wanted a hug and being sad for me and Ming which just triggered the water buckets to tip over.

SO LONG STORY SHORT: Yes, he is getting low carb wet. His snacks are his freeze dried raw so it shouldn't affect his BG. I don't want to change his diet right now because he's a pain in the butt sometimes and won't eat freeze dried raw food but the likelihood of him eating FF is 99%. The 1% is if he hates the flavour or feeling sick.

 

Hmm. I have to get my mind out of PZI. I was thinking: 5 units last night didn't really last. But then I need to remember we are building a depot.

But yeah, hopefully someone will chime in later on in the day

 

Oh and I'm doing tests every 2 hours because I was told to do em by my vet.

 

What is your work schedule? Is there someone that can test when you are at work?

I agree. If possible no changes with anything. Get on a good schedule that works for you. Get into a routine and see where you are at in 3-5 days unless, of course, he needs less insulin.

 

I don't have work until Tuesday night. So I've got lots of time to figure this out. I'm on the night shift rotation for the next two weeks.

My schedule for the next two weeks:
Tuesday: 715 pm - 730 am (out of the house. Includes commuting time)
Wednesday: 715 pm - 730 am
Thursday: 715 pm - 730 am

And during the day, I go to sleep. But I can definitely wake up to test him.

My sister can test him at night. I'll have to ask her but she does need to sleep (unlike me).

Then I go back to day shifts 4 days a week. I work 11 hours a day plus commute (1 hour ish). I will be teaching my mom to test BG so she can test him during the day (or night) when I'm not at home.

I HOPE by two weeks, we have some resemblance of normal for Ming.

I'm worried for when I have to leave for a month in December. But I think my sister and my mom can handle it. And hopefully by then, Ming's doses make sense.

 

Don't bet any money on it. About the time you think you have some semblance of "normal" Ming will try something crazy and have you questioning everything. They are cats after all

 

Blaaaaaaaah. Cats. Hate em but also love em way too much.

I spoke to another vet (not Vet A/Dr. R or the IM specialist) and she recommended 6 units tonight. I feel ok with that. BUT AGAIN THIS IS LANTUS.

I’m going to be bald soon.

 

IM specialist just texted. Said 6.5 u tonight and 9 u tomorrow.

Hoowwww about......... just 6 for both cycles ha ha ha ha. If he’s not rising like crazy with his pred dose without a shot, I don’t think he needs 9 units.

I’m going to do the smile and nod thing as Lizzie suggested.

 

Gosh darnit. I missed his pee pee and it was all soaked up by the corn litter. Still too much litter. I’ll go get some paper pellet tomorrow.

But he’s hungry. And walking around and happy. Gonna feed his snack later.

 

Oh yes vets said it’s ok to give pred early.

 

Soooooo... my lantus vial is NOT refrigerated. I was told it doesn’t need to be once it’s opened. But now I just read the sticky and it says it needs to be.

?????? Jesus another headache.

 

Hi there

Catching up on the events of the day...I'll be right back with comments...

 

Hi Sandy!!! Thanks for helping last night

 

I keep my Lantus in the fridge on a middle shelf half way between the front and back of the shelf. It would get jostled around too much in the door and the back of the shelf could get too cold.

 

Good idea.

Would it be okay to re-refrigerate now? Or should I just refrigerate the next vial I get?

 

I'd put it in the fridge now.

 

Ok. It was opened on October 22 fyi if helpful.

Sucks that Lantus needs to be discarded after 28 days. What’s the longest people keep it for?

 

FYI - you can buy Lantus over the counter here in Ontario. Check a variety of pharmacies for the best price. I don't buy a 10 mL vial though. I buy a 5-pack of Lantus cartridges that fit inside a dosing pen. I don't buy the pens. The cartridges are 3 mL each so a total of 15 mL in the box for a little over $100 depending on where you buy them. I paid $109 at my Rexall.

No, you don't have to discard a vial after 28 days even if that's written on the box. Many here use a 10 mL vial for up to 6 months. The 5 pack of cartridges is better that way because they usually have a box expiry date two years from date of purchase. Each 3 mL cartridge can be used like a mini vial when drawing up insulin.

 

Interesting! I have one 3 ml cartridge right now. I’ll check out my local pharmacies.

 

This is really nice. He’s staying in the 20s. Even though it’s high, it’s nice. I guess his pancreas isn’t being a butt face plus the Lantus.

 

Hi there

Being that 18 hours is way past typical Lantus duration (which is somewhere in the neighborhood of 12 hours) 5,6 or 7u would poop out somewhere between 12 and 18 hours. With ketones on the scene in the very recent past skipping a shot to drain an overly full depot is risky. Doing two 18 hour cycles served to continue to get some insulin into him in an amount that would not hammer his BGs down to the lowlands and at the same time allowed the depot to drain some. Building a stable depot starts with tonight's shot. One additional thought on the depot is that it will always seek to maintain a sort of equilibrium with a given dose, however as with all things Lantus this does not happen immediately. That's why chaos often ensues when doses differ with every shot.

Regarding the pred, dose as directed and be consistent. Establishing consistency in feeding and other meds gives you a few less things to be scratching your head over when evaluating insulin needs.

So how many hours since the last shot?
how many hours until your next shot?
What dose are you thinking of for your next shot?

 

It’s been 14 hours since. Or 15 if I count the +18 hour. Sorry. Counting/math is not a strong point for me.

Would you say his 5 u dose pooped out already? Or is it still working on the surface? He was in his 20s or 370s since +6 of the 18 hour.

I plan to shoot in an hour and half. So at +17. Not +18. I don’t like the current schedule he was on which was 8 am/8pm. I want 7 am/pm.

I would prefer to give his pred at the same time as his shot. But stay consistent with that. This morning and last night was not good for me personally. I was hung up on testing him that I forgot I would need to wake up earlier to give him his pred.

I’m thinking 6 units. What do you think?

 

If it’s better to give him time to drain the depot, then I don’t mind continuing the 8am/pm schedule.

 

NN thinks 6 u is reasonable. But she also wants to stay safe and wonders if trying 5 u first is better.

I mirror her thinking. And just looking for another opinion.

 

My last vial I used for a little over 6 wks. As long as you keep in fridge it's okay. Even if you mistakenly leave it out one night, it's good.

 

As long as you can monitor and have enough supplies including some HC should you have to guide the numbers, 6u sounds reasonable to me.

I’m out for dinner tonight but will check back in later.

 

Thanks Sandy!

Let’s say 6 u was still too much. Would I reduce his dose in the AM by 0.5 u or continue with 6

 

Ok he got 6 units. He was high at 511 or 28.4. Ate well but definitely sleepy and lethargic the hour before his shot. Probably from being so high. But he woke up and walked up to his bowl when he saw me get food. Now he's sleeping again.

I wonder how long it will take him to recover from being at the vet for so long. He has his moments after his naps where he's curious and energetic. Of course, him being lethargic is also from his BGs going up and down and up and down. Ugh. But definitely today in the AM, his "energetic" moments were not as energetic as when he was low last night.

I was talking to NN and saying how I wish managing diabetic cats was a full time job. She said she'd be RICH!

Is there a magical vet out there that understands FD like we do?

 

Negative for ketones! Though, I did get some litter on the stick. I had to stick it under his bum.

 

472 at +2. Sleeping and lethargic. Praying it goes down down down. A little lower than PS. Which is normal as I read the sticky that tells me to keep testing.

The doubting duck in me thinks maybe the insulin didn't get in the skin, maybe it getting refrigerated about a week out of the fridge did something, maybe 6 u was too conservative, maybe he's bouncing, etc. etc. etc. oh god I need to be knocked out (but still able to perform testing somehow LOL)

 

Yay!
Keep up with testing - before you know it you will have figured out the best approach for you and Ming.

 

He’s still really high. 515 or 28.6. Is that... normal? At +3

 

He’s not going down. 526 or 29.2. It’s +4.

What should I do? More in AM?

 

I'd stick with the 6U for now

We need to give the depot a chance to settle in at one dose so we really know what it's doing. With the 18 hour cycle thrown in, it confuses the picture.

I'd hold the 6U dose for at least 4 cycles (we will sometimes fast track them and increase every 4 cycles instead of every 6 depending on the cat and the circumstances) and let's see what's going on at that point.

Keep testing for ketones whenever you can though. That's very important.

 

Okay.

Whatever's been happening before... is it because he's being overdosed in the AM? And maybe the stress when the hospital is in action keeps him from going hypo? And when its PM and the hospital is quiet and I'm there to watch him, he relaxes?

This is so frustrating. Doc will want me to try 9 u tomorrow in the AM and I hate lying. What if he sticks in the 400s / 25+ for another cycle? I know we should hold but I'd just like to know if he will go down even just a little bit.

I think I'll go read other people's threads and just have a feel of what others have gone through.

Edit: Reading other people's threads was a good idea. It reminded me of things: it's a marathon, not a sprint. It reconfirmed again how incredibly knowledgable and excellent you all are. That there is a FUTURE where Ming will be regulated. It's a marathon, it's a marathon, it's a marathon. Patience is a virtue.

 

30.1 or 542 at +4. I'm going to sleep now. There's no point and nothing I can do. Will check ketones in the AM.

 

I think it’s a safe bet to say we totally pi$$ed off whatever depot Ming had

Get some rest while you have the opportunity to do so.

I’m glad you wet to visit other condos. It helps put things in perspective. Check out other spreadsheets as well. Check out my Black Kittys spreadsheet for an example of a marathon. In my signature box there are links to his OTJ party and tribute videos-have a look...

You came here seeking a better way. Stick with us and give our methods a fair chance.

You won’t regret it.