? Vegetable finally at 10.2 (184) delay shooting

So miss vegetable decided her blood sugar was going to keep dropping this afternoon & she got down to 1.7

I had my hypo tools ready & fed her some high calorie wet food, about 6 pieces of greenies kitty treats & a quarter of a glucose tablet dissolved in water. That brought her up to 2.2 I repeated the food, treats & glucose again & re-tested in 10 minutes but she didn't want to eat anymore food so just the treats & glucose tablet & she's now up to 3.7 it's been about 30 minutes now since the original 1.7

How long/often should I be testing after a hypo? Would a safe number to try to relax a bit be around 4.5?

 

You want to keep testing every half hour now until you get two rising numbers that aren't food influenced then you can back off to every 45mins for a couple of tests and if she's still rising or at least not falling you should be okay. If she starts dropping back again more high carb - gravy food is best please get some when you have a chance. If she won't eat you can rub syrup on her gums. The reason for this, rather than a certain number, is that the high carb food/syrup can wear off and she could start dropping again.

 

Here's the info on handling low numbers. Lots of folks print this out or bookmark the post so they have it handy. (It's also in the sticky on shooting and handling low numbers.)

(Just as an FYI, it's really helpful if you can give your numbers in US forma (i.e., 31 vs 1.7). The majority of the people here are in the US and won't recognize how low (or high) the numbers are if you use mmol/L rather than mg/dL which is what we're used to.)

 

Ok thank you for the info. I have gravy but she doesn't like it & refuses to eat it. DH gave her some honey this morning when she got to 67 just to make sure she didn't drop to low since she's recovering from keytones. Here is the condo from earlier

http://www.felinediabetes.com/FDMB/threads/8-06-vegetable-amps-12-8.142203/

I will keep checking her every 45 minutes now. She's not eating very much but was sniffing her food so I gave her a Zantac about 15 minutes ago to see if that would encourage her to eat. If j can't get her to eat some more food now I'll start syringe feeding her a little bit to make sure she doesn't start dropping again.

 

If you have kibble, try mixing with water and smashing it up to a soup like consistency. Sometimes it's easier for them to drink their calories, especially if they have nausea.

She needs to have more food in her for the insulin, so you might have to supplement with syringe feeding, even if she's eating some on her own. Higher carb food will help keep the sugars up, don't worry about needing to feed her low carb foods. Carbs or ok when they have ketones.

 

You can find some foods without gravy that are still high carb. Merck Cowboy Cookout has potatoes in it and is 18%, It is chunky, not really gravy. I've stopped giving it because it's higher phosphorus, but there are some good kidney friendly but higher carb options in the Weruva cans or pouches (Cats in the Kitchen). Alternatively, just add a drop of corn syrup or honey to her regular low carb food.

For the US crowd out there 1.7 = 31. 2.8 = 50 as a reference point.

 

I fed her some wet food mixed with some water & a little bit of honey mixed in with a syringe. I'll just keep supplementing her food with some Syringe fed food for a couple days until she starts eating more & I'll add some honey to it to keep her sugars up a little bit.

 

Jennifer, how long ago was the 31? Have you tested again?

 

I tested every 10 to 20 minutes until she got up to 4.5 (81), then I just tested again about 5 minutes ago & she's up to 5.6 (101). It's been about 3 hours now since her 1.7 (31).

She just ate a little bit more food & I'll feed her with a syringe shortly. I'll test again in half an hour just before her pm shot to see how she is doing then hopefully shoot but I may have to delay her pm shot by a little bit, I'll see how she is when it comes time.

 

Thanks for the update. You are doing a great job!!!!

 

glad she's moved up some....
next time... since she doesn't like gravy....

does she like ice cream? it's a lot like the gravy.... short but helps boost those numbers....

 

Great job getting her up.

 

Thanks for all the support!

Next time I will try ice cream, she loves ice cream! she just had some baby food & pumpkin, you should have seen the look I got, apparently she doesn't like baby food & pumpkin, lol. My other kitties, they gobbled up the pumpkin like it was the best wet food they have ever had, I shouldn't be to surprised they are a bunch of garbage cans. I figured a little bit of pumpkin couldn't do the rest of them any harm so the he's h got a little bit as well. Maybe now they won't feel so left out after vegetable getting all the good stuff in their opinion.

 

She may be high enough now that you can hold off any more high carb stuff.

Just to make sure you realize that after a drop into the 30's, you want to reduce her dose by 0.25u. The dose has changed several times because of the vet visit, but I think I'd suggest you drop to 0.25u for now and see how that works.

Since Lantus is a depot insulin, when you reduce the dose to a smaller dose (like going from 1.0u to 0.5u) the depot from the 1.0u is larger than it will be at 0.5u, and that larger depot will continue to give out insulin, and therefore lowering the numbers, for as many as 6 cycles afterwards. In other words, the 1.0u that she got yesterday morning could still be influencing his BGs today and have a play in causing the 30's. So 0.25u might end up not to be enough, but for now, I would try that as the next dose.

Great job catching that drop today - your testing saved her from what could have been a disaster. Well done!

 

I just tested again & she is only at 5.6 I'm giving her some freebies kitty treats, it's about the only thing she really likes & will eat willingly more then a couple of bites right now.

 

at 101, you probably don't need to feeding her again until you give her the next shot. Unless you're bringing up low numbers, typically you want to avoid feeding in the 2 hours prior to the shot. That lets you know that the preshot test isn't artificially inflated by just having eaten carbs. Since this is +11, if you give her high carbs now then the preshot test will be higher because she just ate. The thing is that food carbs can wear off quickly, and you don't want to think she's higher than she is and have her numbers tank after the carbs wear off.

Not sure if that makes sense or not. The important part is that you don't need to feed her between now and her shot. 101 is safe.

 

I'm not sure that I would reduce with the ketones still an issue. It would be better if you can manage to hold the course -safely- on the dose you are at. When less insulin or more food is the choice, try to go with more food.

Also, post ketone strip results when you are able to get them so we have a baseline.

 

@julie & punkin (ga) i understand what your saying but vegetable is already almost an hour late for her even shot. She's just getting better from keytones so now I'm not sure what to do. Should I delay her shot tonight for another hour or so & see if she comes up some more or skip it all together or just give a reduced dose?

I've been trying hard to get her numbers up for the last 5 hours. They are coming up slowly but I'm not sure how much more I can or should feed her. I've given her almost half a bag of treats as well as about 3 table spoons of baby food that I mixed with a teaspoon of pumpkin & water plus she ate a small amount of wet food and about half a glucose tablet mixed with water.

I'm starting to get frustrated, I feel like I'm failing her.

 

You're not failing her. Taking care of a diabetic cat isn't for the faint of heart! You're saving her life - it takes more than 2 months to get a cat regulated, so don't worry about that.

The rule of thumb with a cat post-DKA is to not skip shots, but instead to use high carb food to keep the cat high enough. Have you tested her for ketones today/yesterday?

I wonder what the carb content of the treats is. Maybe it wasn't high enough to bring up her blood sugar. I don't think pumpkin would do anything to raise blood sugar. Do you have access to honey, karo (corn) syrup or maple syrup?

And tonight, are you able to monitor her if she goes low again? If you are exhausted then we need a plan B.

 

I just saw @Meya14 posted - she has more experience with ketones than I have, so I would defer to her. Punkin never had ketones.

 

Yes, if you are exhausted and aren't sure if you will be able to monitor and intervene in the night, then we do need a plan B. We need to keep her safe too. If you need to stall for a while longer for the 0.5U dose then you can shoot the following dose on the new schedule. Or you can shoot 0.25U. It's really a judgement call on your part and what you are able to do tonight.

 

I just fed her some more wet food mixed with water & honey. I'll test her again in 20 minutes & see how she's doing then decide if it's ok to shoot.

Oh & the pumpkin I put in her food was to help with constipation, the vet said she was constipated but she seems to be going ok since she came home, but the pumpkin can't hurt.

I can monitor her for s few more hours & if I have to I can set my alarm & get up every hour to test. I'm sure between DH & I we can keep an eye on her all night.

I'll check back in a bit & let you know what the plan is.

 

The pumpkin is a good source of potassium as well, which most ketone kittys are lacking.

 

sounds great, Jennifer! Meya, I sure appreciate how you've been helping with all the ketone/DKA situations in the last little while. You're a blessing!

 

Off topic: What's with it lately and all these kitties getting sick? I'm having trouble following all of them in the past week.

 

i know - we've had a lot. Lots of new kitties too - seems like every day there are several more!

sorry for hijacking your condo (thread) Jennifer! How's it going at your place? By the way, it helps if you edit your subject line throughout each day and post the latest test results. That helps keep your latest info front and center so it doesn't get missed!

 

Happens every summer.....................

 

huh.?

Sorry for the hijack.

 

I tested her about 30 minutes ago & she was still holding at 5.6 (100). Any other time I would be so happy with that number but tonight it's still to low to shoot.

Just got back from a quick trip to the store & stocked up on some wet food & other treats. She's eating whiskes turkey & giblet dinner right now, maybe that will bring her up enough to shoot at least a little bit. I'll re-check in another 30 minutes or so & see how she's doing.

 

We seem to see more DKA or post-DKA kitties in the summer months.

 

What time are you at now, Jennifer? +12 yet?

 

@julie & punkin (ga) I'm at +15 and she's finally up to 10.2 I think I'll wait & shoot .25 units in about an hour from now. I'll try to see if I can get her to eat a little bit more before I shoot.

Thanks for checking in.

Over the last 6 hours her numbers have been:
1.7, 2.2, 3.7, 3.8, 4.3, 5.6, 5.4, 5.6 & now at +15 she's at 10.2

 

Jennifer:

Ordinarily, a drop below 40 requires a mandatory dose reduction. The problem that I'm running into is that you've changed Vegetable's dose pretty much at each shot time since 8/3. Lantus dosing is based on the nadir, not on the pre-shot numbers. In part, the back-to-back changes usually result in wonky numbers. More importantly, it doesn't allow the depot to stabilize and it makes interpreting the effects of dosing next to impossible.

If you're going to stick with the 0.5u dose, please monitor carefully. If numbers are stabilizing and looking reasonable, please stick with the dose for 3 days/6 cycles. If numbers start running into the 300s, please post after 3 cycles and we can take a look at whether the dose needs to be increased. And obviously, if numbers are tanking, then a dose reduction is needed.

Even post-DKA kitties can get too much insulin.