8.3 -- Miko AMPS 500, home from ER, ? about dosage & Merrick

Previous Condo: http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=101339

Miko is back home (YAY!) from a 2 day stay at the hospital today after vomiting on 8/1 and a likely diagnosis of pancreatitis. He was receiving Rigular in the hospital and even got down to a 178 reading at 8p last night!

He was back up to 500 AMPS today, and they restarted him on Lantus this morning. They advised he should receive between 1-2 units to be safe because he may be more responsive now if the pancreatitis has been resolved. They are considering it largely resolved because he is eating and no longer nauseous, although he seems to have been largely asymptomatic so far as the pancreatitis goes, so I'm not quite as confident.They gave him 2 units before discharge.

The discharging vet was one of the emergency vets and not the internist. He advised that if Miko's BG is >400 I should give 2 units, and if <400 to give 1 to 1.5 units.

I'm checking with my family vet, too, but are these adjustments consistent with how Lantus works? It seems to me that since it takes time to build up depots and to run through it's cycles that adjusting from injection to injection may not be entirely the way to go. Miko had just moved to 2.75u the morning he went to the ER, so the 2.0 is still a lower dosage. What do you all think?

I also have a question about MErrick canned food. Miko's been on raw, but they are advising he switch to canned at least while he is compromised. I found some Merrick Before Grain food, but it seems it is being phased out for Purrfect Bistro. Does anyone have any carb info on that type yet?

Hope everybody is having a beautiful day with their little fur friends.

Re: 8.3 -- Miko AMPS 500, home from ER, ? about dosage & Mer

Regular insulin is very potent insulin and is used by vets to get a cat's BG numbers down fast. I'm not surprised he went down to 178.
Lantus works best with consistant dosing. You are right. It sounds like the vet who gave you the instructions is used to other insulins that do not work off a depot.

I have to run out the door, but will be back to look at your dosing question. I'm glad Miko is home. :YMHUG:

Re: 8.3 -- Miko AMPS 500, home from ER, ? about dosage & Mer

No advice from me, but I'm glad Miko is home safe - sending some get well soon vines your way. I hope you can get his numbers down soon - you're in the right place for that! Have a great Caturday!

Re: 8.3 -- Miko AMPS 500, home from ER, ? about dosage & Mer

Does anyone have any carb info on that type yet?

Click to expand...

Hi, Sarah, unfortunately not yet. Not even Merrick. They told me at the beginning of summer that it would be several months (4-6?) before their labs would have nutrient/carbs info...

Sending vines to your sweet Miko!

Re: 8.3 -- Miko AMPS 500, home from ER, ? about dosage & Mer

I personally, think you should go back to the 2.75 unit dose, tonight, as long as you can get in a test or two. Ketones are nothing to mess with. Let's see if any others chime in with their opinions.

Re: 8.3 -- Miko AMPS 500, home from ER, ? about dosage & Mer

He may have to go back to the ER. He last ate about noon but became nauseous a few hours ago. He's got anti-nausea meds, but they aren't really helping. He ate a bunch of Halo chicken treats and he is drinking water, but anytime he smells other food he gags. No vomiting yet, but not looking good. I think the high BG must make the pancreatic symptoms flare up, or maybe it's just coming and going intermittently.

Not sure I'll be giving any insulin tonight unless he starts eating, but in the meantime, I talked to my vet, and she's also thinking I should adjust the dose from injection to injection. She said if his BG reads 450+ I should shoot 3 units, 300-450 2.5 units, under 300 1 unit, and under 200 none.

I'm confused and sad and worried.

Re: 8.3 -- Miko AMPS 500, home from ER, ? about dosage & Mer

With the variable appetite and vomiting, a conservative approach might be to start the Lantus at 1 unit, and then use a very tiny dose of R to deal with higher glucose levels if he eats. As he gets more stable, you could slowly increase the Lantus and phase out the R.

Re: 8.3 -- Miko AMPS 500, home from ER, ? about dosage & Mer

Hi Sarah,
The experience of most cats on this board suggests that it is not good to jump around with different doses when using Lantus. Lantus likes consistency. I hope that you can settle on a dose that you can give consistently and that allows you to follow the protocol. Also, it isn't good to skip a shot when pancreatitis is present or when ketones are an issue. Miko needs insulin.
I worry about the variable dosing suggested by your vets, but I am not knowledgeable enough to give advice for your situation. I know that you will get some good suggestions this evening, however.
Sending healing vines to Miko.

Ella & Rusty

Re: 8.3 -- Miko AMPS 500, home from ER, ? about dosage & Mer

What meds did they give you for nausea? Hopefully, you were given either Cerenia (maropitant) or Zofran (ondansatron).

I agree with Dyana. I think bringing Miko back to 2.75u makes sense. I do not agree with BJ. That's not the way R (Regular insulin) is used. Dropping the Lantus to 1.0u with numbers this high and the possiblity of active pancreatitis is a great way to court DKA developing. Right now, if Miko isn't eating, I would urge you to try finger feeding or syringe feeding. Of course, if you feel that bringing him back to the ER is necessary, your instincts were right on target previously.

If you want to use R as a bolus insulin, there are people here who can help you with doing so. Dyana and Marje have both used R.

As others have noted, Lantus is not used on a sliding scale. It will likely result in very confusing numbers if you make constant dose adjustments.

Re: 8.3 -- Miko AMPS 500, home from ER, ? about dosage & Mer

Hi Sarah! Looks like your vet isn't familiar with the way Lantus works. (like most of them it seems) You have to keep the same dose for at least 6-10 cycles to let the "depot" fill. Reductions and increases are in .25 units. It's important to go slowly so you don't miss that "perfect dose" for Miko.

Ketones are nothing to play with, and Miko needs insulin. Syringe or finger feed to get some food in too.

As high as Miko has been, I'd stick with the 2.75u as the best thing right now. He might also need a little R to get him down until the Lantus depot can fill but I'm not at all familiar with R dosing. I do know it's often used in conjunction with Lantus until the cat's under better control though.

Go with your gut on the ER vet...If you are concerned, better to be safe!

Sending healing vines to Miko!!

Re: 8.3 -- Miko AMPS 500, home from ER, ? about dosage & Mer

Thanks, all! I so appreciate your advice. He ate a tiny bit and is still eating treats so I am going to try to syringe feed before PM injection if he's still not eating. I'm a little nervous syringe feeding may make him vomit again, but I guess there's only one way to find out.

The vets are all saying that the goal right now with his Lantus injections is to bring down his blood sugar and not necessarily to manage his diabetes until he's stable. I worry that it may not be safe or effective. But I also worry that BG is so high. It really is like being b/w a rock and a hard place.

I like the idea of using R in conjunction with the Lantus but I don't think I'm going to be able to get that from anybody until at least Monday -- I don't see the emergency vets even having the knowledge I'd trust to be able to prescribe and advise on such a thing (or even the willingness to do so, although if I thought I could do it safely, I'd ask).

If he's still in the 400s or 500s and I can get food in him tonight maybe I will go back to 2.75. It scares me that the ER vet is recommending 2 units and my vet is recommending 3 for 450+. But everything scares me right now. If I can't get food in him or to stay down I am going to have to bring him back to the ER. He seems really uncomfortable tonight. He's on buprenorphine for pain and ondansetron for nausea.

Re: 8.3 -- Miko AMPS 500, home from ER, ? about dosage & Mer

You don't need a prescription for R. You can get it at any pharmacy. Before you shoot, though, make sure someone is guiding you through the process. It's very potent.

Re: 8.3 -- Miko AMPS 500, home from ER, ? about dosage & Mer

Sarah

I'm sorry he's not feeling well tonight. I know how worried you are.

We will see if one of our members experienced with shooting R to bring down numbers can help you. My experience is limited to just stopping a bounce and what you need is a whole different ball game. Sienne is right...you can buy it without a prescription. The last time I bought it, I got a vial at Costco for about $90 but that was Humulin R. I understand you can buy Novolin R at Walmart pharmacy for much less. You might want to call first.

Remember the SSs I linked for you the other night and suggested you increase .5u after four cycles? That's probably still a good approach until he starts coming down into yellow....when you can start getting Lantus in him. That suggestion might need to change if/when you shoot R....I don't know. That will depend on what his numbers are and what the membe helping you thinks.

Re: 8.3 -- Miko AMPS 500, home from ER, ? about dosage & Mer

A ray of sunshine! Miko tested at 399 for his PMPS. I thought it was a mistake so I did it again and got 405. I'm calling it a 399 so I get some pink on his chart.Then he ate his TikiCat Koolina Luau like a champ (he must have heard the words "syringe feeding" and decided to buck up). I gave him 2.5 units of Lantus. I'm hopeful this is because he's responding to the lantus but since his +6 was higher I don't want to get carried away. It may just be because he wasn't eating like a little piglet all afternoon like he likes to do.

Paws crossed that his BG keeps moving towards the yellows and blues. THANK YOU so much each of you for your support and advisement -- I'd be lost without you.

Re: 8.3 -- Miko AMPS 500, home from ER, ? about dosage & Mer

Good to read he ate at his pm feeding and glad he is home