9/6 Zeke-PM Shot:Prob COMPLETE furShot-Ketones question

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MrZ

MrZ

Member Since 2013
So, really, there's nothing we can do, huh? Have to wait for AM?

!%?!$%?!@??##?#? - Very likely we have a complete fur shot. Lost opportunity. Can't shoot again and risk OD. !$%&!@%!!!!!

{BEFORE SHOT}

OK, here we are. Decision time. Please help! He's above 130 so I guess we shoot full dose of 1.25u? Yes? Oops, got a little panicky. His +11 = 157 (AT); PMPS=192. I feel much less nervous but I know it's gonna {it could have been} an active cycle. Let's go surfing!!! {Ah, not!!}


Since we started testing Zeke’s BGs, we’ve been using an AlphaTrak. Unfortunately, yesterday we were running low on strips so we had to take his 9/5 (PM) and his 9/6 (AM) readings using the ReliOn Micro. We'll resume using Alpha Trak tonight for 9/6 (PM) data. His BGs have not been that great today. Zeke can't seem to stay <300 entirely despite having had some low numbers at times. Is this still bounce we’re seeing or an indication we need to increase his dose?

We have some questions on the protocol, specifically related to Phase 2 as reflected here: Protocol using AlphaTrak.

We decreased his dose on 9/4 and since then his BGs have sometimes been > 300 and his nadir was > 200 on one occasion (all other nadirs have been either within the normal target range or just above). We’re wondering is Zeke due for a 0.25u increase or should we wait maybe two more days?

Also, we’re having trouble understanding the following reflected in Phase 2 (highlighted in the above doc for which a link is provided), which reads:

“If nadir blood glucose concentration < 200mg/dL but peak is > 200mg/dL “

Could someone please explain what is meant by “peak” in this sentence and how exactly to apply this criteria?

Does this “peak” mean the period of peak effectiveness of Lantus, which my understanding is 5-7 hours? Does that fact that Zeke’s nadir is typically at +6 (once +7) come into play in determining if the “test” as per this sentence is met? Looking at Zeke’s ss, can you explain how we would conclude that he is or is not yet due for an increase?

Thanks,
Laura

Yesterday's condo(s):

Click here for: 9/5/13 AM info on Zeke
Click here for: 9/5/13 PM info on Zeke
 
Re: 9/6 Zeke-PMPS=157(AT); Should we shoot?

If you have plenty of strips and high carb food in the house and will be there to monitor, I think you're fine to shoot.

Any new post in your thread moves the thread to the top of the board. Rhiannon "bumped" your thread (aka condo) to the top of the board so it didn't get buried.

I honestly think you're going to find it a whole lot easier to use the modified protocol located in the sticky note at the top of the Board. Basically, what this means is that if the nadir is under 200 but the high point is over 200, you want to hold the dose for 5 - 7 days. The way we do this is based on nadir so if nadirs are under 200, hold the dose for 5 - 7 days.

Regarding Zeke's numbers, you're seeing bounces. When he's dropping into dose reduction territory, he's then bouncing into higher (over 200) numbers. This isn't unexpected. It can take roughly 72 hours for a bounce to clear but Zeke is clearing the bounces much more quickly. It's important to remember that Lantus dosing is based on the nadir. Since Zeke's nadirs are often below 100, you need to ignore the bouncy numbers.
 
Re: 9/6 Zeke-PMPS=192(AT);Prob COMPLETE fur shot. Do anythin

If the fur shot is for the pm shot.....do not re-try. You never know how much may have gotten in.
None of us try again. It is too dangerous.


I'm a little confused with your adding new information to your post.
Use the little box at the top that says Post Reply .... and put up a new comment or question....

that was why I bumped you....
each new post brings you up to the top of the forum .... whether I do it for you or you do it yourself by asking a question.....


But you are doing the right thing.... with editing the subject line with new questions.....
 
Re: 9/6 Zeke-PMPS=192(AT);Prob COMPLETE fur shot. Do anythin

Thanks Rhiannon, still learning the "protocol" on posting and such. So, what can we expect if Zeke actually got no insulin tonght? Major set back? Any medical possible side effects tonight we need to watch for?
 
Re: 9/6 Zeke-PMPS=192(AT);Prob COMPLETE fur shot. Do anythin

Oh yes. There's a lot to learn here. It's a steep learning curve. ;-)

I don't think you will have too big a set back, IF you have one. You might be back in the pink in the morning. But that could have happened anyway, Zeke seems to bounce up to pinks when he has a green bg. That will improve over time.
As Sienne said, the more important numbers are the lowest ones each cycle. Those are the driving force in dose adjustments.
 
Re: 9/6 Zeke-PMPS=192(AT);Prob COMPLETE fur shot. Do anythin

I wouldn't worry about the fur shot. The likelihood is that numbers will be high in the AM but Zeke will get back on track. If he has a history of ketones, then get a ketone test just to be safe. Fur shots happen. There's not much you can do other than get a good night's sleep.

Also, can you remove the 911?
 
Re: 9/6 Zeke-PM Shot:Prob COMPLETE furShot-AnythingToWorryAb

I removed the 911. I'm the worrying type so I was hoping for answer on the "anything to worry about since he got no insulin?" question before removing it. I do have a new question. Our vet, whose gone MIA by the way, never mentioned the need to test for ketones. After seeing the comments on ketones, we asked her about whether we needed to worry about, or test Zeke, for ketones. She said they tested him when he was diagnosed with FD and it came up negative. She further stated that we didn't need to worry about it. Do you think it's ok to follow her advice and "not worry about it"? Is the standard practice test every time BGs > 300?
 
Re: 9/6 Zeke-PM Shot:Prob COMPLETE furShot-AnythingToWorryAb

Some cats are ketone prone. Especially the ones who have had a trace amount at some point....

you can get ketostix at any pharmacy ( and walmart or walgreens) to dip in the urine. If your cat ever smells like acetone, fingernail polish remover breath, that means ketoacidosis
which can be fatal if not treated immediately.


Here's the link.....ketone info
 
It's a good thing to routinely check .... I'd get some ketostix tomorrow if you are out and about.
Hopefully Zeke is cooperative getting a urine sample.....
some use aquarium gravel.... someone catches it with a ladle ....( something my cat would never allow :lol: ) and I have been successful by covering the litter with a plastic bag....
Needs to be fresh urine....
 
Some cats are ketone prone. Especially the ones who have had a trace amount at some point....
Click to expand...
Not entirely correct. Rhiannon is right -- some cats are prone to developing ketones. Usually, but not always, cats who are prone to developing ketones have had an episode of diabetic ketoacidosis (DKA). There are cats who seem to develop them without a history of DKA, though. The basic "recipe" for ketones is not enough insulin + infection/inflammation + not eating.

Gabby has a history of DKA but she never had any ketones developing since that one episode. I grab a ketone test whenever I catch Gabby in the litter box. I look at it as a bit of prevention.
 
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