10/2 Heart - R Advice Please

Hello,

Follow-up to yesterday's thread (viewtopic.php?f=9&t=105549)

I'm bringing Heart home from the vet today. His BG is high again (20s, or 400s in US). I want to try this R stuff to bring it down, in addition to his regular Lantus. I want to take the high BG stress off of his system while he recovers from his DKA and his general relapse. It took me weeks to get his numbers down when he was diagnosed in 2010 (check the 2010 tab in my spreadsheet link below) and I want to kick-start some nice numbers sooner this time - want to give him a boost as he starts to normalize on Lantus. I am willing to stay up all night measuring his BG every hour if need be. Can someone give the quick and dirty on how to do this? This is my thinking - If he shoots high again tonight, give him his Lantus. And then do I also give him an R, or do I wait a few hours? And then a small amount, such as 0.5 units of the R, monitoring every hour? Is that right? I did some quick searches on a protocol but haven't found anything yet...

Thanks,

Sophia

Hi Sophia,

What time is PMPS tonight?

I put a note out to several people who are experienced with using R. Hopefully, someone will get back to you soon.

hi sophia. i bet you'll be glad to have him home!


before we begin, some questions that need answering:

• what time is pmps?

• what time was he given lantus this morning?

• when was he in the 400s today? i'm not seeing it on your spreadsheet.

• what time (+hour) was he given R this afternoon?

• you picked up some R. what is the name of the insulin (on the box)?

• your time zone is EDT?

• please test him when you get him home so you'll know if he's on the rise at his lantus shot time.

• how is his appetite? has he eaten his usual amount so far today?

• what instructions has the vet given you for at home care (fluids, meds)?

initially, you don't want to give any more than 0.1u of R:



practice measuring out that tiny amount of R.
0.1u may or may not be enough, but we have to start somewhere.

R is given in a separate syringe. do not mix lantus and R in the same syringe.

you never want the nadirs of lantus and R to overlap. in other words, you want the R to either be out of his system before nadir OR you want to give R after nadir. there are other circumstances such as seeing high numbers throughout entire cycles when R can be given at other times, but let's talk about them if they come up.

you never want to administer R as a bounce is clearing.

after administering R, you'll want test every hour for the next 4 hours or until the numbers start to rise. generally, R is out of kitty's system in about 4 hours... sometimes longer. ECID. what you want to do is collect data so you can figure out the onset, nadir, and duration of R with Heart.


this is very important:
you don't want to yank heart's numbers down with R. when we yank kitty's numbers down all it does is set them up for bounce to high numbers... not something we want to do. ideally, you want the R to only pull down kitty's numbers by 50 - 100 points... just enough for the lantus to grab onto.

using R may or may not be appropriate tonight. we have to let his numbers be our guide. just because you have the vial in the refrigerator doesn't mean you're going to use it. mine collects dust most of the time.



please answer the questions above and let's see what his BG is at shot time compared to when you brought him home.



note: sienne has contacted several of us to help guide you. please don't shoot any R without posting and asking about it. R can be a wonderful tool, but R is a strong and powerful insulin that could be dangerous if not used properly and with caution. an extra set of experienced eyes is best. we all want to keep Heart safe!

also, keep your spreadsheet updated at all times so that those helping you can see what's going on at a quick glance.


i'm working today and this evening, but will check in as often as i can. i'm sure others will be, too.


if anyone sees anything i'm forgetting... please add to the information. :mrgreen:



EDITED TO ADD:
are you using expired test strips: Expired Test Strips Experiment?
i'm not so sure it's a good idea given the circumstances. you'll want to count on the results of these tests.

Thanks for the replies. To answer the questions:

I just updated my spreadsheet with the values from the vet - sorry, I just got them when I picked him up, so haven't been able to keep it up-to-date

His PMPS is at 8pm EST

He was given the R yesterday afternoon, according to the notes, Novo-Rapid insulin 1 unit at 2:30pm, which was +6.5

I haven't picked up any R yet, and yes, if I get some R, I'd get new test strips

Appetite is good, and so is bowel movement apparently - as I'm writing this, he came to the litter box beside me and left a nice steamy pile. Ugh.

Vet instructions are observation (obviously), 2 units of Lantus 2x per day, make sure he keeps eating and drinking normally, and come back in a week for follow-up. And back after that for a dental.

I'm wondering if I should wait until tomorrow night to try the R - give him 24 hours to get settled in again and recover from the stress of the vet's office, and give me 24 hours to see how his BG goes

hi sophia,

still on the information gathering phase - so just to be clear, the test strips that you're using right now are past their expiration date? right?

Yep.

Hi Sophia,

A couple of people sent me to this thread to see if I can help out. Jill is working, but will be back when she is able. Is it correct that the vet gave an additional 0.5 units of Lantus at +2.5? But no R today? If so, let's see what the PMPS number is before deciding what/when to shoot. Normally we would not recommend giving Lantus just 9.5 hours after a shot, even a partial one. You could run into extended duration or double nadirs. However, in this case it might be a good way to stay ahead of any bounce that is coming. It's probably not a good idea to try R for the first time under these circumstances, unless PMPS shows that a bounce is clearly starting. Let's see where he is.

For sure I would get new test strips before PMPS tonight. The old ones might work ok, but if I had a cat fresh out of the hospital I wouldn't want to take chances.

I want to get this posted before your PMPS, but I did want to point out one thing on his spreadsheet. Jill mentioned that you don't want to give so much R that it yanks the numbers down too far, setting off another bounce. Yesterday they gave 1 unit and it pulled him down over 350 points! Then he bounced to the moon. They can do that at the vet because they have the dextrose drips to pull the numbers up quickly. If you are using less (much less!) than 1 unit of R, hopefully that will not pull him down so fast and not make him bounce quite so much. But as she said, do post for advice before giving R for the first time.

He was at 320 today PMPS, so I gave him his 2 units and will leave it at that. He's been eating, but just a little. No drinking yet, but then again he did leave the vet fully rehydrated. Used the bathroom again, so I tested for ketones (negative)

Hi Sophia,

Great on the negative ketones!

Can you get a +2 or +3 tonight? I am just wondering if the shot at AMPS, and the "chaser" at +2.5 today might have, or still might cause "wonky timing" as far as onsets and nadirs for this cycle.

Yep, will definitely get one.... Just a bit too early now....

dodgingwrenches said:

He was at 320 today PMPS, so I gave him his 2 units and will leave it at that. He's been eating, but just a little. No drinking yet, but then again he did leave the vet fully rehydrated. Used the bathroom again, so I tested for ketones (negative)

Click to expand...

hip-hip-hooray for negative ketones!!!

what you'll want to do is try to get as much food into him as he should be eating/normally eats everyday even if it means syringe feeding. however, first i'd try enticements to get him to eat on his own such as these ideas from member cheryl and Winnie:

Here are some things you can do do entice your cat to eat:

-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.

-making a buffet to give him choices
- heating food

sprinkle food with :
- forta flora -- a probiotic you can get at vets or online. is very smelly and cats love the taste of it.
- parm. cheese
- smashed crumbles of dry food
- bonito tuna flakes
- halo chicken treats -- crumble into dust over food -- my Wolfie loves this stuff.
- 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

If enticements don't work, you should consider:
-assist feeding ( syringe or make little meatballs and place in mouth)
-and/or talking to your vet about appetite stimulents ( mirtazapine or cyproheptidine)


alex is partial to cheetos and cheeze-it white cheddar crackers. if all else fails i'll crumble some of these up to sprinkle on her food. :mrgreen:

+2.5 after PMPS is 266

So far he is eating a little... Not up to his usual chow-down level, but he's come out to nibble a few times this evening. I'll see how his appetite is tomorrow.

nice! he's heading in the right direction. :mrgreen:
see if it's possible to get a little more food into him before you go to bed tonight...

I forgot to ask earlier...did the vet send any fluids home with Heart?

Hi Carl,

No, he didn't send home any fluids. And I honestly forgot to ask for some. Just told me to make sure he was eating and drinking. And so far he is. Woke up this morning and he asked for his breakfast. Came back a few minutes later for water, and now he's in the litter box

Sophia

Sophia,
I am off for the next three days and can help you with R should you choose to use it. I am waiting for you to open a new condo. I see that he is 315 this morning, so I think I would wait to see if he's dropping into the 200s before giving any R. Did you buy the R insulin and test strips, yet? How is his appetite this morning?
Test again at +1 and let's see where he's at.

Hi Dyana,

He's come around for food and water a few times int he past two hours. And I even got him to play a tiny bit with a catnip mouse. Now he's back under the bed for a nap, so I'll leave him be. Have to head to work and will then come home at lunch and get a +4.5. I don't want to prick him too much at the moment, because they did a number on his ears at the animal hospital (obviously not as good a pricker as I am - I've become a pro ;-) ) So I'm waiting to see how the day goes.... Maybe will do R on the weekend if it's not looking better. But then, I'm wondering how necessary is this? Is this something newer that is done here? I don't remember reading about this at all when he was diagnosed three years ago. Is it only done if there are ketones? Those were negative this morning. Or is this done more often now just to get high numbers under control?

Sophia

I will only be around on Saturday, as I have to work on Sunday.

R is only recommended to be given with guidance from someone experienced with it to help you. If a cat just had ketones, they can come back. I would make sure that he eats at least as much as he normally does. Like Jill said, syringe him with food if necessary. Ketones are a mix of not enough insulin, not enough food, and infection or a systematic stress. You don't want him to get ketones again. I would test him at least daily for a couple weeks at least, and then whenever he has high numbers or is inappetant or lethargic or acts out of sorts.

I'm so glad his ketones were negative this morning.

dodgingwrenches said:

So I'm waiting to see how the day goes.... Maybe will do R on the weekend if it's not looking better. But then, I'm wondering how necessary is this? Is this something newer that is done here? I don't remember reading about this at all when he was diagnosed three years ago. Is it only done if there are ketones? Those were negative this morning. Or is this done more often now just to get high numbers under control?

Click to expand...

good morning, sophia! eating, drinking, playing, and negative ketones are all good signs! :mrgreen:

in addition to what dyana said...

using R at home is and has been typical if kitty is throwing trace ketones or just coming off of DKA if BG numbers remain high. there's more of an urgency to using R at home when kitty is throwing trace ketones. however, some will use R simply to get high numbers under control.

"Ketones in the urine, as detected by urine testing stix or a blood ketone testing meter[1], may indicate the beginning of diabetic ketoacidosis (DKA), a dangerous and often quickly fatal condition caused by low insulin levels combined with certain other systemic stresses. DKA can be fixed if caught quickly." [emphasis mine]
http://petdiabetes.wikia.com/wiki/Ketoacidosis



we've been following your lead (first post in this thread):

"I'm bringing Heart home from the vet today. His BG is high again (20s, or 400s in US). I want to try this R stuff to bring it down, in addition to his regular Lantus. I want to take the high BG stress off of his system while he recovers from his DKA and his general relapse. It took me weeks to get his numbers down when he was diagnosed in 2010 (check the 2010 tab in my spreadsheet link below) and I want to kick-start some nice numbers sooner this time - want to give him a boost as he starts to normalize on Lantus. I am willing to stay up all night measuring his BG every hour if need be. Can someone give the quick and dirty on how to do this? This is my thinking - If he shoots high again tonight, give him his Lantus. And then do I also give him an R, or do I wait a few hours? And then a small amount, such as 0.5 units of the R, monitoring every hour? Is that right? I did some quick searches on a protocol but haven't found anything yet..."
http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=105610&p=1121575#p1121575



let us know how we can help...