PMPS 43! (No shot) +1 46/+1.5 62/+2 70/+2.5 94/+3 79/+4 119

Hello All,

You can read my intro here http://www.felinediabetes.com/FDMB/viewtopic.php?f=28&t=127888

JuJu's numbers were really low on Tues, so the doc advised us to skip his PM dose. Start again Thursday morning with a 50% reduction.

After giving him his AM dose on Wednesday, his BG was still dropping at AM+11. I decided to feed him and skip his PM dose for the second straight day.

Here we are Thursday morning, it's been about 20hrs since his last dose. I checked his BG and it's 420. However, I'm a bit confused by his behavior. He just ate a 1/2 can of FF Elegant Medley's. It's the most I've seen him eat in one sitting since he got sick. I did give him an appetite stimulant around 7pm lastnight. He's also being extremely lovey and vocal. Is he finally feeling better? Because if I didn't know his BG I would think he's showing HYPO symptoms. I decided to recheck his BG and it dropped to 358, roughly 40 min after eating. Should I give him 1 unit, or wait another hour and recheck? Why would it be dropping after he ate?

Also, if someone would please review his SS. Why did his BG continue to drop at the AM+11 on Wednesday? Is that depot or carryover?

I work nights, so it's my bedtime but I'm not sure if I should shoot before I go to sleep?

Quick note. JuJu has been eating mostly kibble. This morning he had the FF and last night he had Hills m/d.

Re: 11/6 JuJu AMPS 424

Welcome to LL, Matt, Ava, and JuJu!! I only had time to scan your intro post, where you received a ton of great info. You guys have done an awesome job of getting up and running very quickly - JuJu is lucky to have you!

I took a quick peak at JuJu's SS - impressive first curve! It looks like JuJu is already responding very well to insulin. He is also doing what we call "bouncing"; when the body isn't used to normal BGs, the liver basically "overreacts" and tosses a bunch of glucose-like stuff in the bloodstream to protect the body from going hypo (sorry for the lack of technical terminology...it's early here and my brain isn't fully awake yet :lol: !).

I'm sure he's also reacting from the skipped shots, as well. Lantus does need consistency - shots every 12 hours - to really work its best. And, since JuJu is a DKA kitty, you definitely want to be consistent with shooting - he needs that insulin to keep the ketones at bay.

If you are able to test as well as you did yesterday, I would stick with the 1.00U of insulin today. We do like to start testing a little earlier - usually by +2. That gives us a good idea where things MIGHT be heading for the cycle.

What you can this evening if JuJu is looking a little lower than you feel comfortable shooting is get that +11 test again, then post here. Someone is usually around and can help you make a decision about how to proceed. The numbers he had last night were very perfect, shootable numbers, but when you're new to all this, it can be scary! We're here to help you feel comfortable with all aspects of FD, so ask as many questions as you need!

Re: 11/6 JuJu AMPS 424

Also, where are you located? That just gives us a little more info so we know if we need to have "east coasters" or "west coasters" keeping their eyes peeled for you!

Re: 11/6 JuJu AMPS 424

Just wanted to stop by and say:





It looks like you shot an hour later than normal? If so, just remember that your next shot needs to be 12 hours from when you last shot, if that makes sense. I did not have a chance to read your intro yet as I am getting ready for work, but did take a look at your spreadsheet.

I agree with Amy that consistency is key and Juju's numbers last are wonderful numbers to see and shoot, but I also agree that when first starting out with this dance, shooting those lower numbers is a bit scary....there were a few times with Skoots where I did not shoot when I could, just because to me it was a "super low" number....but when you are used to high 30ss/low 400s, a number in the 100s can be scary....

Amy&TrixieCat said:

He is also doing what we call "bouncing"; when the body isn't used to normal BGs, the liver basically "overreacts" and tosses a bunch of glucose-like stuff in the bloodstream to protect the body from going hypo (sorry for the lack of technical terminology...it's early here and my brain isn't fully awake yet !)

Click to expand...

Amy, that is more technical than I get when explaining it, so

I cannot tell you how much this forum has helped me and Skooter over the past several months since we started our sugar dance....Skooter and I look forward to getting to know you all!!!

Re: 11/6 JuJu AMPS 424

Thank you both for the welcome (especially the fancy one ) and great info. Everyone here has been really nice and extremely helpful.

Since JuJu skipped his PM dose lastnight I decided to give him is AM dose at 5am (instead of 8am). This should work better because, I can shoot at 5am, then the wife can test at 7am (+2).

I'll be back for some guidance for his PMPS.

Re: 11/6 JuJu AMPS 424

Hi there and welcome to Lantus Land!

Great job getting up and running with testing and the ss.

I saw in your introductory post that Juju has had a very recent bout with DKA and HL. Although I have no experience with HL, my Black Kitty went 2 rounds with DKA (our bank account was depleted after the first round).

:!: If you have not already done so, please purchase a package of Ketostix so that you can monitor Jujus urine for the presence of ketones. This is critically important. You can find them at practically any pharmacy but do call and make sure they have them in stock beforehand. If you don't have them I urge you to get them today. Jujus urine should be tested several times per day at this time. Ketones can quickly develop to life threatening levels - my BK went from "negative' to "large" in 24 hours, which meant a second trip to the ER and hospitalization. Testing is easy, you just have to catch him in the litter box and place the strip under the urine stream for a few seconds.

At this time it's important that Juju gets enough calories, enough insulin and that any underlying infection be addressed. Hydration is also important.

You have come to the best place a diabetic kitty can be. Hang in there and hang in here. There is a world of 'tribal knowledge' that will help you get Juju well on the road to good health.

Re: 11/6 JuJu AMPS 424

Welcome to Lantus Land JuJu, Matt, and Ava

Thanks so much for linking your introductory Health thread. Very helpful to get the background.

A couple things from that thread that I'd like to address:
--I use a Relion Micro and really like it. It does, in fact, provide the time and date of testing. As you press the "up" arrow on the meter, it cycles back through each test; when it shows a BG, then just wait for a couple seconds and it will automatically show the date and time it was taken. Then press the "up" arrow again to go to the next one.

--You can buy urine ketone test strips at Walmart or even any drug store. I would highly recommend you do this and that you test him daily regardless of his numbers. All you have to do is stick the strip in fresh urine, wait 15 seconds, and then compare it to the chart on the bottle. If you see anything but "negative", please be sure and let us know. Anything more than "trace" requires a visit to the vet. Ketones can develop quickly and rapidly. If you get "trace", let us know and we'll discuss ways to get that back under control.

--it's very important that you shoot as often as possible since he's had DKA. We don't have a "no shoot number" in this forum but we do suggest that if you get a 150 or below at shot time or any number that makes you nervous, don't feed, post here for help. Our cutoff number for safe shooting is anything above 50 but we get you there gradually as you collect data (in other words, please don't shoot a 50 yet without posting for help....we can help you best maximize getting insulin into him safely). There is almost always someone here 24/7. As us west coaster types are going to bed, often the east coasters are getting up; there ight be a short time of no overlap but it's usually pretty short.

--it's great that you took advantage of the skipped shot to change the shot time so you can get a +2 every day. That is huge. I would also recommend one every cycle you can get it and always at least a before bed test in addition.

--here are some Testing and Shooting Tips that might help you a bit more.

As Amy said, JuJu is having a great response to the insulin. Newly dx cats typically want to eat a little more but it could still be the appy stimulant depending on whether you gave him mirtazapine or cyproheptadine. The former's effects last for about three days and the latter for about 12 hours. In terms of his +7 from last night being 424 and his +8 being 358, that is pretty much in meter variance. Meters can vary up to 20% so he was actually pretty flat last night.

Why did his BG continue to drop at the AM+11 on Wednesday? Is that depot or carryover?

Click to expand...

Good question but it wasn't either ;-) ;-) Two things can be occurring when a cat continues to drop that late in the cycle:
--kitty is clearing a bounce (which is what it looks like to me especially after the 70 the night before); when kitties clear bounces, they often start higher and then gradually through the day will drop and continue to drop into the next pre shot. With time and experience, you can learn to safely "shoot a dropping number" which allows you to take advantage of carryover and overlap.
--kitty is getting a "second dip". Lantus and levemir are known for their second dips. That means kitty comes down after onset from his shot, nadirs, heads back up, but at the end of the cycle will dip back down just a bit (but not as low as nadir). Second dips at PS are typically safe to shoot as long as they are above 50.

You'll want to keep a close eye on numbers as dry food is removed. We've had cats come down pretty fast in dose when there is no kibble. Usually we recommend the kibble be slowly removed so the dose can be adjusted downward slowly and you don't wake up to a really low number. If the kibble is suddenly removed or JuJu just decides something else is better, it's wise to be vigilant on the testing so we know if/when to drop the dose.

We love questions so please let us know how we can help. When you are not feeling quite so overwhelmed, please let us know; we've got tons of helpful information in this forum

Re: 11/6 JuJu AMPS 424

Thank you all for the responses. I'll read over them better later. But...

PMPS 43! I immediately gave him some of the FF Elegant Medleys that he has been eating really well all day. He ate 1/2 can AMPS, then snack at +3 and +6. Why is he so low?! Should I give him some kibble too?

There's no way I can shoot him now, right? I'm soooo confused...please help

Re: 11/6 JuJu AMPS 424

Meds:
11/1/14 Baytril 1 per 24, finished this morning
11/1/14 Amoxi, 1mL every 12, finished this morning
11/5/14 FortiFlora, one packet daily split between meals
11/5/14 Mirtazapine, 1/4 of 15mg tablet upto once a day.

Re: 11/6 JuJu AMPS 424

DId you retest that 43? If you get too little blood on the test strip, sometimes it can read low so it's always good to retest a reading like that. Don't give kibble. Do you have some food with gravy - high carb wet food? Try testing again 20 minutes after he eats.

Re: 11/6 JuJu AMPS 424

Retest 20 mins after eating...47.

He's eating the highest carb wet food I have. It's Fancy Feast Elegant Medleys. I think it's about 15% carbs. I also have the d/m but it's lower carb. He did have a couple kibbles, not much though.

Re: 11/6 JuJu AMPS 424

Do you have some honey, karo or syrup around? You could add a couple drops to his regular food to make high carb. Dry food takes longer to metabolize so wet food is better for getting numbers up quickly. The kibble is Fine, just not ideal.

Re: 11/6 JuJu AMPS 424

Gave him a spoon full of wet with a drop of honey. I'll retest in 20min.

Re: 11/6 JuJu AMPS 424

I hate to suggest skipping tonight, but it's probably best. And a lower dose tomorrow too. Let's see what others say.

Keep feeding small amounts of higher carb food the testing 20 to 30 minutes later until he's over 50. How is JuJu behaving?

Re: 11/6 JuJu AMPS 424

He seems fine. Good energy, alert, walking normal. His energy has been better overall the last 24hrs. He's not purring at the moment but he has been for most of the day.

Re: 11/6 JuJu AMPS 424

A couple of questions....

Can you manage to be off schedule again?

Do you have a stockpile of strips and high carb food/honey. I'm assuming you have the latter.

Are you able to monitor tonight?

Re: 11/6 JuJu AMPS 424

good catch on the 43! yikes!

Just so you know, the subject line that is visible on the main page is only the subject line from the first post in a thread (condo). We edit the subject line of that first post so that people checking the main page see what's going on.

I see Sienne just asked all the questions I was going to. Because you have DKA and ketones in his recent history, it might be wise to go ahead and shoot as soon as his blood sugar rises to a shootable number.

Can you recheck him every 20-30 minutes and update the subject line to reflect your new tests?

Re: 11/6 JuJu AMPS 424

Retest at +1 (No insulin administered) 46

Re: 11/6 JuJu AMPS 424 PMPS 43! (No shot) +1 46

You want to pull him up over 50. I'd give another teaspoon of food with another drop of honey in it. A little more honey than you gave last time.

recheck in 20-30 minutes.

don't give insulin unless someone advises you to. You'll need to reduce the dose no matter what, and i'm uncertain about shooting at this point. let's see how long it takes to get him up.

can you also answer Sienne's questions?

Re: 11/6 JuJu AMPS 424

Sienne and Gabby said:

A couple of questions....

Can you manage to be off schedule again?

Do you have a stockpile of strips and high carb food/honey. I'm assuming you have the latter.

Are you able to monitor tonight?

Click to expand...

I'm certainly not comfortable shooting him tonight...

Yes/Kibble/Yes

I have to be at work in an hour but my wife will be home. She usually heads to bed around 10pm and I get home around 3am.

Re: 11/6 JuJu AMPS 424 PMPS 43! (No shot) +1 46

He still needs to be monitored until he's over 50 and staying there. We don't know how long that's going to take.

Cats blood sugar can wobble and drop back down when the sugar carbs wear off.

I'd avoid giving the dry food as long as someone can monitor him now. Can you show your wife how to post so we can continue talking to her when you've gone to work, if necessary?

Re: 11/6 JuJu AMPS 424 PMPS 43! (No shot) +1 46/+1.5 62

retest at +1.5 62

Ok, no kibble. I'll show my wife how to post. Her name is Ava.

Re: 11/6 JuJu AMPS 424 PMPS 43! (No shot) +1 46/+1.5 62

Does she also give shots? or test?

It would be typical for him to "bounce" which is what cats do when they've gotten into blood sugar numbers lower than they are used to. So he may start climbing up and go high before long.

It might be possible to give his shot in the next little while if he's on his way up. Could you shoot when you get home from work? How many hours late from his regular shot time would that be?

Re: 11/6 JuJu AMPS 424 PMPS 43! (No shot) +1 46/+1.5 62

Yes, she does give shots and test. Better than me, actually.

She can shoot if advised to.

If we wait till I get home, it will be about 4am. That would be 23 hours since his last injection.

Re: 11/6 JuJu AMPS 424 PMPS 43! (No shot) +1 46/+1.5 62

If Juju's numbers start to skyrocket -- like in an hour or so -- it may e worth considering shooting.

Ordinarily, with numbers like this and with a kitty who's new to diabetes, we'd encourage skipping. However, given Juju's history of DKA and HL, skipping is a bit like playing with fire. Ketones develop when there's an infection/inflammation, a kitty isn't eating, and there's not enough insulin. While the first 2 items I'm presuming are fine, skipping falls into the "not enough insulin" category and can increase the risk for ketones developing again.

If you can get a test at +2.5, or if your wife can and if she can post, we would be in a better place to make a decision about shooting.

Re: 11/6 JuJu AMPS 424 PMPS 43! (No shot) +1 46/+1.5 62/+2 7

+2 70

He has been eating like a piggy all day, that's why I don't understand his numbers dropping over 12hrs after is AM dose.

I'll check back at +2.5

Re: 11/6 JuJu AMPS 424 PMPS 43! (No shot) +1 46/+1.5 62/+2 7

Hello!! I'm just adding a welcome from me and Billie. It looks like you are off to an awesome start with testing! That's so great. You are certainly in the right place for advice. Good luck tonight!

Re: 11/6 JuJu AMPS 424 PMPS 43! (No shot) +1 46/+1.5 62/+2 7

+2.5 94

Getting ready to test +3

Re: PMPS 43! (No shot) +1 46/+1.5 62/+2 70/+2.5 94/+3 79?

+3 79?

More food, yes?

Re: PMPS 43! (No shot) +1 46/+1.5 62/+2 70/+2.5 94/+3 79?

Can you get another test in an hour at +4?

Cats are very unique in their ability for their pancreas to heal and to begin putting out insulin again. Hard to know yet if that's happened to Juju, but it isn't uncommon for a newly diagnosed cat.

No, you don't need to feed him more at this point. Let's see if he'll coast along for a bit.

Re: PMPS 43! (No shot) +1 46/+1.5 62/+2 70/+2.5 94/+3 79?

He did eat a little more, not much though. My apologies, I didn't see your post until after I fed him again. I'm new to this so when I see a dropping number I may be quick to panic... nailbite_smile

Called work, they said I can be a little late tonight. Thankfully, they've been extremely supportive from the start of JuJu's Dx. I will have to leave in about a hour. At which point Ava will stay in touch.

I will check in at +4

Re: PMPS 43! (No shot) +1 46/+1.5 62/+2 70/+2.5 94/+3 79?

it didn't hurt to feed him - that's ok. you only need to be concerned when he heads under 50. did you just give him his regular low carb canned food?

save the high carb/honey for when he's under 50.

Re: PMPS 43! (No shot) +1 46/+1.5 62/+2 70/+2.5 94/+3 79?

Yes, I fed him FF Tuna Feast Flaked. It's around 9% carbs.

Noted <50 = High Carb Wet/Honey

Re: PMPS 43! (No shot) +1 46/+1.5 62/+2 70/+2.5 94/+3 79?

right!

Re: PMPS 43! (No shot) +1 46/+1.5 62/+2 70/+2.5 94/+3 79?

Matt

I agree with Julie that I would not feed any more at this time. We need to see if he can come up on his own without food.

We are discussing some strategies. One would be to have you shoot a reduced dose (because he earned a reduction with the 40s) at +18 which is in two hours. That is only if he's up high enough on his own without food. If you shot at 5 a.m. today, then 18 hours would be 11 pm tonight. The downside to that is if you were able to shoot at +12 from that shot, you'd be way off schedule OR one thing we often do to get back on schedule more easily is to shoot again 18 hours later instead of 12 hours. So that would put you back at shooting again at 5pm tomorrow night. Does that make sense? Summary: shoot at +8 tonight (11pm) if he's high enough and then shoot again at 5 pm Friday night.

Normally, this is not an issue but we worry because he's had DKA. Thus, our discussion . So hang in there, think about it, and we will be watching and post to help you decide.

Re: PMPS 43! (No shot) +1 46/+1.5 62/+2 70/+2.5 94/+3 79?

+4 119

My wife could administer at +18 (11pm) but she would have to set her alarm for 1am to get a +2. Not ideal but doable. She's exhausted but I told her when JuJu was 1st diagnosed that we would both have to step our game up and make sacrifices. 11am would work good for me because I could get 7hrs sleep, then test and monitor him for the remainder of the day.

I'll check back in at +5.

Thank you both, Marje and Julie, for all the help. We certainly would be lost without you and the rest of the group. I look forward to the day Ava, JuJu, and myself can put the tough times behind us and help others through this.

Re: PMPS 43! (No shot) +1 46/+1.5 62/+2 70/+2.5 94/+3 79/+4

Matt

Just to be clear, you say 11 a.m. would be ok with you but that would be your new schedule (11 a.m./11 p.m.) unless you skipped again at some point or shot an 18 hour schedule at another time.

Yes, talk to Ava and see how she feels about getting up more to test tonight. Even if he's on his way up and everyone feels it is safe to shoot at +18 (11 pm), there is no guarantee he will continue to rise. He might....but he might also onset and come back down. Ava needs to know that is a real possibility.

As some of the other ladies said, it might be best to skip and start again at 5 a.m. tomorrow just for the ease of your schedule. But we'll let you all discuss the pros/cons and then continue to watch him to see where he is by +17 or so.

Re: PMPS 43! (No shot) +1 46/+1.5 62/+2 70/+2.5 94/+3 79/+4

Yes, I understand 11am/11pm could be the new schedule. It didn't come out well, but what I was getting at is that would be perfect for me but not ideal for her. 3-5 works best for us both, but we also need to consider what works best for JuJu. We've been flexible because we know the first couple weeks are the most important and difficult.

I'll check back at +5.

I guess +17 is more accurate. Would it be best to use +13/+14/etc. in the future for cases of delayed/skipped injections?

Re: PMPS 43! (No shot) +1 46/+1.5 62/+2 70/+2.5 94/+3 79/+4

+17 175

Sounds like it would be okay to feed and shoot, but how much insulin?
1 unit or another reduction?

Also, skip his 1/4 pill of Mirtazapine or give it to him again?

Re: PMPS 43! (No shot) +1 46/+1.5 62/+2 70/+2.5 94/+3 79/+4

we definitely want you to reduce his dose.

If you shoot still tonight, are you going to be able to monitor? There's no guaranteeing that he won't just go back down.

Re: PMPS 43! (No shot) +1 46/+1.5 62/+2 70/+2.5 94/+3 79/+4

Ava said she can shoot and set her alarm for 1am to test him. Then I will be home at 3am.

Re: PMPS 43! (No shot) +1 46/+1.5 62/+2 70/+2.5 94/+3 79/+4

not ignoring you - hang on.

Re: PMPS 43! (No shot) +1 46/+1.5 62/+2 70/+2.5 94/+3 79/+4

Sorry, Matt, for the delay. We were discussing some options.

First, let's talk about shooting and then the mirtazapine.

The pro of shooting at +18 is getting some insulin into a kitty that has had a bout with DKA. If you and Ava elect to do this, we think you should just give a token dose of 0.25u for the reasons I will mention below.

The con of shooting at +18 is that Ava will need to be up at +2, test, and post. I'm two hours behind you so I will wait up to get that number. But if he's coming down, Ava will need to get up and test again, possibly before you get home. Or, let's say he's not down at +2, but when you get home at 3 a.m., Matt, which is +4, and he's down, there might not be anyone on the board to help you with low numbers. The other con is being way off schedule but we can usually work with that.

If you decide to skip, I'd shoot 0.5u at your regular time tomorrow. If you skip and see any signs of lethargy or Inappetence, vomiting, etc, call the vet immediately.

On the mirtazapine, it's typically dosed as 1/8 or 1/4 a 15 mg pill every third day but there is some recent info that the half life isn't as long as thought so it could possibly be dosed at 1/8 of a 15 mg pill every other day. IF you gave it at 7:30 last night, I wouldn't give it again until you talk to the vet.

Thoughts on the shot?

Re: PMPS 43! (No shot) +1 46/+1.5 62/+2 70/+2.5 94/+3 79/+4

Matt

Any update?

Re: PMPS 43! (No shot) +1 46/+1.5 62/+2 70/+2.5 94/+3 79/+4

Wow what a night. I'm at work, hear a thud, look around the corner and a young lady is passed out on the floor. I got her up but her legs gave out and she went limp. We got her some ice and water and kept her talking until the medics got here. I think she will be fine. Not sure if she hit her head though, so a concussion is a possibility.

I agree that it would be best to get JuJu some insulin tonight. Skipping doses is not a good habit. Ava will give him the token 0.25 dose. I will call her to make sure she's awake to test him. She has read your instructions/suggestions.

We'll skip the apps stim tonight.

If we encounter low numbers in the early am then we will do the same as earlier. 30min checks and food if he drops below 50, high carb/honey.

Also we can reference the FDMB post for handling low numbers.

Re: PMPS 43! (No shot) +1 46/+1.5 62/+2 70/+2.5 94/+3 79/+4

+18 254

Ava gave him a 0.25 injection.

Sorry for the late reply. Ava was waiting to hear from me and I was late getting back to her because of the crisis at work.

We really do appreciate you being here for us, walking us through this.

Re: PMPS 43! (No shot) +1 46/+1.5 62/+2 70/+2.5 94/+3 79/+4

Wow...I hope she is ok! It's good you were there to help her.

I'll wait for Ava to post at +2.

If numbers go low after you get home, just check to see if anyone is on. We do have a few night owls. If not, then yes, follow the instructions in "Handling Low Numbers" which is linked in my signature block. You've got the idea right and had a bit of a trial by fire already.

If he goes up and stays up, you might want to shoot 0.5u in the morning as his new dose. We are just trying to be careful tonight since all dry food is gone.

I'll see Ava shortly. Good job you all did today!

Re: PMPS 43! (No shot) +1 46/+1.5 62/+2 70/+2.5 94/+3 79/+4

Matt and Ava,

Welcome to Lantus Land! We're glad to have you. It would've been nice to have a more peaceful introduction but nailbite_smile oh well, join the club!

You're doing fabulously well and so is JuJu. You can see that you're in good hands here with many caring and knowledgeable individuals. I'm not a knowledgeable one, just a newbie; but I wanted you to know that you've found the right place!

Welcome and I hope you can get a good rest after all of this activity tonight!

Georgette and Clare

Re: PMPS 43! (No shot) +1 46/+1.5 62/+2 70/+2.5 94/+3 79/+4

PM +2 342

Ava is exhausted, she is safe to go to sleep, yes? I'll be home at +4.

Re: PMPS 43! (No shot) +1 46/+1.5 62/+2 70/+2.5 94/+3 79/+4

Yes...absolutely. You can grab a before bed when you get home if you feel more comfortable but I think he's done for the night.

She did a great job!!!

Tomorrow morning, if he's still high at 10 a.m., you could shoot then to get closer to being on schedule. But there will be more people around so you can post.

Sleep tight over there!