? 08/27 Kirby AMPS 516 +6: 228, PMPS 105. +1: 136. +2:83. +3: 77, +4: 113(AlphaTrak)

Good morning, Kirby seems to be feeling a bit better overall. He tested at 516 this morning AMPS on AlphaTrak but surprisingly he was at 724 at +4, last night.

I'm hoping to test for ketones but haven't been successful in getting a urine sample yet.

I read that it is normal for a cat's levels to increase during the first few days of Lantus use. I wonder if that is where the 724 came from. My vet wants to keep him at 2 units for the time being to allow him to get adjusted to the Lantus before changing the dose.

 

I posted I think on yesterday thread. Here's what I said

Staci, since Kirby is coming out of DKA episode, you might look into ketone meter. It is more accurate then trying to get urine sample and ketones show faster in blood than urine.

Yes, readings will be higher until depot is established.

 

Have you read the information on ketones and DKA? I was lucky never to have to worry about that with Max. @Olive & Paula took the words out of my mouth. Since high bg can contribute to DKA and the depot needs to build I’m confused at your vet’s reasoning that it’s better to start with 2 rather than 3 units. Again I have no personal experience but would be asking my vet why.

 

Kirby was at 228 (alphatrak) at +6 today. I'll speak with my vet about the dosage but this does seem to be movement in the right direction.

 

Thank you. I just ordered a ketone meter.

 

A kitty's numbers generally do not go over over the first few days when starting Lantus. The depot is building and the numbers should start to come down. There is a phenomenon we call New Dose Wonkiness, which is a temporary increase in numbers that some cats do when the Lantus dose is increased. NDW is not something you will be seeing now.

It takes 5-7 days for the depot to build when you first start Lantus. That +6 is promising. I would suggest you might want to vary your testing, maybe get another one in a couple hours. Not all cats nadir at +6 and it can vary somewhat from cycle to cycle. And a bit of housekeeping, please keep the subject line updated with the latest numbers. I was glad to see Kirby had come down from that AMPS.

The reason we all keep asking about testing for ketones is that it is extremely important to monitor ketones at this stage for cats that have recently had DKA. They can go back into DKA very quickly, ketones can go from trace to high in less than a day. DKA has to be managed by a vet and is very expensive. Preventing DKA includes plenty of food, fluids/liquids, sufficient insulin and staying and top of ketone levels. Glad you ordered a ketone meter. I would keep trying on the urinary ketone testing until it arrives. If ketones start increasing, that means the dose may need to be increased.

And one last thing, the link to your post from yesterday for continuity: https://www.felinediabetes.com/FDMB/threads/08-26-kirby-amps-670-start-lantus-day.234162/

 

Thank you for the advice. How do I update the subject line? I don't see a way so I must be missing something.

 

Near the top of your thread on the right, look where it says "Thread Tools." The pulldown menu will let you edit your title. Looks like he's making progress!

 

thank you! yes I hope so!

 

Kirby just tested 105 before dinner. Should he still get insulin if he eats his dinner?

 

Since he's so new to Lantus and responded so dramatically I personally would be nervous about doing it, but I'm also a cautious newbie, and one of the more experienced members may have better advice. You can edit the title to add the "?" in the pulldown menu to let people know you need help. Can you test him again to see if his numbers are rising or falling? (complicated by the fact that he just had dinner, but still might be helpful info.)

 

..

Level before dinner is 105 on alphatrak. Do I give him his insulin dose or skip or reduce?

 

I just gave 1.5 units per vet's advice and will retest this evening.

 

Please get a +1 and +2 and have your hypo supplies ready. We don't have enough testing data for Kirby on Lantus yet to advise you to shoot at that low a number.

In the future, if you get a Pre-shot under 150, you should stall, DON'T feed and test again in 20-30 minutes to see if the number comes up without the influence of food. Use that time to post here but make sure your subject line gets people's attention. I suggest "STALLING! NEED HELP!!" (it usually works...LOL) Once you have someone's attention, you can edit it back again

As you gain more experience and data, that "Stall point" comes down and you learn to shoot lower and lower numbers.

 

With a recent DKA cat, it's good that you shot tonight. I had thought he might be coming down during the day, one of the reasons I'd suggested another test after that +6. Then you would have know whether he was still coming down, or going back up to PMPS. Those early tests Chris suggested will help you determine if he's still coming down and how much testing you'll have to keep doing tonight.

Side note - yeah for low blues! Go Kirby!

 

Thank you! My new test strips arrived so now I can do then more frequently. Won't the +1 test be very influenced by the meal he just ate?

 

It should...but if Kirby's on a mission, he could continue to drop. We just want to make sure he does get the expected "food bump".

 

Kirby is at 136 (alphatrak) at +1.

 

Good going! See you in an hour!

 

83 at +2

 

OK....that's a pretty big drop for so early in the cycle. I'd feed him a teaspoon or 2 of medium carb food (11-15%) and test again in 30 minutes

If you don't have a medium carb food, you can mix a teaspoon of high carb with a teaspoon of low carb to make a MC

You don't want to "fill him up" in case you need him to eat more later

 

77 at almost +3 (2 hours 50 minutes) and 2 teaspoons MC. kirby's tired of being poked!

 

just fed him some more.

 

That's about the same as the 83 so that's good! He's not really dropping

You're doing great! I'd test again in 45 to 1 hour

 

thank you!

 

113 at +4

 

Yeah!!

No more food and if you could get 1 more test in an hour and he's still stable, I think you could relax

He sure is liking the Lantus a lot better than the N!

 

Thanks for your help! I fell asleep after that last post, I was wiped out. Kirby is doing well this morning, testing 190 before breakfast.