12/1 Chloe 168 @ 7 am

Hi Roberta,
here's the link in the main forum https://www.felinediabetes.com/FDMB/threads/11-30-chloes-biggest-jump-ever.239340/

I nearly had a coronary when I saw the ss, it shows the 35 in the pmps window then 1u dose, it doesn't reflect that you waited to see the 164 before shooting. You need to amend that you can stack all the numbers in the pmps column 35@+12 82@+13 pmps 164 (the note in the comments that pmps was at +15hrs)

Did you shoot this morning 12 hours after you shot last night? or did you shoot after
 
Gill & George said:
Hi Roberta,
here's the link in the main forum https://www.felinediabetes.com/FDMB/threads/11-30-chloes-biggest-jump-ever.239340/

I nearly had a coronary when I saw the ss, it shows the 35 in the pmps window then 1u dose, it doesn't reflect that you waited to see the 164 before shooting. You need to amend that you can stack all the numbers in the pmps column 35@+12 82@+13 pmps 164 (the note in the comments that pmps was at +15hrs)

Did you shoot this morning 12 hours after you shot last night? or did you shoot after
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I shot this morning when I saw 'HI". She seemed to be hungry and thirsty. She pooped and peed, but I didn't catch it for ketones.
 
link to previous lantus post please remember to include the link to your previous post in every new daily condo, it helps us to look back through history and see what advice has been given

https://www.felinediabetes.com/FDMB/posts/2689753/

Red & Rover (GA) said:
No shot tonight but you will have to get Chloe up over 50 and keep her there.
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35 is absolutely not shootable, but with the DKA history, I'm not sure I would like to with hold insulin altogether. In the end waiting for the numbers to rise and shooting was possibly a better option.



Roberta and Chloe said:
I shot this morning when I saw 'HI"
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What did you shoot and how many hours after shot time last night was that?
Did you shoot the full 1unit last night?
 
Gill & George said:
link to previous lantus post please remember to include the link to your previous post in every new daily condo, it helps us to look back through history and see what advice has been given

https://www.felinediabetes.com/FDMB/posts/2689753/


35 is absolutely not shootable, but with the DKA history, I'm not sure I would like to with hold insulin altogether. In the end waiting for the numbers to rise and shooting was possibly a better option.




What did you shoot and how many hours after shot time last night was that?
Did you shoot the full 1unit last night?
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Roberta and Chloe said:
I screwed up my SS
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Don't worry about that at them moment we can fix that up for you.

Just tell me what was the sequence of events.
35 @+12 you quite rightly stalled, waited for the rise and then shot 164 at what time was that? (hours after amps)

Then this morning HI, how many hours after your pm shot?
 
Roberta and Chloe said:
That's what I did. I waited until she reached 163.
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I know, but can you tell me how many hours after amps that was and please also tell me how many hours after last nights shot was that HI this morning/which you shot. It's really important to know that. And can you confirm it was 1 u you shot on both occasions please.

I know it's horrible to see the HI, I am not so concerned about that at the moment, clearly she bounced of the 35, and delaying the shot also acts like a slight dose reduction.

The 35 warrants a dose reduction 1u is getting her to 35 which is too low. So she should now be on 0.75u. In theory last night and tonight you should have shot 0.75u.

We only have one midcycle test in just over a week in the am cycle.... we don't know how low this dose has been taking her. It is really important with lantus to get those midcycle tests in. Any time between +1 and+11. Moving forward I would aim to do that.
 
Gill & George said:
Don't worry about that at them moment we can fix that up for you.

Just tell me what was the sequence of events.
35 @+12 you quite rightly stalled, waited for the rise and then shot 164 at what time was that? (hours after amps)

Then this morning HI, how many hours after your pm shot?
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Last night:
35 @5:15, 82 @7:00, 163 @9:20 gave her 1 unit
Today:
HI @ 6:20am gave 1 unit immediately
 
She seemed to be doing well on 1 unit until yesterday. I know there was one evening when I forgot to dose her at her regular time and started doing her PMPS at around 9:00 pm. Then I was trying to gradually put it back at its regular time, which was 7:00 pm. That's been hard since she's been eating her dinner at 5:30 pm. So I've been off schedule the past 4 days. I'd like to get her back on schedule before changing the dose and also trying to get a ketone test.
 
Thanks for the info.
That helps.

So let me explain.
Unlike the in out insulins with lantus you have a depot, shooting early (ie with an interval of less than 12 hours) can impact the numbers significantly (it can depend on the cat and on the particular cycle), in any case it is considered that it can act as a dose increase. This mornings shot was only 9 hours after last nights shot, so that could be a concern. However she was hi and she looks to be bouncing, shooting early on a bounce, when you have got of schedule can sometimes be helpful though usually we don't shoot more than an hour early.
But what's done is done.

What you need to do this morning is be careful that she doesn't crash, I fear that with the 1u shot she has too much insulin on board as it is, and the early morning shot is ineffect increasing that shot further.

So I would make sure you monitor this morning.
Let's start with getting a +1
 
Roberta and Chloe said:
She seemed to be doing well on 1 unit until yesterday. I know there was one evening when I forgot to dose her at her regular time and started doing her PMPS at around 9:00 pm. Then I was trying to gradually put it back at its regular time, which was 7:00 pm. That's been hard since she's been eating her dinner at 5:30 pm. So I've been off schedule the past 4 days. I'd like to get her back on schedule before changing the dose and also trying to get a ketone test.
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What time do you want to shoot?
 
Gill & George said:
What time do you want to shoot?
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I would like to get her back to 6:30 AMPS, breakfast, then 7:00 shot. I guess 6:30 PMPS and 7pm shot. But Chloe and the other cats are bugging me to feed them at 5:30 pm. With 4 cats crying and getting underfoot, it's hard to get them to wait until 6:30 pm.
 
Roberta and Chloe said:
he seemed to be doing well on 1 unit until yesterday.
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She's had some alright amps and pmps numbers, but with lantus, we need to look at the nadirs to assess how well a kitty is doing on the dose, that is what we base our dosing decisions on, 'the lowest number in the cycle' by and large we ignore the highs.

My problem with assessing how well Chloe was doing on this 1u dose is that there isn't the data there to say one way or the other. Though that 35 yesterday is an alarm call for too much insulin. I suspect she will have been getting some green nadirs in the last week.
Roberta and Chloe said:
I would like to get her back to 6:30 AMPS, breakfast, then 7:00 shot.
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Any reason you are waiting 30minutes before shooting, essentially with lantus, unlike the faster accting insulins you would test feed shoot all within 10min. I would test George, put his bowl down and give him his shot while he had his head in the bowl. Lantus doesn't onset until +2 so there is no need to wait 30min between amps and shot, infact it is preferable to do it all in the space of 10min.
 
I'll set alarms on my phone for 7/7. The days are getting shorter and Arizona does not have daylight savings time.
Thank you for you help, Gill, or is it George? I should have been setting the alarm on my phone a long time ago because I've got COVID fatigue and I can barely remember what day it is. All day Saturday, I thought it was Sunday and couldn't figure out why 60 Minutes wasn't on.
 
Gill & George said:
do you think you can test feed shoot within 10min or so?
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I have to figure out a way to keep all the cats from bugging me for dinner at 5:30 pm. I'll have to delay my own dinner until 7:00 because they won't let me eat until I feed them first. Maybe I can have my dinner earlier, at 3:00 pm instead of lunch. Usually they are all sleeping at that time and sometimes I am, too. I think I need to get myself on a schedule to get Chloe on a schedule. l've been in my pajamas for about 2 days now. Also, Stray hasn't been coming until about 7 am when the sun comes up. He used to wake me up by yowling beneath my window, but he hasn't done that for a long time, I think because it's been cold, so he waits for the sun to come up. Do you think it would be okay to go on a sunrise/sunset schedule for Chloe?
 
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Are you home?
Did you get a +1?
According to mr google it's 8am there now, so over an hour since you shot. If you shot at 6.20
 
Roberta and Chloe said:
She's still at HI at 8:00 am.
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:(
Good job getting the test.

How is she in herself?
How are 5 the p's
  • peeing?
  • pooping?
  • preening?
  • purring?
  • Playing?
does she seem herself? Is she lethargic? Is her appy good?

Give her a couple of hours and get another test? (we don't want any surprisest)
She's might have one heck of a bounce on from that 35 last night, she might have even been lower??? Did you notice any other strange behavior last night, other than she was insistent bugging you for food? George would get very bossy about food if he dropped into lime greens he would come let me know straight away. Wouldn't move away from his bowl until he was above 50.:rolleyes:
Do you just feed her twice a day?
I would definitely do the LB dance and try get a ketone test in.
 
Gill & George said:
:(
Good job getting the test.

How is she in herself?
How are 5 the p's
  • peeing?
  • pooping?
  • preening?
  • purring?
  • Playing?
does she seem herself? Is she lethargic? Is her appy good?

Give her a couple of hours and get another test? (we don't want any surprisest)
She's might have one heck of a bounce on from that 35 last night, she might have even been lower??? Did you notice any other strange behavior last night, other than she was insistent bugging you for food? George would get very bossy about food if he dropped into lime greens he would come let me know straight away. Wouldn't move away from his bowl until he was above 50.:rolleyes:
Do you just feed her twice a day?
I would definitely do the LB dance and try get a ketone test in.
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10:30 am, still HI. She is drinking water. She isn't moving much, but then she never does. I tried getting a ketone test, but had to do it where she peed out of the box and it was dirty.
 
:(
Darn it, Chloe, come down from the moon.
That's one heck of a bounce.
Is she eating?
Did you get a result from the ketone test even if it was mucky?
 
Gill & George said:
:(
Darn it, Chloe, come down from the moon.
That's one heck of a bounce.
Is she eating?
Did you get a result from the ketone test even if it was mucky?
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She just pooped. I put a bowl of fresh water down in front of her and she's drinking a lot. As soon as I finish making the bed, I'll get another test and then we'll take a nap.
 
Roberta and Chloe said:
2:00 pm. She's still HI. She ate a little earlier but I'm more concerned about getting water into her. I'm going to email the vet.
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I think that is a good idea.

Getting water in her is important. Though food is also important, with respect to DKA, a combination of not enough food, not enough insulin, + illness or other stress are the ingredients that lead to ketones and if action is not taken, DKA.
The water can help to flush out ketones..

It's good she ate a little, but I just wonder if she has something else going on.
 
3
Gill & George said:
I think that is a good idea.

Getting water in her is important. Though food is also important, with respect to DKA, a combination of not enough food, not enough insulin, + illness or other stress are the ingredients that lead to ketones and if action is not taken, DKA.
The water can help to flush out ketones..

It's good she ate a little, but I just wonder if she has something else going on.
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3:10 pm HI
 
Roberta, I'm very glad Gill @Gill & George was here, she has given you some excellent suggestions and help. I also am concerned seeing that 35 and wonder how low she was before that test. Was Chloe able to eat a little during the day?

I always got into the habit of drawing out a little extra insulin, then I actually use the light from the fridge as a back drop; I stand with the fridge door open, and squirt out the excess and can see very clearly to the lines because the light in the fridge helps me see.

It may be Chloe is bouncing badly, but I wanted to just caution you that we don't know for certain whether she did get 1u this morning, so giving more insulin this early may be an issue again, just as the time interval from last night's shot to this morning's was early as well. Please do try and test a few times tonight, at least before you go to bed, just to be sure she is not dropping significantly.
 
Christie & Maverick said:
Roberta, I'm very glad Gill @Gill & George was here, she has given you some excellent suggestions and help. I also am concerned seeing that 35 and wonder how low she was before that test. Was Chloe able to eat a little during the day?

I always got into the habit of drawing out a little extra insulin, then I actually use the light from the fridge as a back drop; I stand with the fridge door open, and squirt out the excess and can see very clearly to the lines because the light in the fridge helps me see.

It may be Chloe is bouncing badly, but I wanted to just caution you that we don't know for certain whether she did get 1u this morning, so giving more insulin this early may be an issue again, just as the time interval from last night's shot to this morning's was early as well. Please do try and test a few times tonight, at least before you go to bed, just to be sure she is not dropping significantly.
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She's gone down to 502!
 
I
Christie & Maverick said:
Roberta, I'm very glad Gill @Gill & George was here, she has given you some excellent suggestions and help. I also am concerned seeing that 35 and wonder how low she was before that test. Was Chloe able to eat a little during the day?

I always got into the habit of drawing out a little extra insulin, then I actually use the light from the fridge as a back drop; I stand with the fridge door .open, and squirt out the excess and can see very clearly to the lines because the light in the fridge helps me see.

It may be Chloe is bouncing badly, but I wanted to just caution you that we don't know for certain whether she did get 1u this morning, so giving more insulin this early may be an issue again, just as the time interval from last night's shot to this morning's was early as well. Please do try and test a few times tonight, at least before you go to bed, just to be sure she is not dropping significantly.
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couldn't leave her at HI all day so I'm glad I followed my vet's advice. Thank you for the tip about drawing from the syringe using the fridge light. I'll try that. I think I was just too panicked this morning before my coffee. I will wait until she goes below 200 to give her the other .5 unit, then go back to her 7/7 schedule tomorrow at this reduced dosage.
 
Roberta, we cross posted. Please, do not give her more insulin before you go to bed. That is not how Lantus works. You don't split the dose, then give some more a few hours later. You will need to ride this cycle out without more insulin. Then shoot 0.75u tomorrow at your usual time. This is very important Roberta, even your vet would not suggest doing what you are planning.
 
There is a considerable danger with giving 2 shots of Lantus (i.e. splitting doses) in a single cycle.. You end up with 2 nadirs which will cause problems with overlap tonight (in other words numbers could tank for a long time) as well as with extended duration tomorrow. In addition, the 1.0u dose dropped Chloe to 35 and if I'm understanding, you're planning on dosing a total of 1.5u when your dose, given the low numbers should be 0.75u.

The information your vet is giving you to give an extra 0.5u is not appropriate for a depot insulin. It's the way a shorter acting insulin is used. You can't "shoot down" high numbers with a depot insulin. It's just not the way the insulin is designed to work and can cause all kinds of complications.
 
Sienne and Gabby (GA) said:
There is a considerable danger with giving 2 shots of Lantus (i.e. splitting doses) in a single cycle.. You end up with 2 nadirs which will cause problems with overlap tonight (in other words numbers could tank for a long time) as well as with extended duration tomorrow. In addition, the 1.0u dose dropped Chloe to 35 and if I'm understanding, when your dose, given the low numbers should be 0.75u.

The information your vet is giving you to give an extra 0.5u is not appropriate for a depot insulin. It's the way a shorter acting insulin is used. You can't "shoot down" high numbers with a depot insulin. It's just not the way the insulin is designed to work and can cause all kinds of you're planning on dosing a total of 1.5ucomplications.
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My vet knows what she is doing. I'm giving the other .5 at her regular time at 7:00 and I will test her at least twice tonight before bed. I am very suspicious that her morning dose contained no insulin in the syringe. I don't know why the pens do this and as soon as Covid ends, I'm putting her back on the vial.
 
Sienne and Gabby (GA) said:
depot insulin
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I understand this, but I waited for 7 hours and she didn't go down. That's enough. My vet said to give her a half dose and she started coming down. I almost took her to the emergency room. Besides, I thought she has to be regulated before you can change a dose.
Sienne and Gabby (GA) said:
you're planning on dosing a total of 1.5u when your dose, given the low numbers should be 0.75u.
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Her regular dose is one unit and I'm not changing it until she's flat for a couple days.
 
Christie & Maverick said:
Roberta, we cross posted. Please, do not give her more insulin before you go to bed. That is not how Lantus works. You don't split the dose, then give some more a few hours later. You will need to ride this cycle out without more insulin. Then shoot 0.75u tomorrow at your usual time. This is very important Roberta, even your vet would not suggest doing what you are planning.
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I am pretty sure there was no insulin in the syringe this morning. I'm not a morning person.
 
Roberta and Chloe said:
I will test her at least twice tonight before bed.
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Please do.

And to reiterate what Sienne posted, Lantus is not an in and out insulin. Multiple doses in one cycle may lead to overlapping effects. Why is this important? Think of it this way, the first dose is onsetting now. You gave another shot, so within an hour, it is possible that the second dose kicks in, while the other dose is gaining momentum, and the two combined can lead to unforeseen effects, and significantly sharp drop in BG.

As for dose tomorrow, we have given you our recommendations to reduce. Even the most experienced members who test a lot (more than you do) would take a full 0.25u reduction. 35s are nothing to mess around with, frankly speaking. I can only share what I have learned being here over the time that I have, and am genuinely trying to help.
 
Roberta – anything under 40 is an automatic reduction. Chloe is HI possibly because of a fur shot and definitely HI from the 35. Bounces are tricky. One never knows when the bounce will subside, and when it does, 1 unit will be too much insulin.

Insulin is a potent drug. If you give too much or too often, it is hard to undo.
 
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