? 118 Stalled 30m 124 gave half dose +1 80 +1:30 66 +2 54 +2:30 94 +3:15 80 +4:15 141

Orange Kitty was switched from 2.5u Vetsulin to 2u Lantus Tuesday night. He is due for his shot right now but tested 118 on an AlphaTrak 2. I am reluctant to skip his insulin because he has had very high numbers and was recently in ketoacidosis. Spreadsheet is up to date but the numbers are a mess, we've had quite the learning curve. Please advise if I should perhaps give a reduced dose instead of skipping.

 

Hi! Welcome and you're doing great I can't give dosing advice but can encourage you to edit your title (up at the top of the thread) and pick the ? from the drop-down and change your title to "STALLING *NEED HELP*" - this may help get more eyes on your question from the experienced people

*Note that "911" is reserved for symptomatic hypos, very low numbers (below 30 on a human meter), and/or very sick cats potentially needing ER care.

 

I agree you don't want to skip his insulin altogether when DKA is in the picture especially. I'm looking to see who is online right now....
@Panic do you by chance give dosing advice? I see you're online. Sorry if you don't....I'm not sure.
@Wendy&Neko @tiffmaxee

 

Ah shoot, I don't have DKA experience but skipping the shot isn't an option for him.

 

Yeah, that's all I know, too.

 

I have been looking at your spreadsheet. Just wondering, the blanks in your "U" column...did you not give Orange Kitty any insulin then?

 

We gave his standard dose, I just didn't fill them in if I wasn't collecting numbers related to that shot. I went and filled them in just now to avoid confusion. The exceptions are the two blank ones with comments, where we had "fur shots" and are not sure how much he received.

 

At 8:05 he tested 124. Gave 1 unit instead of 2 and he is eating his dinner. Will monitor his blood sugar tonight, but would still appreciate some insights.

 

For the potential fur shots you could put how much you gave and just include fur shot? with it to show you gave but aren't sure how much he got.

Sorry I couldn't help with dosing advice, if DKA wasn't involved I probably would have recommended skipping but that's simply not an option for Orange Kitty. Please check him again in two hours and let us know what his reading is.

 

Okay. Fill in as much as possible in your spreadsheet as that'll be the first thing that the advisors on here will look at. All data that you have will be good. If you do a fur shot, you can put "FS" in that same column ("U" column) with the dose.
I'm glad you gave Orange Kitty something. So important with DKA not to skip. I've tagged a couple of people so when they're on they should be able to offer you some advice.

Here is a sticky for you to read on how to handle low numbers. I'd recommend getting a +1 and a +2 so we can see if Orange Kitty is still sliding down.

 

That's ok, at least it was validation that skipping wasn't a good idea. This just seems so much harder this time around. I will post his numbers at 1 and 2 hours.

 

Hi. Welcome to LLB. The first thing I noticed on your spreadsheet is that on 9/13 she tested under 68 so a reduction was earned but not taken. Then the next night you slightly increased instead when you should have taken a decrease to 2.25. How long was OC on insulin before? How long in remission? With past DKA you needed to shoot so glad you did.

 

Cassie, a few comments. Can you add a row and make it clear in your SS the switch to Lantus please? I can't speak to the dose change from Vetsulin to Lantus, although I know we take the previous dose and how the cat is doing. 63 on AT2 is getting down there, regardless of the insulin. It may be that 2u on Lantus to start was a bit too much. With SLGS we'd like to see more data on how the kitty is doing on the insulin before shooting lower than 150, but history with DKA trumps that. Did you stall and not feed and retest after that 118? If not, that is something you can consider in the future, if you see a lower preshot you aren't comfortable shooting. It also helps to see if the numbers are rising before shot. Stalling for 20minutes and not feeding sometimes gives you an indication if he was possibly lower earlier and is on the rise, vs continuing to drop.

In any event, good job shooting 1u, skipping is not normally a good idea with history of DKA. Not all insulin given is used to combat the blood sugars, and it is important to get some insulin in.

Do you have some higher carb food and or syrup handy? It may not be needed, but let's see how the +1 is and we'll go from there. It would be good if you can jot down in the comments the percent carbs you are feeding at each interval.

Lastly, please keep your SS and title updated with this evening's numbers, so members can see at a quick glance, sometimes it gets busy here in the evenings. I'll watch for you, and help you if you need it.

 

Change your title so those looking will know. Maybe write new and shot reduced dose.

 

Also I see you are following SLGS in your signature so you will reduce if OC drops under 90. Lantus onset is usually around +1. If the +2 is lower than the preshot, it usually means your cat will need monitoring closely. If higher maybe not as much.

 

Hi there I noticed on your SS there is no date for 9/15/20 and 9/16/20

 

The evening of 9/13 we had a fur shot. There was so much liquid we thought we missed the whole dose, and with history of DKA, we shot again. Clearly with a number like 68 that was a mistake, he must have gotten more of the initial dose than we thought. Evening of 9/15 he was switched to Lantus. I am not wanting to make increases or decreases without guidance, I don't feel I have the knowledge or the number history yet.

Sorry, I missed some of your question. I'm feeling really overwhelmed right now! Orange was on vetsulin from around April to October 2019. We didn't get a blood glucose monitor that time, it was managed easily, he started on 1u, was reduced to .5 fairly quickly, and then he went into remission. He had a bout of pancreatitis this June and I think that triggered him out of remission. In late August he was misdiagnosed with another bout of Pancreatitis, but it was him coming out of remission and he went DKA before it was caught. Since then it has been a roller coaster, nothing like the first time. I feel like I'm throwing darts at a wall.

 

I didn't take any blood sugar readings those dates. So am I still supposed to record the shots I give even if I get no readings? I realize regular readings are important but we are new to taking blood sugar and I really need my husband to be home to assist. Sometimes that is just not possible.

 

The 63 was because we had a fur shot and thought we missed the entire dose, so gave entire second dose. Obviously with that sudden low number he got more of the first dose than we thought.

I stalled 35 minutes, retested at 124, and gave the 1u. I have high carb cat treats and caro syryp and honey. I will update the title, but this is my first thread. I hope I'm doing it right.

 

No problem yes you should still enter a date and yes even if you didn't get a reading still put in the dose you gave Maybe put No Test where you couldn't get a reading

 

You are doing fine

 

Cassie, there is a lot to pick up and learn, we are here to help you. When you get a moment, please do read this info

New?How You Can Help Us Help You!

You have learned why it is never a good idea to shoot again after a fur shot. You really never know how much insulin got in. Let's get you through this evening, which is hopefully uneventful , and then we'll get you set up in the administrative stuff, which is super boring

 

We’re we’re all overwhelmed when we started. That’s why we are here to help you learn. Deep breaths. That information is very helpful. Had OC ever had pancreatitis before? Max had chronic pancreatitis which I believe is why he became diabetic.

 

I think perhaps Elise meant onset is usually around +2 for most cats, but without much data, we don't really know how Lantus is working yet with OC

 

The pancreatitis this past June was his first incident. He was diabetic before that and was in remission at the time of the attack. Hoping it doesn't become chronic.

 

Just did +1. It was 80.

 

He may not even have had it. Perhaps the symptoms were just from coming out of remission.

 

But when a cat is in red and black numbers and just came out of DKA, the thought of them getting no insulin is frightening.

 

We will revisit a proper dose later. Feed a little lc food, a couple teaspoons. He needs to be hungry as it’s early in the cycle.

 

Maybe, that would be a small relief.

 

Then test again in an hour at +3.

 

+1 = 80 he's in the move, I'd actually feed some MC food, but if you don't have any, I wouldn't wait until +2, I'd test in 30 minutes. I just know the AT2 meter better than people who use human meters, and I see the downward movement, just MHO.

 

@Christie & Maverick Are you going to stay with her?

 

He just ate a little more of his fancy feast classic. I have standard cat treats on hand and caro or honey. When he dipped real low the other night after the extra insulin we gave him some of that when he hit 60 and the next morning he was in the 700 range. Don't want to do that again...

 

The 700s wasn't because of your intervention, it was because his liver panicked and kicked in a bunch of sugars for the low number of 60. MC food is generally anything that is from 10-15% carbs, but some cats are more carb sensitive than others, so it is just a ball park range.

 

I'm here for another 3 hours or so, minus checking on Mav now and again.

 

Mc would be about. 11-15% . Is there someone around who could go to the marKey for you?

Ok, great Christie.

 

Cassie, there are some Fancy Feast varieties which are grilled, those would be around 12-14%, I like to keep some on hand in case I need some wet food or gravy from the food to help bump up the numbers.

 

Everything closes early here still due to Covid. I will get some tomorrow and tonight I can use the cat treats if needed.

 

66 at 1:30. Gave a handful of standard cat treats. What do I do with my spreadsheet since columns are divided by hours, not half hours?

 

Put both in same section and color it bright green.

 

Just stack the numbers in the same cell, ie. 80, +1.5 66.

Up you go handsome boy

I'd see where he's at in 30 minutes again. I've never used treats so I can't say how quickly they'll work. Be ready at +2 with a tsp of LC and a drop of honey in the mix.

 

+2 54. Teaspoon of low carb with drop of honey?

 

I would please, maybe even sneak another drop in, we need him up now. The treats didn't do much yet, how is he acting?

 

He's acting fairly normal. He's not been his "normal" self since he lost remission, but he isn't showing any of the symptoms of hypo. Will give food and honey now.

 

I hate to ask, but can you test in 20 minutes? Normally 30 minutes does the trick, since it takes some time for the carbs to get into the bloodstream, but I'd like to stop him from going lower than 54 on AT2, so if he doesn't come up in 20 minutes, let him have a few more drops of honey. Appy is still good?

 

yes I can test in 20. He ate the food right up. Thank you for staying so engaged.

 

When you do go shopping here are some of the Gravy Lovers


Fancy Feast Gravy Lovers Gourmet Beef Feast in Gravy 20% High Carbs

Fancy Feast Gravy Lovers Gourmet Chicken Feast in Gravy. 15% Med Carb

Fancy Feast Gravy Lovers Turkey Feast in Gravy. 15% Med Carbs


Fancy Feast Gravy Lovers Chicken and Beef Feast in Gravy 15% Med Carbs

A must to have these on hand, it's really only the Gravy that is full of the carbs if you ever need to bring up his BG since you said he will only lick the gravy

 

94 just now.

 

Alright! Nice work, but let's keep checking, the honey wears off quickly. We want a couple of tests without intervention, where numbers are stable or rising, another test in 45 minutes or so, please.

 

80 at 3:15.

 

That's just fine, test again in another 45 minutes.

 

141 at +4.25. I don't know where you are located, but do you want to give me some general guidelines for the rest of the night so you don't have to stay up?
Do you have any thoughts as to morning dose/dose moving forward? Clearly the 2u of Lantus is too much, even though he was on 2.5 of Vetsulin prior to tuesday night. But I'm not sure how much to reduce, especially if there is a spike in the morning due to these events. (Reminder, tonight he only got a half dose, 1u.) I will contact vet in the morning also, but I'd like an idea of what to do for his morning shot. I can get pre-shot numbers tomorrow, but my husband will be working most of the day and it will be very hard to get numbers throughout the day without his help.

 

Okay we are going to try to get a little rest and will set an alarm to test at +6.25. I will check the thread again at that time. Thanks for all the help so far.

 

I'm happy to help, I think with this last test of 141 he's probably done with his shenanigans. You may see him bounce to higher numbers tomorrow. I'm wondering about the dose, you mentioned past DKA, which I have no experience with. Are you able to test for ketones at home? Some people use either Ketostix (you have to catch him peeing) or a special meter to measure ketones. I don't want to suggest too low a dose, but I might consider seeing how he does on 1u, since it could be that numbers tonight were due to the 2u and Lantus depot in play. I'll tag @Wendy&Neko if she around, to see what she thinks, since I'm a bit rusty on dosing advice, especially with history of DKA to factor in

I am about ready for bed, I'll be up for work in 6 hours . Good job handling his numbers tonight.

 

Sorry

Sorry, I am a slow typer

 

That's ok! Thanks so much! I will test numbers in morning and hopefully will be comfortable giving the 1u. I can get Ketostix. Have a good day at work. Thanks for staying up late with me!

 

You're welcome, maybe Elise @tiffmaxee will be by before then as well, to comment on tomorrow's dose, I'd feel better if a few more people agreed with 1u

 

I will check the thread first thing when I get up. Thanks to @tiffmaxee for the assistance also!

 

You weren't on Lantus long enough for the proper 2 unit depot to build - it takes 5-7 days. But there would have been enough that it was controlling what happened tonight. You'll also see a rise tonight because of the lowered dose. 1 units seems a bit low with the recent DKA. Maybe 1.5 units?

A favour to ask, when you have some time, could you put DKA (and the date) on your signature, and change his diagnosis date from 9/7/20 to April 2019, but you can add back on insulin 9/7/2020. We look at date of original diagnosis. He's been diabetic since them, he just spent some time as a diet controlled diabetic. Also, please add some comments to the spreadsheet Remarks section. The kind of comments I'm looking for are any changes in food or meds. Examples are 9/13 when you dosed a second time. That isn't obvious. You could put 2.5 FS +2.5 in the units, or just make a comment in the Remarks section of the spreadsheet. Once you are ketones testing, put the results of those tests in the Remarks as well, or we will promise to keep asking if you've done a ketones test lately.

 

AMPS 524 gave 1.5u. Thank you for the dosing advice.

Updated signature as requested, I checked records he was originally diagnosed June of last year and back on insulin this 9/1, 9/7 was date I started home testing and joined forum. So hopefully that is all correct now. On the spreadsheet I updated the cells as suggested, but I did have comments attached to the cells with all the info about the fur shot mishaps, I see the little triangle in the corner of that shows the comment when I hover. Is the remarks section something different?

I will order ketostix off of amazon today.

 

Hi Cassie, I am just poking my nose in to see how Orange Kitty was doing this morning. I also had a quick question, since you recently switched from Vetsulin to Lantus. My recollection is the Vetsulin is a U40 insulin, but Lantus is U100, you are using U100 syringes to measure the Lantus insulin, correct?

 

Scroll all the way to the right on the spreadsheet page and you'll see a column titled "remarks". It's so far to the right, hence often missed. You're better off adding your comments there so people can read them quickly.
Great job handling Orange Kitty's drop last night! Team Orange Kitty rocks.

 

Yes I am, thank you for checking. Hope you got enough sleep last night. I know I didn't! Luckily I am working from home these days and can monitor him.