12/28 Boo AMPS 234 PMPS 504

Boo was great until just now. She had .5 unit at 8:00 AM and must have crashed while I was at work because 504 is the highest I've seen since DX. Very scared. Ketones on Saturday. They seemed all cleared up - No smell. Trying to test pee but she has not gone to the box while we could catch her. We will be up testing tonight.

 

the high number could be because she went lower than she is used to, or it could be the fallout from the delayed shot yesterday (those tend to affect the next several cycles). You don't need to bother with a lot of spot checks tonight coming from a 504 (whatever numbers you see are likely to just be depressing). Definitely do get a before bed test EVERY night, because that will give us an idea of what she is doing in the evening cycles. It's especially important when you can't get spot checks during the day.

 

It can be upsetting to see a very high number.But, Boo's numbers will come down. Get a test or two tonight to convince yourself.

 

Thanks so much for checking in. I am kind of freeking out. We actually tested two non-diabetic cats to see if the meter was working. They were at 55 and 69. After the meter tested at 504 it went to HI which means over 600 but it was the same ear prick blood droplet for the 504 and the HI. Over 600 is crazy! I was so psyced with the 150-250 numbers since starting Lantus Saturday that the high number tonight really shocked me. She never went that high on Vetsulin but on that I could not get her to hold a 200ish number. The curves were too steep.

We are just starting Lantus. I really appreciate your help since I can tell you followed me back to the old board to see the late shot sunday. I'm new here and everyone's so helpful!

Boo is so fragile. She is 6.5 lbs on a good day. She had DKA over Thanksgiving. She was in ICU for 5 days with KDKA and kidney failure ie BUN very high etc. She had Ketones Friday and Saturday. We are struggling to check since then but the bad breath is gone. The vet said her teeth look bad and she has a bladder infection. She is on AB since Saturday. It's so hard to just get her settled. There is so much going on. Meanwhile she seems happy and playful. She eats tons of food. Her behaviour and her health don't jive ever. She a confusing little cat. She's definately the smartest cat of our 8.

 

you really do need to get another ketone test, especially since she has infection present. Things can change very quickly when ketones are involved.

Did you reduce the dose from 1.0 to 0.5 because you were nervous about the blue numbers? I'm thinking that maybe we should increase the dose a little earlier than we usually would, since Boo might have ketones. Let me check with the rest of the dosing people to see what they think.

 

I actually decreased because she was on a small .5 on Vetsulin and went to BG 52 one night on that. I thought .5 would be a better starting point on Lantus. The vet said 1 unit one time per day. I thought better of that and switched to .5 when she was 172 pre shot Sunday after just 1 Lantus shot in her life. To be honest I suspect the high numbers are re-bound from too much rather than too little. I wish I was home to test today. We are comming up on +3 in 30 minutes. I will check then.

Right now she is running around playing fetch tonight and gobbling down food like crazy. You would never know she is sick. It's crazy. She is such a cat!

 

OK she wanted more food so I tested 20 minutes short of 3 hours and she is now at 249. That's like a 300+ point drop in less than 3 hours YICKES! That's why I say she needs less not more if anything. I gave her the same amount this morning when she was at 234. It's amazing she did not go completely Hypo this morning! :shock:

 

you need to clear your mind of your Vetsulin programming. (I know, easier said than done, one of the hardest things most of us have to do is to unlearn a different insulin). Lantus gives a much flatter cycle when given on lower preshots than on higher ones, it doesn't work the same as Vetsulin at all. No worries about shooting the same dose in the 200's as the 500's, as long as you have arrived at your dose in a methodical manner then it is fine.

We believe that Boo needs more insulin and we feel a need to be aggressive with getting her numbers down due to the likelihood of ketones. It is likely that once she gets into blue/green that her insulin needs will decrease quickly, but when ketones are such a strong possibility we don't have the luxury of being able to do very slow dose increases. If you're able to get spot checks at least at night, then we would recommend taking her dose back up to 1 unit. We would settle for 0.75 if that is more comfortable for you, then we can increase to 1 unit in a few days if there is no improvement. Of course it is up to you, you can't do anything you are uncomfortable with.

 

What about the huge drop I just got. Won't she re-bound? Wouldn't a bigger dose result in a bigger drop?

 

Sure, she might, but we dose mainly by nadir. Once we get the nadir where we want it, the preshots gradually come down too until we get a nice flat Lantus/Levemir curve. Rebound is not a bad thing with Lantus, it is part of the process. We keep showing the liver the blue numbers over and over again until it learns not to panic at them anymore. Then we'll show it green numbers over and over again until the liver learns not to panic and release glucose into the bloodstream. Look at as many spreadsheets as you can, especially of the Lantus users who have been here a while, and you'll see that almost all of our cats went through a lot of bouncing at first, but then they leveled out.

Did you get a chance to read our dosing guidelines on the old board? We follow a modified version of the German Tight Regulation protocol at http://www.tillydiabetes.net/en_6_protocol2.htm It really works!

 

You are doing great! Just let the people here guide you, and your cat will thrive..Got a good start here--We all get higher numbers sometimes, but each cat is different..Our dosing advisors like Libby know what they are doing..
Boo show momma what you can do--Ni ni Jen..

 

forgot to ask, are you planning to get a dental any time soon? Bad teeth can also make the numbers high, and can lead to infection. Bad teeth, UTI, ketones are a combination that can go south in a big hurry. Insufficient insulin can cause the ketones to go higher. Right now it doesn't matter what her correct dose of vetsulin was, it only matters that we get enough insulin in her right now to combat the ketones.

 

Completely agree with Libby. Lantus is known for the flatter cycles it gives on lower preshots. You can look at Sasha's spreadsheet for a good example. I can routinely shoot very low preshots without concern because I have collected the data to do so and have worked up to the right dose properly. I used PZI before Lantus with Sasha, and you really do have to change your mindset - it is a completely different way of doing things and it does work. I used to think of a preshot of 150 on PZI as being perfect, and now that is terribly high (for us).

I would also advise on 1u for the dose, and holding it until a dose reduction is earned (going below 50 or staying mostly below 100 for 7 days). This risk of ketones does increase the need for aggressive dosing and monitoring, particularly with bad teeth and a bladder infection. Not enough insulin + infection + decreased food intake is the recipe for DKA.