2/5 Sandy AMPS 163, 120@+2, 47@+4

That would be great if you could get a ketone test Liza.
And can you scan the meter and tell us what the BG is as well please?
I am talking to someone about what we should do with Sandy today.
Try and stay awake a bit longer til we get it all sorted if you can

 

Hi, very ruff night and having hard time staying awake even with alarms st every half hour. It’s bee 1 hour past **** time. I just scanned and he’s at 149

 

When did he last eat Liza?

 

He’s at 149 at the moment, just about 1 hour past hit shy time.

 

He ate a little bit 1 1/2 hours ago. He is asking for food at the moment

 

Can you hang on a bit longer. Gill and I are working out what is best to do.

Have you had any luck with the ketone test yet?

 

He hasn’t gone yet. And ok I’m setting alarms every 15 minutes in case I fall asleep

 

Hi Liza,
I have discussed your situation with @Gill & George and we think you should skip this dose, because you are so sleep deprived and exhausted.
So give him a good feed of ordinary low carb food now and leave some more out for him for later or maybe your hubby could give him some if he is around. Or if needed you might need to set the alarm to make sure he does eat during the cycle. You won’t have to worry about him dropping low as he is not going to be getting any insulin.

For the next dose, can you move the time back a bit so he gets it around maybe 5 or 6pm. Would that work for you?
That way he won’t be going the full 12 hours without a dose.

You will need to test at that time and that will be your new preshot time. You will need to post and ask for help about the dose. I will tag @tiffmaxee to keep an eye out for you.
How does that sound?

Also get a ketone test when you can ...that is really important because we are skipping a dose.

 

We are both concerned because he has a recent DKA episode but equally he has been really difficult to keep out of those lime greens and you are clearly exhausted.

If we just had the DKA to worry about and you hadn't just pulled 24 hours of intensive monitoring and feeding, I would be thinking along the lines of reducing the dose to just a drop (you may need to do this in the morning).
But that is not where we are.
She's been difficult to maintain above lime green, she's on a tiny dose already (so shooting a token dose is not really feasible.
That 149 is influenced by the food 1 1/2 hours ago, so she's not exactly high.
And you may not be able to wake in the middle of the night and are exhausted from the last 24 hrs.

I think that the drop you have seen on the 0.1u cycle may well be influenced by the prior 0.25u dose, and may have resulted in those hard to shift lime greens. Especially if the 0.25u depot got overfull as we attempted to hold onto the dose for a few more days.

This is good.
and Bron tells me Sandy has seemed well and active, she's not lethargic and has been testing negative for ketones. So as long as that next pee test is negative for ketones, on balance, I think the skip may be the better/safer option in your case tonight. It will mean that you can feed him his normal low carb food which I believe he prefers.

Both Bron and I felt that if you can possibly bring the next shot time forward so she doesn't go as long without insulin, it might mitigate the skip somewhat.

For the pee sample, if you go and scrabble the kitty litter, that might make him go, I know my lot all flock to the litter tray when they hear me cleaning it out.

 

Ok sounds good thank you

 

I hope you manage to get a good restful sleep.

 

Ok. He didn’t eat very much when he did eat, he usually takes 3-4 licks of food and he’ll be done. But yes probably why his number is up little higher now. He is up at the moment but he’s not walking around much just sitting with all his legs tucked in. I will tray and feed low carb food now.
Thank you for your help

 

brons headed to bed, I'm around for the next couple of hours, if you need anything.
Then I have to walk dogs/feed the gang, and I'll check back in after all that

 

I’m afraid I’ll be up and down for a while. Husband is walking dogs at the moment then leaves in 1 hour. I’ll be watching over the whole pack for about 3 hours so I’m going to feed Sandy and try and get a quick 30 min nap now

 

Ok. I’m feeding Sandy now and am going to try and get a quick 30 min nap now while my husband is walking dogs, he will be gone soon for about 3 hours and I’ll be watching over the pack too. These furry kiddos are so much work aren’t they.
Thank you for your help

 

They are worth it.

 

Yes they sure are

 

Tested for ketones and it’s negative!

 

Bg?

 

Just took it now he is at 178

 

Nice to see him still in the blues. Hopefully he is still acting fine?

Just a house keeping note.
In the dose column notate the skip with a NS.
Then the +13 will go in the +1 column.
Then the +18 in the +6 and so on for any other tests you take.


Get some rest.

 

What is he at now?

He has come up a bit, we don't actually want him to come up too high. I would stick to the LC. and don't feed him anything after +10.
Do you think he is full from all the steering in the earlier cycle? Has he had a good amount of food in the last 24hrs?
or do you think he's feeling icky?

 

I’m the last 24 hrs he’s probably had 2oz of food tops. And few temptations as snacks when I couldn’t get him to eat anything else. Maybe 10 total(2 calories each).
Trying to give him some of the ff pate that is LC now but he doesn’t seem to want it anymore. He will probably eat the other ff that I have with gravy but that’s about 12% carbs. I know he needs to eat so I’m trying to figure out what’s best and try that but if it fails give him what he will eat. This has been my daily struggle with him.
Or do I wait until it’s shot time to see if she will eat before I give it maybe his appetite will be a little better?
I’ve been giving small snacks and I’m starting to think this is why he just won’t eat because a couple of licks will be enough for his belly to be content throughout the day.
He seems ok, I just woke him up he’s been sleeping since the morning just got up to pee couple of times. He went for the food but smelled it and walked away.
So should I just not give him anything now for another 2 1/2 hours so he will eat then?
He’s only hit a 30 minute window now as it is to eat something anyway and I doubt he will

 

give him that if he will eat it, it's important to get calories into him.
Perhaps avoid the temptations for now unless he ends up in lime green or you are desperate, I have one kitty that sometimes needs persuading to eat his food by me sprinkling some treats on his food. They are really high in carbs. I've seen just one or two send kittis BG through the roof, though some kitties are more carb sensitive than others.
What time are you going to shoot? BTW the dose should be 0.1u.
(I see you have a +20 (+8) and he is flat)

 

How are you getting on?

 

I was planning on 6pm. It’s 4:20 here now. That puts him at about +10.5 from last shot. The plan was to do it prior to the +12 so he wouldn’t go too long after skipping dose.
He only took a couple of bites btw so now he’s got ruffly 1 1/2 hours to go for shot.

 

That's good that he ate a bit more.
Next time he heads for the LB do you think you might manage another ketone test, seeing he has skipped an insulin dose.
Next shot we think a 0.1u, though he dropped when you shot that it was only the first cycle, so it was the depot from the 0.25u that was driving that cycle.
I hope you got some sleep today.

 

How are you both doing?

 

Well after multiple tries with food he finally ate. He was at 163, I gave food, when he finished and I saw he kept it down I gave shot. Hopefully he won’t have too much of a drop like other times

 

I didn’t really get straight rest but took small naps here and there and it helped. Hopefully will be a good night for him so I can rest easy. Crossing fingers

 

Hi Liza, I haven't stopped by before, I see you have been kept busy! I'll be around this evening, if you need any help.

 

I hope so too.
It's important to catch the drop early, and feed to keep him from dropping. You may need to use the higher carb food especially in the earlier part of the cycle.
I'd get a first test no later than +2.

It's past midnight here for me.
You're in good hands with @Christie & Maverick
Good Bob shooting.

I'll look in tomorrow.

 

Hi. Catching up. I will be around tonight as well.

 

Hi yes Sandy is keeping me on my toes 24/7
And thank you

 

Ok thank you for all your help I really appreciate it. Hope you have a good night!

 

Ok thank you

 

@Liza Morales I see in your SS that Sandy has come down at +1 to 114, so if you haven't already, I would suggest you give her a teaspoon or two of LC. If the +2 is lower yet, then I'd say we need a little of the HC food to slow her down a bit. I'm trying to catch up on some history, but if I understand correctly, you needed to use HC before.

 

@Christie & Maverick The +2 is 120.

 

I gave him a teaspoon of food @+1, then he had a few licks of food at +2, now at +3 he dropped to 58.
It’s 9:30 at night here and e is sleeping I’m going to try and wake him up to see if he will eat. I don’t understand why he keeps having these drops at such a low amount of insulin.

 

He’s not eating enough. You might need to add a little syrup to the food.

 

I just gave him some ff chicken in gravy and about 5 temptations. I kno wth ir high in carbs but he seems to be going down fast

 

There are a few FF chicken in gravy foods, so I'd say we have 12-15% carb. Ideally we want him to flatten out now, so can you squeeze a little more of the gravy for him? It is harder when they aren't that interested in eating.

 

He’s had about 3 ounces of food since hit **** time. He has now dropped to 47. Somethings not working here. He’s had these drops even when I was giving .25 and BG was over 200

 

Okay, he's going to need to get up above 50, so can you give him a little more of the FF chicken with a drop of syrup or honey? How is he acting otherwise?

 

He’s actually hungry and eating, he had some more of the chicken in gravy I looked it up and it’s 13% carbs.
He is acting fine, he walked over to the food bowl and started to eat. But I’m worried he’s going to back to sleep and it’s just going to get worse

 

The early drops tend to have a little more speed to them, I'm glad he's eating. Liza, I know it is a bit of a chore, but can you update your title to show this evening's numbers so far?

 

Liza, I'll be back shortly, I just need to check on my sugar kitty, if you can see where Sandy is at 20 Minutes from the carbs please?

 

Ok I just scanned him again and he’s up to 65. But this is exactly what was going on last night to and he’d come up and drop back down. Will scan in 20 minutes again

 

If I recall correctly, the previous time you had also used syrup by now? Syrups are good at bringing up the numbers, but do tend to wear off quickly. The FF is technically MC food, of course depending on how carb sensitive your cat is.

 

I added syrup to the food he just ate so probably same will happen. I’m hoping he doesn’t drop again.

 

He’s come up to 85 @+5

 

I see +5 =85, so let's try if you can give just a tsp of LC now, and check in 1 hour.

 

Just tried to wake him up to feed but he’s not interested. Doesn’t even want freeze dried treats. It’s 11:30pm here right now and he’s back to sleep.
Should I wait to see if his number keeps going up on his own if I can’t get him to eat?

 

Hi Liza
I see Sandy is doing his usual diving competition for us all!
Am just going to read through the thread to get up to speed
Bron

 

Hi Liza,
When did you last get a ketones test?.
How long until the next test?
Did you manage to get some ondansetron from the vet today?

 

Last ketone test was 12 hours ago. I usually will do it in the morning so next one in 7-8 hours.
I did call the vet and left message, usually vet calls me same day or next at latest. I’ll probably hear back form him today. Sandy’s appetite was actually better today thankfully. He’s had 4.5 ounces of food and some freeze dried treats in the past 6 1/2 hours.
3 ounces was 8% carbs
1.5 ounces was 13% carbs
Still his numbers dropped again.
The syringe literally just has a slither showing for the .10 and I’m still baffled that this may be too much for him because it still is causing him to drop.

 

Has he always had an appetite issue? Was he tested for pancreatitis? Usually when the bg is low they are starving.

 

No he never has. He was in ER for 5 days and I know they ran a whole bunch of tests. The only one that they said was an issue was the ketones and acute injury to his kidneys. Jan8th kidneys were normal numbers.
Jan 13 at Er level was 4.5, went up to 6.9, last checkup 1 1/2 weeks ago was 3.5 showing healing. I also had an ultrasound done to check for anything else like tumors. It was clear.
His BG numbers have been above 200 at times and have dropped after insulin shot even though it was a small amount .25 units. Sand happened at beginning with higher BG numbers and higher unit amount. Reason why he’s now to .10.
And still at .10 unit now 2 cycles has had drops after shot.
I’m completely at a loss.

 

Pancreatitis exhibits as just not acting right sometimes. It’s common to become inappetent. There’s a blood test for it, the SpecfPL. If not that I wonder if the food changes don’t agree with him. However it doesn’t sound like he will eat much of any food, even the dry.

 

ok. We are discussing what to do.

 

The dry he will eat no problem. I was mixing some in his wet food on few cycles where it shows the blue amd yellow flow. I was giving him the dry because again he was dropping even if he was above 200. I was told to stop the dry so I did. Just gave him some last night to get his number up from the drop to 47. He ate a lot better today than he has in weeks and still had drop. I was really crossing fingers because of his appetite today this wouldn’t happen. His BG was good at shot time and the .10 caused him to drop once again.
I’m new to all this but I’m completely baffled at this point

 

Is his next test due?

 

Have you tried to get a blood test?

 

BG is 116 now I put it on the SS
Ketone test I will try and get soon as he will go, but he is asleep at the moment

 

Yes I’ve had 2 done past 3 weeks. Plus all the ones they did at ER stay. Those were every 12 hours for the 5 days he was there.

 

I see 116 @ +6.
Don’t feed any more and see how he goes.

 

Sorry. I meant a bg test using the meter. I know you had lots of blood tests at the vet.

 

Ok he just got up and ate some and the. I just saw this. I took a video but I don’t know how to upload it from my phone. Just wanted to show you how he is eating because today he’s really had a better appetite than other days. He’s eating the ff grilled chicken in gravy like it’s his job.

 

He’s got the lifestyle libre on him. I have a human meter but it gives me Error every time I try on it.

 

Have you tried testing yourself to see if you are doing it correctly?

 

I wish you could get the meter to work because the libre I have heard is not so accurate at low numbers. It might be reading lower than he really is.

 

I’ve been told the lifestyle libre is pretty accurate so I’ve trusted it. And when he has dropped to 45 and under he looks little disoriented and sleepy so it’s why I worry with these drops

 

Liza I need to signoff now, I'm up in 5 hours. Glad Sandy continues to come up.

 

I can try the human meter again now and see if it will work to compre the two

 

Th

ank you for your help

 

Thanks Christie for helping out.

 

I think it’s ok except in those low numbers it would be good to be able to check with the other meter.

 

Thank you for your help

 

I just tried it and it gave me an error code again. I know I got enough blood and I even tried it in myself and still errors code. I’m going to go out and get another one tomorrow

 

It’s good to have a backup meter to check when you get a really high or low reading. That being said from how he was acting I do think he was low.

 

Yes gave me error code. Just tried again and it worked in me. Tried it on Sandy and it gave me error code, I’m going to try again

 

Yeah I don’t know I just pricked him 3 times and still gave me error code, but the second time I tried it on myself it worked. I’m definitely going to grab another meter.
Yesterday when he dropped he definitely had me worry because of how he looked m. Tonight wants that bad but he still looked disoriented/dazed so Keynes it’s not quiet as low but still low

 

Last 2 BG #’s 116 + 114. Do you guys think he’s flattening out? Maybe I can sleep a little bit I can still set alarm for every couple of hours if necessary.
mom going to pick up another meter tomorrow because the one I have I just used about 6 strips and only worked 1 time on me

 

I

It is hard to tell with Sandy.....if you feed him now and he eats well you could set the alarm for two hours I think, but no longer

 

Ok will do that. Do you think I should do the same dose come morning? I can also run out and get another meter in the am when Walmart opens. Not sure why the one I got is giving me such a hard time.

 

We are discussing the dose now and will let you know.
Check in here when you wake up, and take a BG for us and post will you please?
I have to go out in an hour, but I should be back before preshot.

 

Ok thank you. He just peed no ketones.
Going to scan now and post

 

Fantastic no ketones!

 

I'm so happy he ate for you and aside from that drop to 47 he did have a decent cycle, he came up nicely, you were not having to fight as hard as on 2/4, so that is positive.

I know you have given some when he was low on 2/4 am cycle.
But when exactly did you stop regularly mixing the dry in with his food? (could you mark it and highlight it on the SS please when you get a mo)
If you have had to give dry or the temptations either to encourage him to eat or to keep his numbers up, please note that on the SS as well as what time he had them, it helps us to assess the SS to be able to see if you've had to take 'extreme measures', we can look at those numbers and see how they relate to the food he has had, ideally it would be good to see what you fed and when on the SS at a glance, to see what is working for him at what isn't.
(I'm sorry to ask you to do a little more admin, you have been working tirelessly for Sandy, I wouldn't ask but I think it will help us help you better)

To give you an example of what I mean.
For instance I know you fed a teaspoon of +1 from reading through the posts, but I don't know what carb's it was.... maybe a higher carb than whatever you fed, might have slowed him down a bit more....???
What did you feed with the 47? I have to look through the thread, posts 142 through to 154 to figure out you gave 12% with a drop of syrup. Then look at the SS trying to remember that info, and relate that to the numbers we are seeing, which is fine I can do that, but what happens in a day or two, if I, or someone else, want to see what worked for Sandy? or didn't work for sandy?
It becomes very difficult and it will delay the advice.

I'm really impressed with all your tireless work you are a very dedicated sugar mom, and all without a word of complaint

 

Hi Liza you must be about getting that pmps?

How are you both doing?

 

He is at 112

 

Hi Liza,
I don't know if you have shot or not.
Have been thinking and debating what to do with the dose for Sandy.
Too options
1) Hold the 0.1
2) Reduce the dose to a drop

Neither of these decisions, because of the recent DKA, are without risk. You are there with Sandy, you know what you are having to do to keep him from dropping, how he is dropping, behaving etc. So I will try to present you with our thought process to try to help you to come to a decision.

Holding the Dose.
The problem with holding the dose is that he may indeed drop again.
I'm not sure if when you shot the 0.1u in his previous cycle if the drop you saw was the insulin or a combination of that and the dry/temptation snacks working out of his system/or the depot from the 0.25u still having an effect (upto 6 cycles, diminishing with each successive cycle)
Now that you have removed the dry as a regular food, his insulin needs may have diminished, I am wondering if that is why you may have been struggling to keep him from dropping.
If you held, and he dropped again tonight, would he eat, the big question? You mentioned that he is always, up to now happy to eat dry, so maybe if he drops into the 40's again, you could give him a tablespoon of dry food, it's very high in carbs, and you have other tools such as syrup to give you a more immediate bump should you need it, while the dry gets absorbed.
I would avoid the dry/temptations unless he has dropped below 50 again and you need him to come up and stay up.
Feed him the MC as his pmps, and HC for his snacks at ?+1+2 +3 if he doesn't give you a food bump at +1
I can't guarantee he will not drop and that you will have to work hard to keep him safe, so you need to assess whether you are able to do that for him tonight. I wish I was there so I could physically support you with this

Reducing the Dose.
The recent DKA puts him more at risk, if he isn't getting enough insulin and he is not getting enough calories, we only have to add in an infection/inflammation/stressor and it could be a recipe for a relapse.
It really puts you in a tough position.
It's good that he's been eating in the previous 18hrs or so, and that he is still negative for ketones, and has been since he came home. Those are positive signs.
If he has been acting lethargic or seems like he is not well, then that would make me more nervous about taking the dose down.
You will need to stay on top of those ketones, perhaps checking that a couple of times a day at the very least, they can develop very quickly.
You still need to make sure he is eating well, perhaps even more so with taking the dose down. Since lack of calories and lack of insulin are both precursors to DKA.
I would suggest taking him down to a drop dose if you want to go for this option.

 

Whatever you decide we are here to support you

 

Absolutely.

 

Bron could you describe a drop dose for Liza please if she decides

 

Definitely.

 

I gave him ff beef in gravy and he ate almost a whole can (13% carbs). He seems to have a great appetite and ate it pretty fast. I know he had more than 2 ounces. I decided to give him the drop. Which I guessed at it just touching the zero line since the .10 was a slither right before it.
I’m sure he’s going to drop again since this is what’s been happening.
The thing I was afraid of happened, as I slept right through my alarm (Again) and didn’t get any more bg’s between +2 and PMPS. He was at 112, ate a good meal, and I gave the drop of insulin.
So now I’ll wait and watch for the drop.
And go from there.
Thanks for the advice and the options I chose the drop because he seems to be needed less insulin and that’s a good thing. And I’m afraid to take it away completely because of the DKA he had.
But since he’s eating better, if he drops again with this cycle do you think I should just give a drop per day?

 

Hi Liza,
I am really pleased he is eating well, that is a good sign.
Now that you have chosen the drop dose you will need to test the ketones twice a day so we can make sure he is able to keep those ketones negative. This is really important.

Any sign of lethargy, or seeming unwell please let us know.

Continue to make sure he is eating well during the cycles, except for the two hours before the preshot when we don’t want you to feed as we want to see the preshot number unaffected by the food.

Test at +1 and if he doesn’t have a food bump ( a higher BG higher the preshot number,) then feed a HC food for his snacks at +1 and +2 and +3.

With the drop dose the easiest way to get the drop is to push the plunger of the syringe in hard and then put the needle into the insulin then release the plunger. Take the needle out of the insulin cartridge. That should give you a drop. I would practise it a several times with an old syringe and some water to perfect the dose. See if you get a drop when you push in the plunger, then release it.

I am heading to bed now.Gill will be back soon and will guide you through the next several hours.
You are a wonderful caring mom to Sandy and he is so lucky to have you.

Let’s wait and see how he goes on this dose. He’s making great progress but we want him to stay on some insulin as long as we can because of the DKA and also you want a strong remission. You don’t want to rush things.
Try and feed him to prevent him dropping low if you can

 

Here is another way to get the drop dose. I like the other option where you push in the plunger and let go but you can try this one and see how much insulin comes out. I would trial it first if you chose this way